- See:
Neuro Exam:
- Discussion:
- mechanism of injury:
- direct neural injury from
sacral frx;
- indirect neural injury from traction accompanying pelvic displacement;
- injury to
lumbrosacral plexus is most common w/
L-5 &
S-1
roots being at greatest risk;
- injury to
femoral nerve is also common;
- its always important to identify these injuries in the ER because neurologic function may deteriorate futher during surgery, and postoperatively (due
to hematoma, scarring. and
heterotopic ossification);
- Exam:
- see:
neuro exam discussion:
- evaluate:
sciatic,
femoral, and
obturator nerve functions;
- rectal exam: assesses lower sacral nerves to rule out
cauda equina injury & will reveal
rectal injuries;
- Surgical Considerations:
- acetabular
ORIF:
- hip is kept extended and knee flexed as much as possible especially when posterior acetabular retractors are utilized;
- release of the sciatic
nerve from the greater sciatic notch to below the insertion
of the gluteus maximus tendon will improve sciatic
nerve symtpoms (radicular pain, paresthesias,
and diminished sensation);
- piriformis will often have to be divided;
Neurologic deficits in major pelvic injuries.
Intraoperative evoked potential monitoring in acetabular surgery.
Somatosensory evoked potential monitoring in the surgical treatment of acute, displaced acetabular fractures. Results of a prospective study.
Somatosensory evoked potential monitoring in the surgical management of acute acetabular fractures.
Injury of the sciatic nerve associated with acetabular fracture.
Subtle neurological injuries in pelvic fractures. EB Weis. Jr Subtle neurological injuries in pelvic fractures.
Neurologic injuries in pelvic ring fractures. MC Reilly et al. CORR. Vol 329. 1996. p 28-36.
