The sacrum is formed by five fused sacral vertebrae forming a triangular bone that wedges between the two iliac bones of the pelvis at the sacroiliac joints, transmitting weight from the spine to the lower limbs.
The sacrum transmits the body weight from the spine to the pelvis through the sacroiliac joints and is the posterior boundary of the true pelvis. Sacral fractures in high-energy pelvic ring disruptions can injure the sacral nerve roots producing neurogenic bladder, bowel dysfunction, and sexual dysfunction. Sacral insufficiency fractures in osteoporotic elderly patients produce acute back and buttock pain that is easily missed on plain radiographs but clearly visible on MRI or bone scan.
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