Delayed surgical management of patients with U-shaped sacral fractures
https://doi.org/10.56618/20712693_2022_14_3_103
Abstract
among all injuries of the musculoskeletal system, injuries to the posterior pelvic ring are the most severe. U-shaped sacral fractures are especially dangerous. The issues associated with the final treatment tactics and the specific aspects of its implementation still remain unresolved.
STUDY PURPOSE: to assess the efficacy of the delayed isolated local decompression in patients with U-shaped fractures of the posterior pelvic ring, without final lumbosacral fixation.
MATERIALS AND METHODS: we have reviewed outcomes of treatment of three patients with severe polytrauma and complicated U-shaped sacral fractures who admitted to the hospital over the period since 2019 to 2021. All patients underwent local decompression of the sacral vertebrae, without subsequent stabilization by metal fixators in the late postinjury period.
RESULTS: one month after discharge, against the background of rehabilitation treatment, 2 patients (1 male and 1 female) had excellent functional outcomes according to the Majeed score, 1 patient had sexual disorders (discomfort during sexual intercourse). According to the Gibbons scale, all patients showed positive changes in the form of regression of motor and sensory disorders in the lower limbs; one patient had persisting numbness in the perianal area (2 points according to the Gibbons scale) after decompressive sacral laminectomy. The mean VAS score of the pain syndrome in all patients at the time of admission was 8–9 points vs. 1–2 points at discharge.
CONCLUSION: delayed isolated sacral laminectomy in patients with polytrauma and complicated U-shaped sacral fractures, after the formed spinal fusion and callus at the site of the sacral fracture allows to obtain favorable anatomical and functional outcomes.
Supporting agencies: The study was performed without external funding.
About the Authors
Z. В. Khadzhiev
Sklifosovsky Research Institute For Emergency Medicine
Russian Federation
Russian Federation
Khadzhiev Zaur B
A. A. Grin
Sklifosovsky Research Institute For Emergency Medicine
Russian Federation
Russian Federation
Grin Andrey A.
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Review
For citations:
Khadzhiev Z.В., Grin A.A. Delayed surgical management of patients with U-shaped sacral fractures. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2022;14(3):103-109. (In Russ.) https://doi.org/10.56618/20712693_2022_14_3_103
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