A sacral fracture is a break in the sacrum, the triangular bone at the base of the spine that connects the lumbar spine to the pelvis. Sacral fractures range from stable injuries that can be managed without surgery to complex fractures associated with pelvic instability or injury to the nerves controlling the legs, bladder, bowel and sexual function.
Road traffic collisions, falls from height, crush injuries, lower-energy falls in people with osteoporosis and sacral insufficiency fractures
Lower back, buttock or pelvic pain, difficulty standing or walking and, in some injuries, leg weakness, numbness or bladder and bowel disturbance
Clinical and neurological assessment with CT; MRI may be required where an occult fracture or nerve injury is suspected
Pain management and progressive mobilisation for appropriate stable fractures; surgical stabilisation for selected unstable or displaced injuries
Progressive mobilisation, physiotherapy, pain management, restoration of walking and daily function, with multidisciplinary rehabilitation for complex injuries
Healing and functional improvement usually progress over several months; complex injuries may require prolonged rehabilitation
Persistent pain, impaired mobility, delayed healing, deformity or instability, neurological impairment and bladder, bowel or sexual dysfunction
Recovery after a sacral fracture depends particularly on fracture stability, neurological involvement and associated injuries. Safe early mobilisation is an important rehabilitation goal where clinically appropriate, while new or worsening neurological symptoms require prompt medical assessment.
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Pain management, assessment of fracture stability and neurological function, protection where required and prevention of complications
Progressive mobilisation where permitted, walking aids as required and increasing independence with everyday activities
Clinical review of healing, progression of weight-bearing where appropriate, improving walking, strength and endurance
Increasing functional activity, reducing reliance on mobility aids and phased return to work, exercise and recreation
Continued improvement in strength, mobility and tolerance of demanding activities; assessment of persistent pain or neurological limitations
Recovery varies considerably according to fracture stability, neurological involvement, treatment and associated injuries.
Bone healing commonly progresses over approximately 8–12 weeks, but pain, mobility and physical capacity may continue improving for several months. More complex injuries can take considerably longer.
Not necessarily. Stable fractures without significant displacement or neurological compromise can often be managed without surgery, whereas unstable, displaced or neurologically complicated fractures may require operative treatment.
This depends on fracture stability and treatment. Some stable fractures allow early progressive weight-bearing, while unstable injuries may require restrictions until sufficient stability has been achieved.
Physiotherapy is often important where pain, weakness or reduced mobility affects walking and everyday activities. Rehabilitation should be tailored to the injury and the person’s functional goals.
Pain can persist while bone and surrounding tissues recover and activity levels increase. Persistent, severe or worsening pain should be reassessed to exclude delayed healing, instability or another complication.
Sacral fracture is also commonly referred to as a broken sacrum, sacrum fracture, fractured sacrum, sacral insufficiency fracture or sacral stress fracture.
Successful rehabilitation following a sacral fracture requires more than radiological evidence of bone healing. Restoring safe mobility, independence and confidence while recognising neurological or mechanical complications is central to functional recovery.
Progression should reflect fracture stability, symptoms and functional ability rather than a timetable alone. Where pain remains disproportionate, mobility plateaus or neurological function changes, timely reassessment is important so that potentially treatable barriers to recovery can be identified.
For more detailed information about this injury, its treatment and recovery, download the full Medicess Rehabilitation Guide.
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People interested in this injury also find the following related rehabilitation guides useful:
You may also wish to explore some of the organisations and publications that informed this guide.