Lésions neurologiques des fractures de l’anneau pelvien

Tonetti, Jérôme; Cazal, Cláudia; Eid, Ahmad; Badulescu, A.; Martinez, Thibault; Vouaillat, H.; Merloz, P.

doi:10.1016/s0035-1040(04)70033-1

Cited by 44 publications

(22 citation statements)

References 25 publications

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“…These palsies were associated in high percentage to femoral fractures: the femoral nerve was injured by compression due to a peri-fracture hematoma and recovery was the rule, as it was previously found by Tonetti [6]. …”

Section: Discussionmentioning

confidence: 63%

“…Sacral fractures seem to mostly be associated to crush injuries in our series; in this kind of bone injury, a compression of the spinal roots by the fracture through the sacral foramina is reported between 22 and 56% of cases in the literature [6,13-16]. Although these cases are amenable of spontaneous recovery, experience has proved that early surgery with reduction of the fracture and consequent decompression of the spinal nerves leads to a faster and better recovery [6,14].…”

Section: Discussionmentioning

confidence: 98%

“…In recent times, reports have been published in the literature stating that LSP injuries might be significantly more frequent than it was thought in the past: Lindahl and Hirvensalo [9] report an incidence of LSP injuries equal to 40% in type-C pelvic ring injuries, Tonetti et al [6] find out that about 52% of posterior osteo-ligamentary injuries were associated with neurological symptoms. The presumed rare incidence of these injuries might be due to the fact that they might go unrecognized in many cases [6,7,10].…”

Section: Discussionmentioning

confidence: 99%

“…The presumed rare incidence of these injuries might be due to the fact that they might go unrecognized in many cases [6,7,10]. Neurological complications are easily underestimated during the early assessment of these patients after the trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Patients are often multitraumatized and the life-treating injuries captivate the attention of the physicians; on the other hand the patient may be unconscious or uncooperative and thus unable to bring the palsy to notice. A careful, complete neurological examination is often difficult or impossible: Tonetti [6] reports that it could not be performed at admission in 10 out of 44 patients included in their series of posterior osteoligamentary lesions of the pelvic girdle.…”

Section: Discussionmentioning

confidence: 99%

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In lumbosacral plexus injuries can we identify indicators that predict spontaneous recovery or the need for surgical treatment? Results from a clinical study on 72 patients

Garozzo¹,

Zollino²,

Ferraresi³

2014

J Brachial Plex Peripher Nerve Inj

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BackgroundPost-traumatic lumbosacral plexus injuries seem to be rare events, spontaneously recovering in high percentage: as surgery is often challenging and results in poor outcome, many Authors have advocated conservative treatment only. Nevertheless surgery should not be ruled out: in invalidating injuries, it can restore basic function in the lower extremities.Therefore, it might be necessary to establish guidelines for the management and the indication to surgery in such cases.This study aims to identify indicators predicting spontaneous recovery or the need for surgery.MethodThe clinical and radiological data of 72 patients with a post-traumatic lumbosacral plexus injury were reviewed. A follow up equal or superior to 3 years is available in 42 cases.ResultsLumbosacral plexus injuries mostly occurred during road accidents. The incidence of associated lesions was relevant: bone injuries were found in 85% of patients, internal lesions in 30% and vascular injuries in 8%.Lumbosacral trunk and sacral plexus palsies were the most frequent injury patterns.Root avulsions were revealed in 23% of cases and only in sacral plexus and complete lumbosacral plexus injuries: L5 and S1 were the roots more prone to avulsions.About 70% of cases recovered spontaneously, mostly in 18 months. Spontaneous recovery was the rule in lumbar plexus and lumbosacral trunk injuries (where root avulsions never occurred) or in sacral and complete lumbosacral plexus palsies due to compression injuries.The causative mechanism correlated with the injury pattern, the associated bone injury being often predictive of the severity of the nerve injury.Lumbosacral plexus injuries occurred in car crashes were generally associated with fractures causing compression on the nerves, thus resulting in injuries often amenable of spontaneous recovery.Motorcycle accidents implied high kinetic energy traumas where traction played an important role, as the high percentage of sacroiliac joint separations demonstrated (found in more than 50% of cases and always associated to root avulsions).Loss of sphincteral control and excruciating leg pain were also invariably associated with avulsions.ConclusionsClinical and radiological data can help to predict the occurrence of spontaneous recovery or the need for surgery in post-traumatic lumbosacral plexus injuries.

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Section: Discussionmentioning

confidence: 63%