EM@3AM: Sacral fractures

A 75-year-old male with a history of hypertension, osteoarthritis, and diabetes mellitus presents to the ED with a chief complaint of lower back pain.  He states that he fell a few days ago and the pain is getting worse, particularly when he is sitting down. His vitals include blood pressure 150/95, heart rate 95, SPO2 99%, temperature 36.6C, and a glucose of 143. On examination, the pelvis is stable, but he endorses tenderness midline along his sacrum. He has a normal neurologic exam in all extremities. What’s the diagnosis?

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