Neurologic deficits associated with sacral wing fractures

Pelvic fractures-A guide to classification and management

Pelvic fractures are common in polytrauma and continue to pose a difficult management dilemma for even the most experienced clinicians. Due to the high energy mechanisms involved, there are often multiple other injuries and many specialists may be involved. Deriving an effective management strategy relies on early diagnosis and prioritisation of the most immediately life-threatening injuries. Contrary to ATLS advice, CT can be used to facilitate this even in the haemodynamically unstable patient. This article defines the role of CT in pelvic fractures and provides an overview of fracture classification.

Neurologic Injury Associated With Pelvic Trauma: Radiology and Electrodiagnosis Evaluation and Their Relationships to Pain and Gait Outcome

OBJECTIVES

To study the electrodiagnosis presentation of patients with lower-extremity nerve injury related to pelvic trauma, to assess gait outcome and correlation to injury type and electrodiagnosis, and to study the incidence of pain postinjury and the relationships between injury type and electrodiagnosis and pain type.

DESIGN

Retrospective review.

SETTING

Tertiary care university hospital.

PARTICIPANTS

Seventy-eight patients who present with lower-extremity nerve injury associated with pelvic trauma.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Electrodiagnostic results, the relationship between electrodiagnosis and fracture or injury type, and gait and pain outcomes.

RESULTS

The characteristic neurologic injury in patients with pelvic trauma was a lumbosacral plexus injury (71% of cases). Sciatic nerve injuries were more common in patients with isolated acetabular fractures (9/10 cases). Gait outcome was related to electrodiagnostic abnormality and severity. Long-term assisted gait was best predicted by absent peroneal conduction to the extensor digitorum brevis (P<.001) and absent motor unit potentials on anterior tibialis needle examination (P<.001). Neuropathic pain was seen in patients with any degree of gait abnormality. Orthopedic pain was more common in patients with an acetabular fracture (P<.025).

CONCLUSIONS

Lumbosacral plexus injury after pelvic trauma is a characteristic disorder with severe long-term implications regarding both pain and gait outcome.