Sacral insufficiency fractures are traditionally treated with bed rest and analgesia. The importance of early rehabilitation is generally appreciated; but pain frequently delays this, resulting in prolonged hospital stay and the risk of complications related to immobility. We describe three women with sacral insufficiency fractures who were treated with percutaneous sacroiliac screws and followed up for a mean of 18 months (12 to 24). They had immediate pain relief, uncomplicated rehabilitation and uneventful healing

Introduction Sacral fracture-dislocations with cauda equina deficits are high-energy injuries, the treatment of which is controversial. The effect of early decompression and stabilization is unclear. Neurologic recovery has not been objectively evaluated in past series, putting into question reported recovery rates. Sacral anatomic constraints make standard principles of fracture reduction, neural decompression and stable fixation difficult to apply. Lumbo-pelvic fixation allows indirect fracture stabilization by transferring loads directly from the acetabulum to the lumbar spine, thus avoiding the difficulties inherent in achieving sacral fixation. The purpose of this study was to determine the results of sacral decompression and lumbo-pelvic fixation for sacral fracture-dislocations, with neurologic deficits, using an objective method to evaluate neurologic recovery.

Methods We have carried out a complete retrospective review of all medical records, original radiographs, and prospectively collected data of 18 consecutive patients with sacral fracture-dislocations and cauda equina deficits identified between 1997 and 2002 through institutional spine and trauma databases. Fractures were classified according to Denis (1), Roy-Camille (2) and Strange-Vognsen (3). All were treated with open reduction, sacral decompression and lumbopelvic fixation. Radiographic and clinical results of treatment were evaluated. Neurologic outcome was measured by Gibbons’ criteria (4).

Results Sacral fractures healed in all 18 patients without loss of reduction. Average sacral kyphosis improved from 41° to 24°. Fifteen patients (83%) had normalization or improvement of bowel and bladder deficits, although only 10 patients (56%) had improved Gibbons scores. Average Gibbons type improved from four to 2.8 at 19 month average follow-up. Rod breakage (33%) and infection (17%) were the most common complications. Recovery of bowel and bladder function was more likely in patients with intact lumbosacral roots (86% vs. 36%,p=.066) and incomplete deficits (100% vs. 47%, p=.241) although the small cohort size precluded statistical significance.

Conclusions Lumbo-pelvic fixation safely and effectively provided the stability necessary for mobilization and weight-bearing without loss of reduction in polytraumatized, neurologically impaired patients undergoing extensive sacral decompression. Although neurologic improvement was noted in 83% of patients only 56% of patients had measurable recovery according to objective criteria. However, the functional improvement noted in most patients and complete recovery of bowel and bladder function in all but one patient with intact sacral roots are encouraging.

Aims

We compared the accuracy, operating time and radiation exposure of the introduction of iliosacral screws using O-arm/Stealth Navigation and standard fluoroscopy.

Sacral insufficiency fractures are not uncommon in elderly patients. We have diagnosed 20 cases in a five-year period, and have reviewed the clinical records, radiographs, CT and bone scans. We also assessed the degree of osteoporosis by measuring bone density using dual-energy X-ray absorptiometry and bone histomorphometry, and monitored the patients' functional outcome. Bone scans were positive in all 20 patients, CT showed a fracture or sclerosis in 7 of 12 patients and was useful in excluding malignancy. Plain radiographs were the least helpful, showing sclerosis in only 4 of the 20 patients. Involutional osteoporosis with a reduced bone formation rate was the most common underlying cause. Seventeen patients had complete resolution of pain within nine months, and no patient lost independence in daily activities. Increased awareness of these fractures may help to avoid unnecessary investigation and treatment. Bedrest and analgesia followed by rehabilitation provide good relief of symptoms

