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Neurologic Injury in Acetabular and Pelvic Fractures

- See: Neuro Exam

- Discussion:
    - mechanism of injury:
           - direct neural injury from sacral frx;
           - indirect neural injury from traction accompanying pelvic displacement;
    - injury to lumbrosacral plexus is most common w/ L-5 & S-1 roots being at greatest risk;
    - injury to femoral nerve is also common;
    - its always important to identify these injuries in the ER because neurologic function may deteriorate futher during surgery, and
                postoperatively (due to hematoma, scarring. and heterotopic ossification);

- Exam:
    - see: neuro exam discussion:
    - evaluate: sciatic, femoral, and obturator nerve functions;
    - rectal exam: assesses lower sacral nerves to rule out cauda equina injury & will reveal rectal injuries

- Surgical Considerations:
     - acetabular ORIF:
              - hip is kept extended and knee flexed as much as possible especially when posterior acetabular retractors are utilized; 
              - release of the sciatic nerve from the greater sciatic notch to below the insertion of the gluteus maximus tendon will improve
                         sciatic nerve symtpoms (radicular pain, paresthesias, and diminished sensation);
                         - piriformis will often have to be divided

Nerve injury with acetabulum fractures: Incidence and factors affecting recovery.

Neurologic deficits in major pelvic injuries.

Intraoperative evoked potential monitoring in acetabular surgery.

Somatosensory evoked potential monitoring in the surgical treatment of acute, displaced acetabular fractures. Results of a prospective study.

Somatosensory evoked potential monitoring in the surgical management of acute acetabular fractures.

Injury of the sciatic nerve associated with acetabular fracture.

Subtle neurological injuries in pelvic fractures.  

Neurologic injuries in pelvic ring fractures.   

Identification of risk factors for neurological deficits in patients with pelvic fractures.

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