Neurological Outcome After Traumatic Transverse Sacral Fractures

Kempen, Diederik H.R.; Delawi, Diyar; Altena, Mark; Kruyt, Moyo C.; Bekerom, Michel P.J. van den; Öner, F. Cumhur; Poolman, Rudolf W.

doi:10.2106/jbjs.rvw.17.00115

Cited by 14 publications

(5 citation statements)

References 125 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Complete neurologic recovery occurs in a variable percentage of patients (46.5–62%) [ 25 , 28 , 43 , 57 ] with abnormal immediate post-injury neurologic examination, whereas failure to recover any lost function may be seen in upward of 21.9% [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…The literature was in favor of routinely performing fixations after surgical decompression because the decompression itself may lead to increased instability [ 16 , 17 , 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…The widely accepted classification system of vertical sacral fractures was proposed by Denis and based on the location of the fracture (lateral to, through or medial to neural foramina; zones I–III) and their association with neurologic injury [ 2 , 20 ]. Medialization of the fracture line and presence of additional transverse sacral fractures increase the prevalence of concomitant neurologic injury [ 3 , 25 , 62 , 65 ]. Subsequent sacral classifications are mainly concerned with fracture morphology and do not consider neurologic injury as a determinant affecting surgical management [ 4 , 30 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Consensus for management of sacral fractures: from the diagnosis to the treatment, with a focus on the role of decompression in sacral fractures

Aprato,

Branca Vergano,

Casiraghi

et al. 2023

J Orthop Traumatol

View full text Add to dashboard Cite

Background There is no evidence in the current literature about the best treatment option in sacral fracture with or without neurological impairment. Materials and methods The Italian Pelvic Trauma Association (A.I.P.) decided to organize a consensus to define the best treatment for traumatic and insufficiency fractures according to neurological impairment. Results Consensus has been reached for the following statements: When complete neurological examination cannot be performed, pelvic X-rays, CT scan, hip and pelvis MRI, lumbosacral MRI, and lower extremities evoked potentials are useful. Lower extremities EMG should not be used in an acute setting; a patient with cauda equina syndrome associated with a sacral fracture represents an absolute indication for sacral reduction and the correct timing for reduction is “as early as possible”. An isolated and incomplete radicular neurological deficit of the lower limbs does not represent an indication for laminectomy after reduction in the case of a displaced sacral fracture in a high-energy trauma, while a worsening and progressive radicular neurological deficit represents an indication. In the case of a displaced sacral fracture and neurological deficit with imaging showing no evidence of nerve root compression, a laminectomy after reduction is not indicated. In a patient who was not initially investigated from a neurological point of view, if a clinical investigation conducted after 72 h identifies a neurological deficit in the presence of a displaced sacral fracture with nerve compression on MRI, a laminectomy after reduction may be indicated. In the case of an indication to perform a sacral decompression, a first attempt with closed reduction through external manoeuvres is not mandatory. Transcondylar traction does not represent a valid method for performing a closed decompression. Following a sacral decompression, a sacral fixation (e.g. sacroiliac screw, triangular osteosynthesis, lumbopelvic fixation) should be performed. An isolated and complete radicular neurological deficit of the lower limbs represents an indication for laminectomy after reduction in the case of a displaced sacral fracture in a low-energy trauma associated with imaging suggestive of root compression. An isolated and incomplete radicular neurological deficit of the lower limbs does not represent an absolute indication. A worsening and progressive radicular neurological deficit of the lower limbs represents an indication for laminectomy after reduction in the case of a displaced sacral fracture in a low-energy trauma associated with imaging suggestive of root compression. In the case of a displaced sacral fracture and neurological deficit in a low-energy trauma, sacral decompression followed by surgical fixation is indicated. Conclusions This consensus collects expert opinion about this topic and may guide the surgeon in choosing the best treatment for these patients. Level of Evidence: IV. Trial registration: not applicable (consensus paper).