Sacral fractures are often underdiagnosed, but are frequent in the setting of pelvic ring injuries. They are mostly caused by high velocity injuries or they can be pathological in aetiology. We sought to assess the clinical outcomes of the surgically treated unstable sacral fractures, with or without neurological deficits. unstable sacral fractures were included in the study. Single centre, prospectively collected data, retrospective review of patients who sustained vertically unstable fractures of the sacrum who underwent surgical fixation. out of a total of 432 patients with pelvis and acetabulum injuries. fifty six patients met the inclusion criteria. 18 patients had sustained zone one injuries. 14 patients had zone 2 injuries and 10 patients had zone 3 injurie. Operative fixation was performed percutaneously using cannulated screws in 18 patients.. Open fixation of the sacrum using the anterior approach in 6 patients. Posterior approach was indicates in all 10 of the zone 3 injuries of the sacrum. While in 4 patients, combined approaches were used. 3 patients had decompression and spinopelvic fixation. Neurological deficits were present in 16% of the patients. 2 patients presented with neurgenic bladder. Of the 4 patients who had neurological fall out, 3 resolved with posterior decompression and posterior fixation. All 4 neurological deficits were due to taction or compression of the nerve roots. No hardware failures or non unions observed. The rate of neurological deficit was related more to the degree of pelvic ring instability than to a particular fracture pattern. Low rates of complications and successful surgical treatment of sacral fractures is achiavable. Timeous accurate diagnosis mandatory

Literature review about the current management strategies for U-shape sacral fractures. A thorough literature search was carried out to find out the current concepts in the management of U-shaped sacral fractures. Meta-analysis of 30 cases of U-Shaped sacral fractures. Radiological assessment for bone healing, and clinical examination for neurological recovery. 7 papers were published in the English literature between 2001 and 2009 about the management of U-shaped sacral fractures. In total 30 cases were included. The most common mechanism of injury was fall or jump from height (63%), followed by road traffic accidents and industrial injuries. Pre-operative neurological deficit was noted in 73% of patients. The average follow up time ranged from 2-12 months. 18 (60%) of patients were treated with sacroiliac screws. In this group pre-operative neurological deficit was found in 12(66%) patients. All of these patients had satisfactory radiological healing at follow up but 5(27%) patients had residual neurological deficit. No immediate complication was reported in this group. Incomplete sacroiliac screw disengagement was reported in one patient without fixation failure. Other procedures performed were lumbopelvic fixation, triangular osteosynthesis and transsacral plating. The most common cause of U-shaped sacral fractures is a fall or jump from height. There is a high association of neurological damage with U-shaped sacral fractures. From the current available evidence sacroiliac screw fixation is the most commonly performed procedure, it is however not possible to deduce which procedure is better in terms of neurological recovery

Purpose: To provide a CT-based description of the anatomic specifics of LC-1 pelvic ring disruptionsand to describe injury severity to other body systems, and their correlation with fracture anatomy. Method: We identified a consecutive series of 100 patients with Young and Burgess LC-1 pelvic ring disruptions. The CT scan was reviewed for each patient. Sixteen categories were reviewed for each patient. Sacral fractures were graded based on severity. The age, ISS, and six categories of AIS were recorded for each patient. A statistical analysis was performed to test the associations between fracture characteristics and injury severity. Results: All patients but three had one or more rami fractures, and all but two had a sacral fracture. Of the 98 anterior sacral injuries, there were nine (9.2%) buckles, 39 (39.8%) simple fractures, and 50 (51.0%) comminuted fractures. Of these 98 anterior sacral injuries, 47 (48.0%) were complete, passing through the sacrum and exiting the posterior cortex. Increasing severity of anterior sacrum fracture was associated with the presence of a complete sacral fracture (p value < 0.0001). Of the 98 sacral fractures, 50 (50.0%) were Denis type I, 41 (41.8%) Denis type II, and 7 (7.1%) Denis type III. Higher Denis types had higher likelihood of complete fractures of the sacrum (p value < 0.0001). There was a significant association between the presence of a comminuted rami fracture and a complete sacrum injury (p = 0.003), and a trend to higher rates in Nakatani two superior rami fractures (p = 0.169). There was a trend to higher mean ISS scores (p = 0.2287), and significantly higher abdominal AIS scores (p = 0.0014), in those with a complete sacral fracture. Those with comminuted and complete sacral fractures were more likely to be symptomatic and require posterior ring stabilization (p-value 0.003 and 0.043 respectively). Conclusion: LC-1 fractures of the pelvic ring represent a spectrum of injuries, with a large proportion having complete disruption of the sacrum. This complete injury of the sacrum is predicted by Denis type, severity of anterior ring disruption, Abdominal AIS, and potentially location of rami fracture and ISS. CT scanning best defines these injuries

