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. 2015 Oct 8:1:15020.
doi: 10.1038/scsandc.2015.20. eCollection 2015.

Management of neglected sacral fracture with cauda equina syndrome: report of two cases with review of literature

R Mahajan  1 , V Tandon  1 , K Das  1 , A Nanda  1 , R Venkatesh  1 , H S Chhabra  1
Affiliations

Management of neglected sacral fracture with cauda equina syndrome: report of two cases with review of literature

R Mahajan et al. Spinal Cord Ser Cases. .

Erratum in

Abstract

Study design: A retrospective study was performed.

Objectives: To analyze the outcome of two neglected sacral fractures who presented late to us after 6 weeks of injury with main complaints of incontinence and numbness in sacral region. There are no guidelines for management of complex fractures of sacrum who present late, and available literature is equally perplexing.

Methods: Patients were evaluated and radiological investigations were done. Anterior-displaced U-shaped fracture was found to be present between S2 and S3 with bony fragments encroaching the canal. Decompression with wide sacral laminectomies was done without any fixation.

Results: Case 1 showed complete recovery of bladder and perineal sensations 6 months post surgery. Second patient (case 2) had partial recovery of bladder control but numbness persisted till last follow-up at 6 months.

Conclusion: Neglected fractures of sacrum that present later than 6 weeks post injury with cauda equina syndrome could be given a chance for decompression if imaging shows canal encroachment with bony fragments. Fixation of fracture may not be required in all unstable sacral fractures after 6 weeks.

Keywords: Physiology; Surgery.

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Figures

Figure 1
Figure 1
Showing X-ray sacrum lateral view showing fracture sacrum (Case 1).
Figure 2
Figure 2
(a, b) Showing CT scan of the fracture (Case 1).
Figure 3
Figure 3
MRI showing sacral fracture (Case 1).
Figure 4
Figure 4
Intraoperative picture showing sacral nerve roots continuity after decompression (Case 1).
Figure 5
Figure 5
Showing X-ray sacrum lateral view showing fracture sacrum with spondylolisthesis (Case 2).
Figure 6
Figure 6
Showing CT scan of the fracture (Case 2).
Figure 7
Figure 7
Showing flowchart of treatment in neglected sacral fractures.
See this image and copyright information in PMC

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