Neurologic Injury within Pelvic Ring Injuries

Ji Wan Kim; Dong-Hoon Baek; Jae Hyun Kim; Young Chang Kim

doi:10.12671/jkfs.2014.27.1.17

Journal List > J Korean Fract Soc > v.27(1) > 1037981

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Baek, Kim, and Kim: Neurologic Injury within Pelvic Ring Injuries

Original Article

Journal of the Korean Fracture Society 2014; 27(1): 17-22.

Published online: 17 January 2014

DOI: https://doi.org/10.12671/jkfs.2014.27.1.17

Neurologic Injury within Pelvic Ring Injuries

Ji Wan Kim, M.D., Dong-Hoon Baek, M.D., Jae Hyun Kim, M.D., Young Chang Kim, M.D.

Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Address reprint requests to: Dong-Hoon Baek, M.D. Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, 875 Haeun-daero, Haeundae-gu, Busan 612-862, Korea. Tel: 82-51-797-0990, Fax: 82-51-797-0991, cocopam76@naver.com

Received 2 July 2013 Revised 8 August 2013 Accepted 18 September 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the incidence of neurologic injury in pelvic ring injuries and to assess the risk factors for neurologic injury related to pelvic fractures.

Materials and Methods

Sixty-two patients with the pelvic ring injury were enrolled in the study from March 2010 to May 2013. When the neurologic injury was suspected clinically, the electro-diagnostic tests were performed. Combined injuries, fracture types, and longitudinal displacements were examined for correlations with the neurologic injury.

Results

There were 7 cases of AO/OTA type A, 37 cases of type B, and 18 cases of type C. Among them, 25 patients (40%) had combined spine fractures, and the average of longitudinal displacement was 7 mm (1-50 mm). Of the 62 patients, 13 (21%) had neurologic injury related with pelvic fractures; 5 with lumbosacral plexus injury, 5 with L5 or S1 nerve injury, 2 with obturator nerve injury, and 1 case of lateral femoral cutaneous nerve injury. There were no relationships between the neurologic injuries and fracture types (p=0.192), but the longitudinal displacements of posterior ring and combined spine fractures were related to the neurologic injury within pelvic ring injury (p=0.006, p=0.048).

Conclusion

The incidence of neurologic injury in pelvis fracture was 21%. In this study, the longitudinal displacements of posterior ring and combined spine fractures were risk factors for neurological injury in pelvic ring injury.

Keywords: Pelvis, Pelvic ring injury, Neurologic injury, Complications, Risk factors

Figures and Tables

Fig. 1

A 69-year-old man's (A) initial pelvis anteroposterior view and (B) pelvis computed tomography image showed the AO/OTA type C3 pelvis fracture. (C) Internal fixation of the pelvis was done. (D) The last follow-up on both hips anteroposterior x-ray at postoperative 13 months demonstrated union of fractures, but he still had deficits of right lumbosacral plexopathy.

Table 1

Neurologic Injury Type versus Fracture Classification

References

1. Atlihan D, Tekdemir I, Ateŝ Y, Elhan A. Anatomy of the anterior sacroiliac joint with reference tolumbosacral nerves. Clin Orthop Relat Res. 2000; (376):236–241.

2. Balogh Z, Caldwell E, Heetveld M, et al. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference? J Trauma. 2005; 58:778–782.

3. Chin CH, Chew KC. Lumbosacral nerve root avulsion. Injury. 1997; 28:674–678.

4. Chiou-Tan FY, Kemp K Jr, Elfenbaum M, Chan KT, Song J. Lumbosacral plexopathy in gunshot wounds and motor vehicle accidents: comparison of electrophysiologic findings. Am J Phys Med Rehabil. 2001; 80:280–285.

5. Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988; 227:67–81.

6. Ebraheim NA, Lu J, Biyani A, Huntoon M, Yeasting RA. The relationship of lumbosacral plexus to the sacrum and the sacroiliac joint. Am J Orthop (Belle Mead NJ). 1997; 26:105–110.

7. Gänsslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury. 1996; 27:Suppl 1. S-A13-20.

8. Huittinen VM. Lumbosacral nerve injury in fracture of the pelvis. A postmortem radiographic and patho-anatomical study. Acta Chir Scand Suppl. 1972; 429:3–43.

9. Kim JW, Hong SK, Kyoung KH, Choi JH, Kim JJ. Comparison of the mortality rate according to the presence of trauma team in hemodynamically unstable patients with pelvic ring injury. J Korean Orthop Assoc. 2012; 47:191–197.

10. Kutsy RL, Robinson LR, Routt ML Jr. Lumbosacral plexopathy in pelvic trauma. Muscle Nerve. 2000; 23:1757–1760.

11. Lam CR. Nerve injury in fracture of the pelvis. Ann Surg. 1936; 104:945–951.

12. Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexus injuries. J Neurosurg Spine. 2004; 1:64–71.

13. Majeed SA. Neurologic deficits in major pelvic injuries. Clin Orthop Relat Res. 1992; (282):222–228.

14. McMurtry R, Walton D, Dickinson D, Kellam J, Tile M. Pelvic disruption in the polytraumatized patient: a management protocol. Clin Orthop Relat Res. 1980; (151):22–30.

15. Patterson FP, Morton KS. Neurological complications of fractures and dislocations of the pelvis. J Trauma. 1972; 12:1013–1023.

16. Rai SK, Far RF, Ghovanlou B. Neurologic deficits associated with sacral wing fractures. Orthopedics. 1990; 13:1363–1366.

17. Reilly MC, Zinar DM, Matta JM. Neurologic injuries in pelvic ring fractures. Clin Orthop Relat Res. 1996; (329):28–36.

18. Schmal H, Hauschild O, Culemann U, et al. Identification of risk factors for neurological deficits in patients with pelvic fractures. Orthopedics. 2010; 33.

19. Smith W, Williams A, Agudelo J, et al. Early predictors of mortality in hemodynamically unstable pelvis fractures. J Orthop Trauma. 2007; 21:31–37.

20. Sugimoto Y, Ito Y, Tomioka M, et al. Risk factors for lumbosacral plexus palsy related to pelvic fracture. Spine (Phila Pa 1976). 2010; 35:963–966.

21. Tonetti J, Cazal C, Eid A, et al. Neurological damage in pelvic injuries: a continuous prospective series of 50 pelvic injuries treated with an iliosacral lag screw. Rev Chir Orthop Reparatrice Appar Mot. 2004; 90:122–131.

TOOLS

Similar articles