Objective. We reviewed clinical results with minimally invasive method and using a new developed plate for unstable pelvic ring fractures, especially vertically unstable sacral fractures. Materials & Methods. Between 2002 and 2010, 35 patients with vertically unstable sacral fractures were treated with minimally invasive method and using an M-Shaped transiliac plate which was developed by the author. This plate is anatomically designed for posterior pelvic ring, and achieved rigid fixation. Patients included 19 male and 16 female, with the mean age of 46.2 (range, 17∼79) years old. According to the AO classification, 23 patients had a C1 injury, 9 had a C2 fracture, and 3 patients sustained a C3 injury of the pelvic ring. Functional outcome was assessed using the Majeed's functional evaluation and radiography. Minimum follow-up was one year. Results. All patients were not fixed anterior of pelvic ring. The average of surgical time was 85 minutes (range: 45∼150), and intraoperative blood loss was 332.8 ml (range: 35∼1055). Postoperative functional results were excellent and good in 30 patients (85.7 %), and fair in four cases due to infection or sciatic nerve paralysis, and one case of poor was nonunion. Three patients complicated wound healing delayed, but there were no residual pain and re-displacement. Conclusion. Using an M-Shaped transiliac plate can be achieved significant outcome and rigid fixation with minimal invasion for vertically unstable sacral fractures

Background Non-weight bearing hip is a common problem in the elderly population after a minor fall. Magnetic reasonance imaging (MRI) is used to diagnose occult fractures in the hip and the pelvic ring in these individuals. The aim of this study is to find the relationship between the incidence of occult fractures in the hip and that in the pelvic ring following low velocity trauma in the elderly. Material and Methods Between January 2000 and February 2004, 106 elderly patients (mean age = 81.4 years; range = 67–101 years), underwent an MRI scan of the pelvis and hip to rule out fracture neck of femur. All of them presented with a non-weight bearing hip after a history of low velocity injury. All had standard radiographs of the pelvis and the hip which did not reveal a fracture of the femoral neck. However, eight patients had fracture of the pubic rami visible on plain radiographs. MRI scans were subsequently performed in all of them to rule out an occult fracture of the femoral neck. Results Out of the 106 patients, 17 (16%) had intracapsular neck of femur fracture, 26 (24.5%) had extracapsular neck of femur fracture, 26 (24.5%) had pubic rami fracture, 17 (16%) had sacral fractures, and 37 (34.9%) had no fractures. All the sacral fractures occurred in patients with pubic rami fractures. Further except in one patient where the pubic rami fracture and the sacral fracture were contralateral, the remaining 16 patients had ipsilateral pubic rami and sacral fractures. None of the patients with pelvic ring fracture had associated femoral neck fracture. Conclusion Inability to weight bear after a fall is a common presentation in the elderly population. Falls can lead to fracture neck of femur or a fracture of the pelvic ring but seldom both. We can also conclude that in an elderly patient with low velocity injury, if a pelvic ring fracture is detected in the plain radiograph there is no indication for further MRI to rule out femoral neck fracture. Further, the fracture in the anterior and posterior pelvic ring commonly involves the same side than the contralateral side, in the elderly after trivial trauma

