DETECTION OF NEUROLOGIC INJURY IN OPERATIVE PELVIC FRACTURES: A MISSED OPPORTUNITY?

Neurologic injury after pelvic fractures occurs in 10–30% of cases and can lead to chronic pain, sexual dysfunction, limb weakness, and incontinence. Neurologic injury is also an important medicolegal outcome and accurate documentation is essential. We retrospectively reviewed patients who underwent operative fixation for pelvic fractures at a level 1 trauma center from 2017–2022. A chart review of neurologic exams, electrophysiologic tests, and imaging was performed. Patients were invited for a clinical review with outcome measures (Majeed and Iowa pelvis scores). Data were analyzed using Mann-Whitney U, Chi square, and regression. One hundred and two (102) patients (70 male, 32 female; mean age 42) were reviewed, with a mean follow-up of 14 months. Twenty-eight patients (28%) had an abnormal neurologic exam in their postoperative course, with a median time to first documentation of 55 days after injury (range 0 to 611). Of the 28, only 3 (11%) were documented to have an abnormal neurologic exam preoperatively. The majority, 24 (86%), of the abnormal neurologic examinations were motor weakness (foot drop, nonspecific weakness, or EHL weakness). The remaining 4 (14%) were sensory deficits (LFCN palsy, S1 radiculopathy). ISS and infection were associated with neurologic injury (B = 0.096 p = 0.025, B=2.630 p = 0.035). Revision surgery approached significance (B=2.571 p = 0.052) for an association with neurologic injury. Neurologic injury was associated with chronic pain (χ2=7.309 p = 0.017), lower MAJEED and IOWA scores (U=41 p = 0.039, U= 16 p = 0.036). Neurologic injury was not associated with facture type, transfusion requirement, gender, age, or fixation (p > 0.05). In this study neurologic injury was present in 28% of operatively treated pelvic fracture patients with the most common finding being lower extremity motor weakness (86%). The first documentation of an abnormal neurologic examination was well after their date of injury, and only 10% of abnormal neurological exams were documented preoperatively. The lower extremity neurological examination should comprise an essential component of the physical examination after pelvic fracture. The low rate of comprehensive documentation raises significant concerns for missed opportunities for care and medicolegal liability.