{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:08:20Z","timestamp":1790996900757,"version":"4.1.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec><jats:title>Objective:<\/jats:title><jats:p>Use modern computed tomographic imaging to reassess neurological injury risks associated with zone I\u2013III sacral fractures as originally described by Denis et al.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design:<\/jats:title><jats:p>Retrospective case\u2013control study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting:<\/jats:title><jats:p>University Level I Trauma Center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients\/Participants:<\/jats:title><jats:p>One thousand five hundred seven consecutive patients who presented with sacral fractures between January 2000 and August 2012.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measurements:<\/jats:title><jats:p>Patients were stratified based on the diagnosis of acute neurological injury. The risk of severe and complex sacral fractures based on the presence of nerve injury was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>The rate of nerve injury was significantly lower compared with historic data (3.5% vs. 21.6%,<jats:italic toggle=\"yes\">P<\/jats:italic>&lt; 0.001). Acute nerve injury was a significant risk factor for displaced (odds ratio [OR]: 8.4, 95% confidence interval [CI], 1.4\u201351.9) and comminuted (OR: 5.2, 95% CI, 1.7\u201316.3) sacral fractures as well as zone II (OR: 3.4, 95% CI, 1.1\u201310.1) and III (OR: 3.9, 95% CI, 1.0\u201316.4) fractures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>The incidence of nerve injuries associated with sacral fractures is significantly lower than originally published by Denis et al. Patients with a nerve injury were highly correlated with having a displaced, comminuted, or zone III fracture, or spinopelvic dissociation; the authors recommend a fine cut computerized tomography for further investigation if these findings are not apparent on initial radiographic imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence:<\/jats:title><jats:p>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p><\/jats:sec>","DOI":"10.1097\/bot.0000000000000772","type":"journal-article","created":{"date-parts":[[2017,1,10]],"date-time":"2017-01-10T18:12:00Z","timestamp":1484071920000},"page":"181-184","source":"Crossref","is-referenced-by-count":25,"title":["Relationship of Sacral Fractures to Nerve Injury: Is the Denis Classification Still Accurate?"],"prefix":"10.1097","volume":"31","author":[{"given":"Jannat M.","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Marquez-Lara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna N.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230828","doi-asserted-by":"crossref","DOI":"10.3928\/01477447-20090818-18","article-title":"Sacral fractures: current strategies in diagnosis and management","volume":"32","author":"Hak","year":"2009","journal-title":"Orthopedics"},{"key":"R2-20230828","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3928\/01477447-20080401-14","article-title":"Evaluation and management of stress fractures of the pelvis and sacrum","volume":"31","author":"Hosey","year":"2008","journal-title":"Orthopedics"},{"key":"R3-20230828","doi-asserted-by":"crossref","first-page":"E12","DOI":"10.3171\/2014.5.FOCUS1474","article-title":"Sacral fractures","volume":"37","author":"Bydon","year":"2014","journal-title":"Neurosurg Focus."},{"key":"R4-20230828","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1097\/00003086-198802000-00010","article-title":"Sacral fractures: an important problem. 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