The December 2014 Trauma Roundup. 360 . looks at: infection and temporising external fixation; Vitamin C in distal radial fractures; DRAFFT: Cheap and cheerful Kirschner wires win out; femoral neck fractures not as stable as they might be; displaced sacral fractures give high morbidity and mortality; sanders and calcaneal fractures: a 20-year experience; bleeding and pelvic fractures; optimising timing for acetabular fractures; and tibial plateau fractures

Introduction. Isolated U-shaped sacral fractures are rare entities, mostly seen in polytraumatized patients, and hence, they are difficult to diagnose. While the pelvic ring remains intact across S2/S3, the U-shaped fracture around S1 leads to marked instability between the base of the spine and the pelvis. As severe neurological deficits can occur, timely treatment of these fractures is crucial. We present a novel technique of percutaneous reduction and trans-sacral screw fixation in U-shaped fractures. Material and Methods. 3 multiply injured patients with u-shaped sacral fractures (female, age 21.7±7.23). Two underwent immediate fracture fixation. In the third case delayed reduction and fixation was performed after referral 6 weeks following open decompression. In prone position, a pair of Schanz pins was inserted into pelvis at the PSIS. A second pair of Schanz pins was inserted into S1 or L5. All pins were inserted percutaneously. The fracture was reduced indirectly, using the Schanz pins as levers. After image intensifier control of the reduction result, two trans-sacral screws were inserted for finite fixation. Results. In all three cases, this novel method of percutaneous reduction allowed an anatomical sacral alignment and stabilization with trans-sacral screws was initially sufficient. At 1 year follow-up, both immediately fixed fractures showed an anatomical sacral alignment. Both had no neurological deficits, no signs of screw-loosening and were pain free. Unfortunately the delayed fixation showed a new tilt and hence loss of sacral alignment. This might be due to posterior structural integrity loss after decompression. Conclusion. U-shaped sacral fractures are rare, but correct and immediate treatment is paramount to achieve good outcome. Percutaneous reduction and screw fixation offers a less invasive treatment method. Anatomical alignment and stabilisation is possible and time of surgery can be reduced significantly

A study of 50 consecutive osteoporotic pelvic rami fractures has been carried out to investigate the full extent of injury following low energy falls. 50 consecutive elderly patients with fresh fractures of the pelvis were each investigated with an MRI scan of the pelvis in order to assess the competency of the pelvic ring. The 50 patients consisted of 45 female and 5 males with a mean age of 77.7 years. 44 patients had unilateral pubic rami fractures. The mechanism of injury in all cases was a simple fall in the home environment. On admission 96% of the patients complained of sacral pain and were tender in the sacral or posterior pelvic region. On MRI, 90% of patients had a sacral fracture associated with the pubic rami fractures and in all but 4 of these the posterior pelvic pain was directly related to the sacral fracture site. At 6 month follow-up, 82% still complained of posterior pelvic tenderness. Areas of tenderness corresponded to the sites of the fractures. Before the injury, 38 of the final 44 reviewed were reasonably independently mobile, whilst at review 39 were significantly disabled. Conclusion: The study shows that the apparently benign traumatic pelvic rami fracture in the elderly has a high association with sacral fractures. After discharge from hospital, attention should be paid to treatment of the on-going anterior and posterior pelvic pain

