Sacral fracture in children: symptoms, diagnosis and treatment
Child injuries are a common problem for parents of active children. Sacral fractures are less common in children than arm and leg injuries, but this doesn't mean adults should ignore back injuries.
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Causes of sacral injury in children
The main cause of injury is a fall or impact (including a car accident). Children have more flexible bones, so fractures are rare.
Fall and impact to the pelvis
The most common cause is a fall on the butt from standing height or higher. This can happen on a playground, on slippery ice, or while jumping. A direct blow to the sacrum can also cause a crack or fracture, especially if the impact occurs on a hard object.
Sports and household injuries
Sports injuries are a common cause of injury in adolescents involved in contact sports, gymnastics, horseback riding, or cycling. At home, injuries can occur from falling down stairs or furniture.
Road traffic and high-energy injuries
The most severe sacral fractures in children occur in road traffic accidents or falls from a great height. In such cases, the spinal and pelvic injuries are combined, requiring emergency hospitalization and a multidisciplinary approach to treatment.
Symptoms of a sacral fracture in children
The clinical picture can be vague, especially if the fracture is incomplete (cracked). It is important for parents to pay attention to any unusual behavior in their child after the injury.
Pain in the sacrum and buttocks
The main symptom is severe pain in the sacrum. The child may complain of a throbbing or aching pain in the lower back.
It is important to note that the pain can migrate. From the sacrum, it can move to the buttocks or groin. In this case, the pain intensifies with pressure and movement.
Limited movement, pain when sitting and walking
Immediately after the injury, movement is limited: the child finds it painful to sit on a hard chair or on the floor, and they tend to shift their weight to one side.
The child's gait becomes unsteady, and they limp for no apparent reason. Severe pain occurs when attempting to lift the leg.
When neurological symptoms appear
Neurological symptoms appear if the nerve roots are affected. Numbness in the perineum and stabbing pain in the feet or calf muscles appear.
The most alarming symptom is impaired control over urination and defecation, which indicates critical compression of the nerve endings.
General information
How is a sacral fracture diagnosed?
Timely diagnosis of a sacral fracture is complicated by the fact that small cracks can be hidden behind intestinal loops on routine imaging. Therefore, the examination must be comprehensive.
Examination by a pediatric traumatologist-orthopedist
The first step is always a clinical examination. The pediatric traumatologist assesses pelvic symmetry, range of motion in the hip joints, and checks the integrity of reflexes. The orthopedic traumatologist also collects a medical history to understand the force and direction of the impact.
X-rays: when are they sufficient?
Plain radiography in two projections is the standard method of initial examination. This is the only way the doctor can detect skeletal displacement and signs of a fracture.
But there's a caveat: due to the peculiarities of bone structure, X-rays don't always provide a 100% diagnostic result.
CT and MRI: When are they prescribed?
If the X-ray reveals nothing and the pain persists, a CT scan is prescribed. This is the only way to see the pelvic bones and assess the extent of the fracture.
Magnetic resonance imaging (MRI) is necessary if damage to soft tissues, ligaments, and nerve roots is suspected.
A sacral fracture in children is a serious injury that requires professional diagnosis and patience. As the expert notes:
"In pediatric traumatology, it's especially important not to rely solely on the severity of pain: even moderate complaints in a child can conceal a serious injury. Therefore, we always assess not only the fracture itself, but also the condition of the pelvis, nerve structures, and range of motion."
With appropriate treatment for a sacral fracture, a child's body is capable of complete regeneration without compromising quality of life. Remember that early diagnosis of a sacral fracture is the key to a successful recovery.
Questions and answers
How does a sacral fracture manifest in children?
How is a sacral fracture diagnosed?
Is surgery always necessary for a sacral fracture?
How long does recovery from a sacral fracture take?
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What is a sacral fracture and why is it dangerous in childhood?
The sacrum is a large, wedge-shaped bone located at the base of the spine. It connects the spinal column to the pelvic bones and provides stability to the entire skeleton. In childhood, the sacrum consists of individual vertebrae separated by cartilaginous tissue, which do not fully fuse until 18–25 years of age.
A sacral fracture in children is a dangerous injury. The main danger lies in damage to the nerve structures passing through the sacral foramina. Even a slight displacement of bone fragments can lead to compression of the nerves responsible for pelvic function and sensation in the lower extremities.
Furthermore, the sacrum is an important part of the pelvic ring. This means that any pelvic injury (if not properly treated) can impair a child's gait and cause organ displacement.