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Neurological Deficits Associated With Pelvic Fractures

1966; American Association of Neurological Surgeons; Volume: 24; Issue: 5 Linguagem: Inglês

10.3171/jns.1966.24.5.0837

1933-0693

Charles L. Goodell,

Pregnancy-related medical research

D ISTURBANCES of neu ro log i ca l func t ion are an u n c o m m o n c o m p l i c a t i o n of pe lv ic f r ac tu r e s a n d r e p o r t s in Eng l ish h a v e been rare . N e u r o l o g i c a l d a t a acc o m p a n y i n g these few p u b l i s h e d cases is gene ra l ly f r a g m e n t a r y a n d h a r d l y a d e q u a t e for d r a w i n g more t h a n t e n t a t i v e conclus ions r e g a r d i n g the m e c h a n i s m a n d s i te of t he per i phe ra l ne rve in ju ry . L a m 7 s u r v e y e d the l i t e r a t u r e a n d found m e n t i o n of ne rve i n j u r y in 0.75 p e r cen t of 1889 pe lv ic f r ac tu res , b u t e n c o u n t e r e d 9 ne rve in jur ies in his series of 100 cases. Bonn in 3 de sc r ibed a s soc i a t ed n e r v e in ju r i e s in 11 p e r cen t of his 44 p a t i e n t s . M o r e recen t ly , P a t t e r s o n a n d M o r t o n TM r e p o r t e d neuro logical c o m p l i c a t i o n s in 1.~ pe r c en t of 809 pelvic f rac tu res . R e a s o n s for th is m o r e t h a n tenfold d i s p a r i t y b e t w e e n ra te s of neuro log ica l c o m p l i c a t i o n s a re n o t obv ious . N o p a t t e r n of pe lv i c r ing f r a c t u r e seems to p r e d o m i n a t e in i n s t ances where n e r v e d a m age has occur red . H o w e v e r , n e r v e defici ts a p p e a r to be m o r e c o m m o n w i t h f r ac tu re s of t h e s a c r u m t h a n w i t h pe lv i c f r a c t u r e s n o t i nvo lv ing t h a t s t r u c t u r e . F u r t h e r c o m m e n t will be m a d e on th i s p h e n o m e n o n l a t e r in t he a r t i c le . P a t t e r s o n a n d M o r t o n 1~ r e p o r t e d sacro i l i ac j o i n t s e p a r a t i o n in o v e r ha l f of t h e i r p a t i e n t s w i t h n e u r a l d a m a g e ; sacro i l iac s u b l u x a t i o n , howeve r , occurs in on ly 6 pe r cen t of unse l ec t ed pe lv i c in ju r ies . 9 W e h a v e r e c e n t l y e n c o u n t e r e d 3 cases of n e r v e i n j u r y c o m p l i c a t i n g p e l v i c f r ac tu res . Al l h a v e u n d e r g o n e carefu l neu ro log i ca l eva l u a t i o n , m y e l o g r a p h y , a n d su rg ica l exp lo ra t ion . T h e d a t a f rom these cases h a v e inc r ea sed ou r u n d e r s t a n d i n g of t h e n a t u r e a n d s i te of t h e neu ra l d a m a g e .