![]() The patient was then diagnosed as having bladder and rectal dysfunction due to a displaced sacral fracture with instability, and she was treated surgically. Magnetic resonance imaging (MRI) showed severe stenosis of the spinal canal at the site of the transverse fracture (Fig. An H-shaped sacral fracture (Rommens classification: type IVb) consisting of a transverse fracture with displacement of the third sacral vertebra and vertical fractures of the bilateral sacral wings was seen on computed tomography (CT) (Figs. Her plain X-ray on admission to the orthopedic department showed a transverse fracture of the third sacral vertebra with displacement, which was not observed in the first X-ray of her lumbar spine on admission to the emergency department (Fig. Her anal sphincter was unable to contract, and urinary retention continued after removal of the urethral catheter. Manual muscle testing of her lower limbs showed mild weakness of about 4 in bilateral flexor hallucis longus and gastrocnemius, and bilateral Achilles tendon reflexes were lost. At the first visit to our department, she could not walk and had loss of sensation from the buttocks to both posterior thighs and around the anus and perineum. She was referred to our orthopedic department because a gait disorder was discovered after her mental condition improved and she was permitted to walk. Even sacral fractures without displacement require attention because they can cause serious injury in the event of a nerve root being severed if not diagnosed early and given appropriate treatment. In cases of bladder–rectal dysfunction with low back pain, the possibility of sacral fracture should be considered, and computed tomography, magnetic resonance imaging, and X-ray examinations should be performed. Three months after the operation, bone fusion of the fracture was observed. Two weeks postoperatively, she could walk with a walker and was discharged. Postoperatively, bladder and rectal dysfunction remained, but the low back pain was alleviated. The bilateral distal sacral nerve roots (S3, S4, S5) were completely severed at the second to third sacral levels, but bilateral second sacral nerve roots were not compressed from the bifurcation to the sacral foramen. First to third sacral laminectomy and alar–iliac fixation using percutaneous pedicle screws and sacral alar–iliac screws were then performed. The patient was diagnosed as having bladder and rectal dysfunction due to a displaced, unstable sacral fracture. Imaging examinations showed an H-shaped sacral fracture consisting of a transverse fracture with displacement of the third sacral vertebra and vertical fractures of the bilateral sacral wings, with severe stenosis of the spinal canal at the site of the transverse fracture. Her anal sphincter did not contract, and urinary retention continued after urethral catheter removal. On examination, she could not walk and had decreased sensation from the buttocks to both posterior thighs and around the anus and perineum. In hospital, she had a urethral catheter inserted and spent 3 months in bed. One month later, she was admitted to a psychiatric hospital for exacerbation of schizophrenia. She also complained of dysuria, and neurogenic bladder and cystitis were diagnosed. Case presentationĪ 62-year-old Japanese woman with schizophrenia with low back pain, gait disorder, dysuria, and fecal incontinence presented to an emergency department, and plain X-rays showed no findings. A case of distal sacral nerve roots severed by a fragility fracture of the sacrum is presented. Fixation of the fracture and stabilization of the pelvic ring usually provide good clinical results. Owing to the aging population, fragility fractures of the pelvis are occurring more frequently.
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