Sengupta 4 defined neglected spinal injuries as those, which are not treated in timely fashion and are found late when options are limited. These injuries may result in serious medical and medico-legal problems. Neglected spinal injuries are unusual in today’s modern health era. Our both cases had transverse fracture below S2 with vertical extensions and were so classified into low fractures category. Low sacral fractures are rare, occur from S3 to S5 and are caused owing to fall on buttocks. High fractures usually occur at S1–S2 region and are due to fall from height on extended knee and flexed hips. 3 had classified transverse sacral fractures into low and high types depending on location of fracture in sacrum. Patient improved and recovered her sphincter control and sensations completely 6 months after surgery. Patient was mobilized immediately post surgery. Intraoperative there was no mobility at fracture site and fracture fragments were found to be united. Left S3, S4 sacral nerve roots were found to be contused but continuity of nerve roots was maintained ( Figure 4). Patient was operated and multiple wide sacral laminectomies of S2 S3 were done. X-rays, computed tomography scan and magnetic resonance imaging were done, which showed anteriorly displaced fracture between S2 and S3 with vertical extensions (U-shaped fracture Figures 1, 2, 3) and canal encroachment with bony fragments. Perianal sensation was absent and voluntary anal contraction was weak. She complained of saddle anesthesia with incontinence of bladder and bowel. Patient was on bed rest for the last 45 days and had taken symptomatic treatment for pain relief. Fixation of fracture may not be required in all unstable sacral fractures after 6 weeks.Ī 36-year-old lady presented to us in outpatient department 45 days after injury due to fall from height with pain and numbness in sacral region. 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. Second patient (case 2) had partial recovery of bladder control but numbness persisted till last follow-up at 6 months. Results:Ĭase 1 showed complete recovery of bladder and perineal sensations 6 months post surgery. Decompression with wide sacral laminectomies was done without any fixation. Anterior-displaced U-shaped fracture was found to be present between S2 and S3 with bony fragments encroaching the canal. Patients were evaluated and radiological investigations were done. There are no guidelines for management of complex fractures of sacrum who present late, and available literature is equally perplexing. 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. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase your fluid intake.A retrospective study was performed.
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