PurposeTo delineate the changes in functional outcomes of surgically treated U-shaped sacral fractures.MethodsForty-one patients with U-shaped sacral fractures were followed for a mean of 4.1years after surgery. Impairment of lower extremities was assessed via a modified Gibbons score. Urinary function was assessed with a structured interview and residual urine volume. Sexual and bowel functions, as well as patient-reported health, were evaluated using a structured interview, and pain was evaluated with the visual analog scale. Comparisons of data at different time points were conducted with a mixed model, and Z-scores of the SF-36 questionnaire were calculated.ResultsForty patients reported pain at 1year and demonstrated no change at 2years (p=0.24). Thirty-six of 39 eligible patients had neurological deficits involving the lower extremities at baseline and demonstrated improvement at 1year (p=0.0002) but not between years 1 and 2 (p=0.47). Twenty-three of 38 eligible patients had impaired bladder function, and 13 of 35 eligible patients had impaired bowel function at 3months. Urinary function was worse at 2years than at 1year (p=0.02). Sexual dysfunction was common, and patient-reported health was significantly worse than that of the normal population.ConclusionsNeurological function in the lower extremities of patients with U-shaped sacral fractures improved after surgery; however, bowel and sexual functions did not change, and urinary function deteriorated over time. The majority of impairments appear to be permanent if still present at 1year after surgery. [GRAPHICS] .