Unstable sacral fracture with neurogenic bladder and bowel dysfunction following high energy trauma: a case report

Abstract

Sacral fractures are uncommon but potentially devastating injuries, most commonly resulting from high-energy trauma. They are frequently associated with pelvic instability, neurological deficits, and multiple system injuries. Delayed diagnosis is common because of the complex sacral anatomy and limited sensitivity of plain radiographs. Early recognition and timely surgical management are essential for optimizing neurological and functional outcomes. We report the case of a 24-year-old female who sustained an unstable Denis zone II–III sacral fracture following a high-energy road traffic accident. The patient presented with severe lower back pain, urinary retention, decreased perianal sensation, and reduced voluntary anal contraction, consistent with neurogenic bladder and bowel dysfunction. Computed tomography confirmed an unstable sacral fracture involving the sacral foramina and central canal. The patient underwent early posterior decompression with lumbopelvic fixation to restore pelvic stability and decompress the neural elements. The postoperative course was uneventful. Progressive neurological recovery was observed, with restoration of bladder and bowel function, satisfactory pain relief, radiological evidence of stable fixation, and independent ambulation during follow-up. Early diagnosis using advanced imaging, prompt posterior decompression, and stable lumbopelvic fixation can provide excellent neurological and functional recovery in patients with unstable sacral fractures associated with neurogenic bladder and bowel dysfunction. This case supports the growing evidence favouring early surgical intervention in unstable sacral fractures with neurological compromise.