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Musculoskeletal Imaging

E3130. Acute Sacral Trauma: What the Surgeon Wants to Know

Simmons D,  Petscavage-Thomas J,  Walker E. Penn State Hershey, Hershey, United States

Address correspondence to J. Petscavage-Thomas (

Background Information: The sacrum and sacroiliac (SI) joints are involved in 45% of pelvic fractures. Most of these fractures occur after high-energy trauma. Recognition of fracture extension, classification, degree of SI joint ligament involvement, and fracture mechanism are important in identifying associated injuries, preventing negative outcomes, and providing a meaningful radiologic report. Additionally, surgeons routinely order dedicated 3D CT reconstructions for preoperative planning. Radiologists should understand what should be reported on in these images.

Educational Goals/Teaching Points: The goals of this exhibit are to review normal osseous and ligamentous anatomy of the sacrum and SI joint and review sacral and SI joint involvement in anteroposterior (AP) and lateral compression injuries, vertical shear injuries, and associated fractures. We will illustrate the Denis, Isler, and transverse sacral fracture classification systems, and participants will recognize imaging findings of neurovascular compromise and complication, and understand standard surgical management of sacral trauma and possible complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Radiographs, CT, and 3D illustrations of normal anatomy, Type I–III AP compression, vertical shear, and lateral compression pelvic fracture patterns will be shown as well as Denis and Isler classification of sacral fractures. Normal and abnormal appearance of surgical fixation techniques of percutaneous iliosacral screws, lumbopelvic fixation, posterior sacral tension bands, and SI joint fusion will be demonstrated.

Conclusion: After reviewing this exhibit, the learner will feel more comfortable interpreting imaging studies of acute trauma involving the sacrum and SI joint. They will understand what is important for surgical planning and the expected surgical outcomes.