Can I walk with a sacrococcygeal fracture?

The sacrum is located below the waist and above the buttocks. If the sacrum is fractured, it will affect walking, and this bone will not recover easily after a fracture. Therefore, try not to walk after a fracture, and be sure to rest quietly. You can eat more foods that supplement zinc and calcium. Especially for the elderly, the body's recovery ability is relatively poor. If they are not properly maintained, the bones will become festered and the consequences will be very serious.

Sacral fractures can occur alone or simultaneously with pelvic injuries; the former is less common, while the latter accounts for 30% to 40% of pelvic fractures. Therefore, its absolute incidence is much higher than that of single injuries and is more common in males. The treatment is also more complicated and needs to be treated simultaneously with the pelvic fracture.

Causes

Both direct and indirect violence can cause this injury.

1. Direct violence

The most common cause is landing on the sacrum when falling, sliding or rolling from a height; the second most common cause is being hit by a heavy object or a direct impact from a vehicle or other object.

2. Indirect violence

It is more common for violence to be transmitted upward from the bottom (distal end of the sacrum and coccyx), while the chance of violence being transmitted from top to bottom is very small; avulsion fractures may also be caused by ligament traction.

The combined injuries are mostly caused by pelvic fractures, most of which are caused by direct violence; while the complications of sacral fractures mainly involve the rectum, anus and sacral nerves.

Clinical manifestations

The clinical symptoms of sacral fractures vary greatly depending on the degree of damage. The following points should be noted during the examination:

1. Pain

Patients who complain of persistent sacral pain after trauma should be examined in detail. Clear linear tenderness is mostly caused by fractures, and the fracture line can be determined along the direction of the tenderness. The conductive percussion pain is less severe than that of a lumbar fracture, especially when examined in the standing position.

2. Fear of sitting

When sitting, gravity acts directly on the sacrum and coccyx, causing pain, so patients prefer to stand or sit on one side of the buttocks.

3. Subcutaneous hemorrhage

Because the sacrum is superficial, deep injuries are easily exposed under the skin. Therefore, hematoma, subcutaneous congestion, or skin contusion and abrasion at the fracture site may be found during physical examination.

4. Digital rectal examination

During digital rectal examination, the course of the fracture line, whether there is obvious dislocation, and whether it is an open fracture can be inferred based on the location of tenderness, displacement of the fracture site, and the presence or absence of bleeding.

5. Sensory impairment in the saddle area

Fractures involving the sacral foramen can stimulate the sacral nerve branches and cause various abnormal phenomena such as hyperesthesia, tingling, numbness and decreased sensation in the saddle area.

6. Classification of sacral fractures

(1) Transverse fractures Transverse fractures can be seen in all planes of the sacrum, but are more common in the middle and lower segments.

(2) Longitudinal fractures are less common than transverse fractures. Both are caused by severe violence and often occur simultaneously with pelvic fractures or unilateral sacroiliac joint separation. Generally speaking, the fracture line occurs at the lateral sacral foramen. In severe cases, the injured half of the pelvis and the ipsilateral lower limb are displaced upward, and bladder, rectal symptoms and retroperitoneal hematoma may occur.

(3) Comminuted fractures are mostly star-shaped or irregular comminuted fractures caused by direct violence on the local area. The displacement is often not obvious. If clinical examination is not careful, it is easy to miss the diagnosis, and attention should be paid to observing X-ray films.

(4) Avulsion fractures are caused by the avulsion of the sacrotuberous ligament at the attachment point on the lower side of the sacrum. Fractures are easy to miss and should be carefully considered.

examine

1. X-ray film

Take anteroposterior and lateral X-rays, and if the sacroiliac joint is suspected to be involved, an oblique X-ray should be taken. In addition to observing the fracture line, it is also necessary to use it for classification and treatment decision. Because there are more intestinal contents in this area, a routine cleansing enema should be performed before taking the film.

2. CT and MRI examinations

CT examination is clearer than X-ray film, especially for determining fracture line and its displacement direction; while MRI examination is clearer for observing surrounding soft tissue.