Study of Sacral Fractures Using Patient Based and Objective Outcomes
Condition: Sacrum Fracture
MeSH terms: Fractures, Bone
Study type: Observational

Summary: 
      The purpose of this study is to define the outcomes, both patient based and radiographic, for
      sacral fractures based upon injury pattern, displacement, and treatment. This will aid the
      orthopaedist in determining the best course for those patients with mild to moderate
      displacement. Multiple centers will be included and not asked to change their protocols for
      management. The prospective evaluation will gather specific data points on mechanism of
      injury, displacements, position at union, and disease specific and general health outcomes.
    

Detailed description: 
      There is wide variation in the current treatment of pelvic ring trauma. This divergence in
      practice patterns includes the use of either operative or non-operative care for the same
      fractures. Sacral fractures are the most commonly observed posterior pelvic ring injury and
      comprise up to 75% of cases reported at most institutions. The optimal and appropriate
      treatment of these fractures is vigorously debated despite the common goal of improving
      patient outcomes. While significant posterior pelvic displacement is universally considered
      an appropriate operative indication in healthy individuals, the threshold for "significant"
      is poorly defined and difficulty to accurately measure. Further, lesser and minimal
      displacement patterns are currently being treated operatively and non-operatively, depending
      on the institution and the experience of the surgeon, and without adequate guidelines. This
      lack of consensus in the treatment of sacral fractures is due to a poor understanding of
      patient outcomes following operative and non-operative treatment, a poor understanding of how
      the morbidities associated with a specific treatment affect patient outcome, and a lack of
      data that allows any meaningful comparison of operative and non-operative treatment.

      The purpose of this study is to define the patient-based and radiographic outcomes of sacral
      fractures based on injury pattern, fracture displacement, and treatment method. We anticipate
      that minimally displaced fractures will be treated non-operatively and significantly
      displaced fractures will be treated operatively by most centers. There will also be a group
      of patients with displacements that are treated operatively or non-operatively by different
      surgeons. We will document the outcomes for all three groups, and compare the outcomes of
      operative and nonoperative management for the middle (overlap) group. This will aid the
      orthopaedist in determining the best treatment courser for those patients based on
      displacement. Fourteen centers have agreed to participate with four already actively
      recruiting. The prospective evaluation will gather specific data points on mechanism of
      injury, displacements, position at union, and disease specific and general health outcomes.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients will be recruited through the Emergency Department or Orthopaedic Clinic