Session VII Pelvis and Acetabulum

Neurologic Outcome after Unstable Pelvic Ring Injuries and Acetabular Fractures: A Prospective 2-Year Study of 51 Cases

Axel Gänsslen, MD, T. Pohlemann, PhD, MD, U. Weber, MD, H. Müller-Vahl, Prof., MD, H. Tscherne, Prof., MD

Trauma and Neurological Dept., Hannover Medical School, Hannover, Germany

Purpose: Pelvic and acetabular fractures are rare but serious injuries. One of the major complication is the neurologic injury, which significantly may influence the long-term outcome. The purpose of this study was to evaluate the neurologic long-term prognosis after 2 years in unstable pelvic fractures and acetabular fractures.

Methods: Between March 1991 and June 1992, 67 patients after B-type, C-type and acetabular fractures were entered in a prospective interdisciplinary study. Beside normal clinical parameters (pain, range of motion, leg length, instability, etc.) a detailed neurological examination was included. A 2-year follow-up was possible in 51 patients (76%). Here beside an orthopaedic examination, a clinical neurologic examination by a neurologist in all cases and EMG and nerve conduction series of the peroneal and tibial nerve in 37 cases was performed. The overall incidence, the prognosis and the type of neurologic lesion in correlation with the pelvic injury was recorded.

Results: Primary: The overall rate of primary neurologic finding was 45% [B-type 36%, C-type 57%, isolated acetabular fractures 73%]. 43.5% had multiple nerve lesions, most of them had involvement of the sciatic and superior gluteal nerve. SI-joint disruption showed primary nerve injury in 28.6%, sacral fractures in 5%. There was a correlation between pelvic ring instability and severity of nerve injury. Iatrogenic nerve damage occurred in 7 cases.

Follow-up: 21.7% had complete recovery, 47.8% had motoric recovery (26.1% complete, 21.7 partial), and 26.2% sensory recovery. Persistant neurologic damage was found in 3.6% after B-type, 50% after C-Type injury and in 35% after isolated acetabular fracture. No rectal sphincter lesion was found. All patients with bladder and sexual dysfunction showed no remission. A correlation was found between grade of primary motor dysfunction and the recovery rate.

Discussion: A detailed study concerning the incidence and prognosis of neural lesions after pelvic and acetabular fracture is missing. Present data support the clinical findings of a high rate of neurological injuries in combination with pelvic and acetabular fractures. The best prognosis was observed after motor lesions with a 47% recovery rate.

Conclusion: A detailed neurological examination should be included in the primary course of each patient after pelvic and acetabular fractures preferable by a neurologist. A follow-up examination is essential as overall rate of 21.7% remission can be expected.