show abstract

Section: Discussionmentioning

confidence: 99%

“…The literature was in favor of routinely performing fixations after surgical decompression because the decompression itself may lead to increased instability [ 16 , 17 , 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Consensus for management of sacral fractures: from the diagnosis to the treatment, with a focus on the role of decompression in sacral fractures

Aprato,

Branca Vergano,

Casiraghi

et al. 2023

J Orthop Traumatol

View full text Add to dashboard Cite

show abstract

“…Pelvic and sacral fractures caused by high-energy trauma are rare but serious injuries, with which neurologic disorder is frequently associated. Sacral fractures involving the sacral plexus, especially bilateral sacral plexus, have a high prevalence of neurological injury, leading to severe disabilities including impaired motor function, loss of sensation in the lower extremities, as well as bowel, bladder, and sexual dysfunction 10 . Although the incidence of neurological injury is high, the functional recovery remains uncertain 11 .…”

Section: Discussionmentioning

confidence: 99%

Ipsilateral S2 nerve root transfer to pudendal nerve for restoration of external anal and urethral sphincter function: an anatomical study

Zhu

Zhou

Shen

et al. 2019

Sci Rep

View full text Add to dashboard Cite

Patients suffer bilateral sacral plexus injuries experience severe problems with incontinence. We performed a cadaveric study to explore the anatomical feasibility of transferring ipsilateral S2 nerve root combined with a sural nerve graft to pudendal nerve for restoration of external anal and urethral sphincter function. The sacral nerve roots and pudendal nerve roots on the right side were exposed in 10 cadavers. The length from S2 nerve root origin to pudendal nerve at inferior border of piriformis was measured. The sural nerve was used as nerve graft. The diameters and nerve cross-sectional areas of S2 nerve root, pudendal nerve and sural nerve were measured and calculated, so as the number of myelinated axons of three nerves on each cadaver specimen. The length from S2 nerve root to pudendal nerve was 10.69 ± 1.67 cm. The cross-sectional areas of the three nerves were 8.57 ± 3.03 mm2 for S2, 7.02 ± 2.04 mm2 for pudendal nerve and 6.33 ± 1.61 mm2 for sural nerve. The pudendal nerve contained approximately the same number of axons (5708 ± 1143) as the sural nerve (5607 ± 1305), which was a bit less than that of the S2 nerve root (6005 ± 1479). The S2 nerve root in combination with a sural nerve graft is surgically feasible to transfer to the pudendal nerve for return of external urethral and anal sphincter function, and may be suitable for clinical application in patients suffering from incontinence following sacral plexus injuries.

show abstract

“…However, a systematic review by Kepler et al revealed early decompression (defined as before 72 hours) did not afford any benefit with respect to neurologic recovery [33]. Similarly, Kempen et al did not provide evidence of improved neurological recovery after surgical treatment of transverse sacral fractures compared with non-operative treatment in their systematic review of 521 patients [32]. Thus, the outcome of surgical decompression is difficult to discern given the overall improvement of 80% irrespective of treatment [56].…”

Section: Treatment Optionsmentioning

confidence: 99%

Sacral Fractures: A Review

Barber

Katsuura

Qureshi

2022

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

At the cornerstone of the pelvis and spine, the sacrum may be fractured in patients of all ages. Sacral fractures range from high-energy injuries, with mortality rates of up to 18%, to low-energy insufficiency fractures. The intricate geometry of the sacrum, the breadth of morphotypes, and the presence of congenital anomalies all can complicate the treatment of these fractures. Agreement on the surgical indications for these injuries is limited. This narrative review aims to update orthopedic surgeons on the clinical evaluation and the non-surgical and surgical management of these fractures.

show abstract

Neurological Outcome After Traumatic Transverse Sacral Fractures

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 14 publications

References 125 publications

Consensus for management of sacral fractures: from the diagnosis to the treatment, with a focus on the role of decompression in sacral fractures

Consensus for management of sacral fractures: from the diagnosis to the treatment, with a focus on the role of decompression in sacral fractures

Ipsilateral S2 nerve root transfer to pudendal nerve for restoration of external anal and urethral sphincter function: an anatomical study

Sacral Fractures: A Review

Contact Info

Product

Resources

About