8/11/2023 0 Comments Nondisplaced transverse fracture![]() ![]() Five cases were treated conservatively with bed rest for 6 weeks. Classifying the neurological deficit according to the ASIA impairment scale led to the following: four-complete (A), one-incomplete (B) and one-normal (E). While the bladder and bowel and motor paralysis was present in five cases, sensory involvement was present only in four cases. In one patient, there was no neurological deficit. Of the six cases, five of them had cauda equina syndrome at the time of presentation. We report six cases of transverse fractures of sacrum that presented to our centre and reviewed the relevant literature to see whether managing these fractures conservatively or operatively have an effect on the outcome of bladder and bowel function. The motor and sensory paralysis being typically subtle, the bladder and bowel paralysis are distressing and have an impact on the quality of life. 5 The neurological involvement involves motor and sensory function as well as paralysis of bladder and bowel function. 4 These are classified as transverse Zone III fractures by Dennis et al. This reminds us of Kinnier Wilson quotes ‘the cauda equina is too complex a structure for simplicity of syndrome…’. Subtle neurological deficits complicated by frequently associated poly-trauma make these fractures difficult to detect at the time of presentation. Although Purser did not mention a neurological deficit in his original description, subsequent description of these fractures by several authors had high incidence of neurological damage and often associated with poor prognosis. 2, 3 The position and strength of sacrum makes it less vulnerable to fracture. 1 They constitute about 0.1% of polytrauma patients. This fracture was reported by Purser in 1969. Transverse sacral fractures are uncommon injuries. Presence of a severe angulation, displacement of fracture and neurotomesis dictate poor prognosis. ![]() There is no statistical evidence of benefit of either surgical or conservative management on the outcome of bladder and bowel function. Rest of the 13 cases were treated conservatively, with the improvement of bladder and bowel function in 10 cases. Of these, 47 cases were managed surgically, with the improvement of bladder and bowel function in 34 cases. A review of English literature identified 18 (60 cases) of the 25 publications mentioning the outcome of bladder and bowel function. Bladder and bowel function did not improve in three out of five cases. Five cases were managed conservatively and one case surgically. Results:įive of our six patients had cauda equina syndrome. A review of literature was carried out and publications that reported the outcome of function of bowel and urinary bladder were considered for the study. Six patients with transverse sacral fractures were identified and their case notes were reviewed. Regional spinal injury Unit, Southport, UK. (2) To review the literature and see the influence of the type of treatment on the neurological outcome, in particular, of the bladder and bowel and to identify the possible factors determining this outcome. ![]() (1) To report the management and outcome of a series of six cases of transverse sacral fractures. A retrospective study with review of literature. ![]()
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