The U-shaped sacral fracture is a fracture pattern poorly recognized, that is not included in the standard classification of sacral fractures. These fractures are significant as they represent spino-pelvic dissociation, have a high incidence of neurological complications and information regarding modern treatment options is sparse. A number of authors have reported isolated cases or small series of patients with this type of fracture, although none explicitly note the bilateral vertical element that makes them U-shaped and represents spino-pelvic dissociation. We present four patients with U-shaped sacral fractures. All patients were polytraumatised patients of whom three had jumped from a height in suicide attempts illustrating the high energy required to produce this fracture. Three patients had ilio-sacral screw fixation, supplemented in one with instrumentation from the lumbar spine to the iliac crest. The other had sacral laminectomy with bony stabilization by instrumentation from the lumbar spine to the iliac crest without ilio-sacral screw fixation. No complications were encountered as a result of fixation. The fixation devices used essentially represent the local expertise that is available. The ilio-sacral screw technique is minimally invasive and appears to provide satisfactory fixation in our limited experience. However as fracture deformity often involves rotation of the upper sacrum, the use of a single screw may not provide adequate support against the deforming forces or allow reduction of the fracture. Additional ilio-sacral screws will provide some rotational control of the sacral fragment if their safe insertion is possible, if not then the forces should probably be neutralized by an additional device from L5 to the pelvis. The role of sacral decompression is unclear but may be appropriate in the presence of neurological deficit and a severely compromised sacral canal. These are complex, rare injuries. We recommend their referral to a specialized pelvis/spinal unit for definitive management

Introduction: Unilateral posterior Pelvic Ring injuries but especially bilateral sacral fractures or bilateral sacroiliac joint (SI) ruptures as well as lumbosacral dislocations and fracture dislocations remains a significant surgical challenge. 1. ,. 2. ,. 3. despite advances in surgical techniques. Although the true incidence of these fractures are unknown, 30% are identified late. 4. The treatment of those fractures varies from conservative treatment, posterior plate fixation, anterior plating as well as percutaneous and open Sacroiliac (SI) joint screws. However, screw pull-outs and loss of fixation in those methods are well described In the Alfred Hospital, Melbourne (Australia) a Level 1 Trauma Center a series of 14 patients were treated from 10/2006 to date with a multiaxial spinal system. Methods: Patients with posterior pelvic injuries separation were identified prospectively since October 2006. Data was extracted from the trauma registry database and medical record and diagnostic imaging. Since Ocober 2006, 10 patients with bilateral posterior pelvic ring injuries and 4 with unilateral injuries were identified for fixation. Technique: The patients were put supine and a incision medial/distalto the posterior iliac spine was made. The placement for the incision gives the surgeon the opportunity to estend the approach to an open reduction of the sacral fracture or SI Joint disruption if a closed reduction cannot be achieved. A pedicel screw from a multiaxial spinal system (Xia, Stryker or Pangea, Synthes) is placed percutaneously in the posterior iliac crest on both sides and the reduction is performed with the screws attached to the screw handles and with Image Intensifier. After the reduction the multiaxial screwheads are bent and transfixed with a bar which is tunneled epifacial. All patients underwent a multislice pelvic and lumbar spine CT and these patients were assessed clinically for neurovascular symptoms and stability. The follow-up included clinical assessment and CT imaging. Results: Since October 2006 14 patients (10 male, 4 female) with an average age of 32.4 years (range: 20–44 years, median 33 years) and an average ISS (Injury Severity Score) of 37 (range: 14–66, median 34). The mechanism of injury for these patients included: pedestrians versus car; motorcylce; paragliding and motor car collision. All patients had associated anterior pelvic ring injuries which were internally fixed in all but one case. The follow up time was one to 18 month. The patients were assessed clinically and with CT imaging. No complications or loss of fixation have been observed in this patient group in this short follow up time. Discussion: The fixation system is highly versaitle and the whole posterior iliac crest can be used for fixation. The posterior instrumentation provides also a good control of the reduction of anterior pelvic ring fractures which should be fixed when associated. In all cases but 3 the nature of the comminuted sacral fractures did not allow the use of SI-Joint screws or anterior SI-Joint plating. The construct provides initial stability and allows mobilization of the patient. It can be used in cases with sacral comminution and may offer advantages over posterior plate fixation, by reducing complications with prominent metalware

The April 2012 Trauma Roundup. 360 . looks at fibula-pro-tibia plating, galeazzi fractures, distal radial fractures in the over 65s, transverse sacral fractures, acute dislocation of the knee, posterior malleolar fractures, immobilising the broken scaphoid, the terrible triad, lower limb amputation after trauma, and whiplash injuries

