title: Management of neglected sacral fracture with cauda equina syndrome: report of two cases with review of literature.
abstract: METHODS
  A retrospective study was performed.
  
  
  OBJECTIVE
  To analyze the outcome of two neglected sacral fractures who presented late to us after 6 weeks of injury with main complaints of incontinence and numbness in sacral region. There are no guidelines for management of complex fractures of sacrum who present late, and available literature is equally perplexing.
  
  
  METHODS
  Patients were evaluated and radiological investigations were done. Anterior-displaced U-shaped fracture was found to be present between S2 and S3 with bony fragments encroaching the canal. Decompression with wide sacral laminectomies was done without any fixation.
  
  
  RESULTS
  Case 1 showed complete recovery of bladder and perineal sensations 6 months post surgery. Second patient (case 2) had partial recovery of bladder control but numbness persisted till last follow-up at 6 months.
  
  
  CONCLUSIONS
  Neglected fractures of sacrum that present later than 6 weeks post injury with cauda equina syndrome could be given a chance for decompression if imaging shows canal encroachment with bony fragments. Fixation of fracture may not be required in all unstable sacral fractures after 6 weeks.
authors.affiliation: Indian Spinal Injuries Centre , New Delhi, India.
authors.forename: R
authors.initials: R
authors.lastname: Mahajan
authors.affiliation: Indian Spinal Injuries Centre , New Delhi, India.
authors.forename: V
authors.initials: V
authors.lastname: Tandon
authors.affiliation: Indian Spinal Injuries Centre , New Delhi, India.
authors.forename: K
authors.initials: K
authors.lastname: Das
authors.affiliation: Indian Spinal Injuries Centre , New Delhi, India.
authors.forename: A
authors.initials: A
authors.lastname: Nanda
authors.affiliation: Indian Spinal Injuries Centre , New Delhi, India.
authors.forename: R
authors.initials: R
authors.lastname: Venkatesh
authors.affiliation: Indian Spinal Injuries Centre , New Delhi, India.
authors.forename: H S
authors.initials: HS
authors.lastname: Chhabra
keywords: Physiology; Surgery