The therapeutic strategies for pelvic fractures complicated with nerve injuries / 中华骨科杂志

ABSTRACT

Pelvic fractures usually are high-energy injuries, which often involve high incidence of nerve injury, including lumbosacral plexus injuries and cauda equina injuries. Duo to 50% of neurological improvement has been reported regardless of the type of operative or nonoperative management after pelvic fractures complicated with nerve injuries, it still remains controversial whether surgical exploration is effective in such cases at an early stage and there is also some disagreement between anterior exploration or posterior exploration. We should find out the mechanism of pelvic fractures and the nature of nerve injuries. What's more, we must have a clear understanding of the location and qualitative diagnosis of the nerve injuries. After admission of patients, a detailed physical examination, combined with pelvic X-ray, CT, magnetic resonance neurography (MRN) and other imaging findings, which are conducive to make accurate diagnosis of the nature of nerve injuries, are carried out to make a targeted treatment plan. Generally speaking, cauda equina injuries are more common injuries in U-shaped sacral fractures, which cause the compression and space-occupying lesions of the sacral canal, so the posterior approach is a major approach to achieve the reduction and fixation of the sacral fractures and the decompression of sacral canal. While the lumbosacral plexus injuries are caused by the anterior compression, it is better to perform anterior approach to achieve the desired effect.