[Follow-up and prognosis of neurologic sequelae of pelvic ring fractures with involvement of the sacrum and/or the iliosacral joint].
The extent of neurological lesions following an injury of the pelvic ring is often not initially recognized, as interest is then focused on the treatment of the pelvic ring fracture. Once the fracture has healed, the patient suffers from the sequelae of the neurological injury. Our series of 323 pelvic ring injuries includes 161 sacral fractures and 12 complete disruptions of the sacroiliac joint. Twenty-three patients sustained an injury of the lumbosacral plexus, and 20 patients were examined retrospectively. The different parts of the lumbosacral plexus showed variable recovery potential. An important or complete recovery was noted in 8 of 9 patients suffering from a motor deficit of the lumbar plexus, the obturator nerve, the superior gluteal nerve or the inferior gluteal nerve. Four out of 8 patients with a motor deficit of the sacral plexus had an important or complete improvement. In contrast to these results was the poor recovery of lesions of the lumbosacral trunk. Eight out of 11 patients showed no or only minor recovery, although the pelvic ring was stabilized by operative means in 9 patients. In 2 patients the lumbosacral trunk was directly decompressed by a dorsal approach. In both cases the recovery was complete. In 6 patients the sphincter function was damaged. Recovery was dependent on the localization of the sacral fracture. If the fracture traversed the sacral canal, no neurological improvement was noted.
Hersche
O
O
Universitätsklinik für Orthopädische Chirurgie, Inselspital Bern.
Isler
B
B
Aebi
M
M
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D007596:Joints / Q000293:injuries* / Q000294:innervation / Q000601:surgery; D008160:Lumbosacral Plexus / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010384:Pelvic Bones / Q000293:injuries* / Q000294:innervation / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D012447:Sacrum / Q000293:injuries* / Q000294:innervation / Q000601:surgery; D013124:Spinal Injuries / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000293:injuries*
Verlauf und Prognose von neurologischen Ausfällen nach Beckenringfrakturen mit Beteiligung des Os sacrum und/oder Iliosakralgelenks.