Subtle neurological injuries in pelvic fractures

Area of Science:

• Orthopedic Surgery
• Neurology
• Rehabilitation Medicine

Background:

• Fractures of the acetabulum, pelvis, and sacrum are common orthopedic injuries.
• Nerve damage, particularly to the lumbosacral plexus, can occur secondary to these fractures.
• Electromyographic (EMG) changes are indicative of nerve injury.

Purpose of the Study:

• To investigate the incidence of electromyographic changes in patients with acetabular, pelvic, or sacral fractures.
• To determine the correlation between fracture type and the presence of lumbosacral plexus injury.
• To assess the impact of these EMG changes on the rehabilitation process.

Main Methods:

• Retrospective analysis of 28 patients with acetabular, pelvic, or sacral fractures.
• Electromyography (EMG) was performed to assess nerve function.
• Clinical manifestations and rehabilitation progress were evaluated.

Main Results:

• Eleven out of 28 patients (39%) exhibited electromyographic changes suggestive of lumbosacral plexus injury.
• The incidence of EMG changes was higher in patients with sacral fracture or sacroiliac separation (64%) compared to acetabular fractures (24%).
• EMG changes were diffuse, and clinical manifestations were subtle, yet they complicated the rehabilitation process.

Conclusions:

• Fractures of the acetabulum, pelvis, and sacrum are associated with a significant incidence of lumbosacral plexus injury, detectable via EMG.
• Sacral and sacroiliac injuries pose a greater risk for lumbosacral plexus damage than acetabular fractures.
• Subtle nerve injuries identified through EMG can impede successful patient rehabilitation and require consideration in treatment planning.