Introduction. Sacral fractures were previously treated with transiliac bars, sacroiliac screws or posterior plates. Sacroiliac screws are not as invasive, but the risk of intra-operative neurovascular damage must be considered. Posterior plate fixation is slightly invasive. In 2006, we conceived a new fixation method with spinal instrumentation system, and I will introduce it. Procedure. We make 5cm skin incisions just above each side of post. sup. spine of ilium and make a tunnel under the soft tissue. Then, we insert 4 screws to ilium, pass two rods through the tunnel and fix them. If needed we make reduction or compression. Finally, set the transvers connecting device on both sides. Material and Method. We indicate this method for type C1 and C2 sacral fracture on AO classification. We treated 17 cases, C1 for 6 and C2 for 11 cases. We evaluated clinically and radiologically. Result. Mean operating time was 105 minutes, and mean hemorrhage was 125ml. We had 2 miss-directional insertions of screws out of 68 screws. We had 3 cases that complained of irritation pain around screw heads. No surgical site infection and no soft tissue necrosis. On radiological evaluation, we had no cases of correction loss, nonunion or implant failure. Conclusion. The advantages of our method are (1)easy and safety procedure, (2) high compatibility, (3)soft tissue protection, (4)stiffness of fixation, and (5)intraoperative manipulation, such as reduction or compression

We have evaluated retrospectively the relationship of bony injuries seen on 106 consecutive MR scans in elderly patients of a mean age of 81.4 years (67 to 101) who were unable to bear weight after a low-energy injury. There were no visible fractures on plain radiographs of the hip but eight patients (7.5%) had fractures of the pubic ramus. In 43 patients (40.5%) MRI revealed a fracture of the femoral neck and in 26 (24.5%) there was a fracture of a pubic ramus. In 17 patients (16%) MRI showed an occult sacral fracture and all of these had a fracture of the pubic ramus. No patient with a fracture of the femoral neck had an associated fracture of the pelvic ring or vice versa. Occult fracture of the hip and of the pelvic ring appear to be mutually exclusive and if an acute fracture of the pubic ramus is diagnosed radiologically further investigations are not needed to rule out an occult fracture of the hip

Purpose: To describe the diagnostic planning and treatment modalities of six patients with this rarest of sacral fractures. Due to the low incidence of these injuries, there is no literature evidence concerning their management. Materials and Methods: Six patients with a transverse fracture of the sacrum with anterior displacement. All patients were admitted with bowel and bladder dysfunction, perineal anesthesia, sensory and motor deficits at the lower extremities. Prompt diagnosis of the sacral fracture was obtained in five of the six patients. Results: Operative treatment including extensive lumbosacral laminectomies, spine instrumentation and fusion was performed in all cases. Neurological recovery was almost complete in one patient, partial in 4 patients and absent in one patient. Conclusions: A more favorable clinical outcome can be achieved when operative treatment is implemented using lumbosacral decompression by laminectomy, dural repair and posterolateral instrumented fusion with bone grafting. Although reduction of the fracture was not ideal in many of these patients, long term clinical and radiographic follow – up as well as neurological improvement were rewarding

