Agreement rate of surgically treated sacral fractures with the recommendations proposed by the sacral AOSpine Injury Score

Background: Several sacral fracture classifications addressed different characteristics of these injuries to help identify neurological risk and pelvic or spinopelvic instability. The AOSpine sacral injury classification system established treatment recommendations. However, it is important to assess its use in clinical practice. Objectives: To assess whether the surgical indication for sacral fractures in this series, based on the classifications proposed by Denis, Roy-Camille, Isler, and Rommens, achieved >70% agreement with the AOSpine Injury Score (AOSIS) recommendation. Materials and Methods: A cross-sectional study based on the prospectively collected data was performed. Consecutive patients with sacral fractures that were treated surgically were evaluated. An agreement percentage was established between AOSIS and the surgical indications in this series. The AOSpine classification reliability (kappa coefficient [κ]) was evaluated. Results: Out of 16 patients, 12 (75%) patients matched the AOSIS recommendations; 66.7% of Type B and 76.9% of Type C injuries. The AOSIS mean was 5.75 (standard deviation: 2.84; P = 0.262). The AOSIS score in relation to fracture subtype was statistically significant ( P = 0.028), which corroborates its ability to discriminate the hierarchical severity of fractures. Three elderly patients were treated in disagreement with the AOSIS proposal. The interrater κ was 0.75 for fracture types and 0.51 for subtypes, whereas the intrarater κ was 0.63 for types and 0.72 for subtypes. Conclusions: The AOSIS algorithm was considered satisfactory for guiding surgical decision-making in sacral fractures. The AOSIS score underestimates fragility fractures of the sacrum. The score for the M2 modifier is zero, resulting in a recommendation for conservative treatment for C0M2 fractures, which is controversial.