A Narrow Escape. High-energy Comminuted Fractures of Sacrum and Pelvis - are they always associated with neurological deficits? A report of two cases.
Keywords:High-energy impact fractures, Sacral fractures, Denis classification of sacral fractures, Neurological injury with sacral fractures, Pelvic trauma, Polytrauma.
High-energy impact sacral fractures after polytrauma are often assumed to be associated with significant neurological damage especially when the fractures are in Denis Zones 2 & 3 where the sacral foramina and canal are involved.
We present two cases of high energy impact polytrauma with sacral fractures involving Denis Zone 2. Both these patients underwent spine instrumentation and stabilization surgeries; however, they did not have significant neurological damage despite the injury being close to the sacral foramina. Our findings in these two cases along with recent evidence suggest that the risk of lumbosacral plexus injury is not related to the zone of sacral fractures, but rather related to the displacement of the pelvis and with transverse fractures.
Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 1988;227:67-81. PubMed PMID: 3338224.
Fujii M, Abe K, Hayashi K, Kosuda S, Yano F, Watanabe S, et al. Honda sign and variants in patients suspected of having a sacral insufficiency fracture. Clin Nucl Med 2005;30(3):165-9. PubMed PMID: 15722819.
Sugimoto Y, Ito Y, Tomioka M, Tanaka M, Hasegawa Y, Nakago K, et al. Risk factors for lumbosacral plexus palsy related to pelvic fracture. Spine (Phila Pa 1976 2010 Apr;35(9):963-6. PubMed PMID: 20150832.
Massin P, Vidil A, Thoumie P, Huten D. A propos of an unusual case of lumbar-pelvic dislocation in a suicidal jumper. Rev Chir Orthop Reparatrice Appar Mot 1997;83(3):270-3. PubMed PMID: 9255364.
Hersche O, Isler B, Aebi M. Follow-up and prognosis of neurologic sequelae of pelvic ring fractures with involvement of the sacrum and/or the iliosacral joint. Unfallchirurg 1993;96(6):311-8. PubMed PMID: 8342059.