Summary. Application of RSA in supine and standing positions allows pelvic fracture stability to be measured more accurately than current techniques. RSA may enable a better understanding of these injuries. Introduction. The in vivo stability of the pelvic ring after fracture stabilisation remains unknown. Plain radiographs have a low accuracy in diagnosing loss of fracture reduction over time. Radiostereometric analysis (RSA) is an accurate imaging measurement method that has previously been applied to measure the healing of other fractures. This pilot study investigated the potential application of RSA in supine and standing positions to measure pelvic fracture stability over time and under weightbearing load. Methods. Five patients with a similar type C pelvic ring disruption who were all operated on using the same surgical technique and had RSA markers inserted at the time of surgery. All five patients had a unilateral comminuted sacral fracture lateral to the sacral foramina treated with posterior plating and pubic rami fractures stabilised by external fixation for six weeks. All patients were mobilised partial weight bearing after regaining leg control. RSA examinations at 2, 4, 12, 26 and 52 weeks included three radiographic pairs taken in supine, standing and supine positions at each time point. Two additional RSA examinations were performed the day prior and post pin removal at 6 weeks. Results. All patients ambulated before the 2 week follow-up and progressed uneventfully. At latest follow-up, there were no complications. Minimal displacements (translations less than 0.3mm and rotations less than 0.5°) were recorded between the supine exams pre and post standing at 2 weeks. Hence, the supine examination was found to be a reliable position to measure the migration of the ilium over time. No loss of reduction was identifiable on plain radiographs over time. At 52 weeks, in contrast to plain radiographic results, RSA measurements revealed that one patient had a fracture migration greater than 4mm. Such large displacements could result in sacral nerve root transection, leading to devastating consequences, such as incontinence, for patients whose sacral fractures are through or medial to the sacral foramina. In one patient, the migration recorded for the apparent uninjured posterior complex side exceeded the migration of the injured side suggesting an unrecognised bilateral injury. Comparative RSA examinations pre and post external fixator removal demonstrated that in three patients the injured hemipelvis migrated greater than 2mm after the removal of the external fixator, which may be indicative that the fixator was removed prematurely. Discussion and Conclusion. The application of RSA allows accurate measurement of pelvic fracture stability which is difficult, if not impossible, to identify and quantify with any other imaging techniques. Hence, RSA has the capacity to enable a better understanding of pelvic ring injuries and optimise their treatment

Introduction. Displaced fractures in the sacrum are associated with other intra-pelvic organ injuries. There are some reports on short term outcome, however there is little knowledge about the long-term morbidity after these severe injuries. Aims of study. -. Describe neurologic deficits in the lower extremities and impairments involving the uro-genital, bowel and sexual functions a minimum of 8 years after injury. -. Compare the long-term results with our previously published results after one-year follow-up (1). Materials and methods. 39 consecutive patients with displaced sacral fractures were prospectively registered at Oslo university hospital, Ullevaal between 1996 and 2001. Tötterman et al. published 1-year results on 32 of the 39 patients(1). In the present study we followed 29 of these 32 patients for 8 years or more. The following evaluation instruments were used: Neurology: Sensorimotor function was classified according to ASIA score. Bladder function: Structured questionnaire with regards to frequency, urge or incontinence. Also, flowmetry and ultrasound were done to determine maximum flow and post-micturition volume. Bowel function: Structured questionnaire with regards to frequency, urge, diarrhea, constipation and incontinence. Sexual function: Open questions to address any problems associated with sexual function. For male patients, selected questions from the International Index of Erectile Function were used. For comparison with previous data from the one year follow-up we used the Wilcoxon Signed-rank test for non-parametric data. Results. Neurology: 26 patients had neurologic deficits in the lower extremities. Two patients were not testable and only 1 was asymptomatic. Bladder function: 5 had slightly changed, 11 significantly changed and 4 completely changed voiding pattern. Bowel function: 6 had slightly changed and 3 completely changed bowel pattern. Comparing our results with previous data showed deterioration in voiding function over time in 38%(p=0.005), improved bowel function in 28%(p=0.047) and no significant changes in neurological deficits (p=0.47). Sexual function: 45% reported sexual dysfunction versus 38% at the 1-year follow-up. Conclusion. Neurologic deficits, uro-genital and bowel dysfunction are frequent after displaced sacral fractures. Voiding and sexual problems deteriorated over time, while bowel function improved, and neurological deficits showed no significant changes. Pathologic bladder function may cause irreversible structural damage to the bladder, and subsequent impaired renal function. These problems should therefore be addressed early in the rehabilitation period and the patients must be followed by adequate expertise for many years after the injury