Skip to main content
SpringerLink
Log in

Factors associated with gait outcomes in patients with traumatic lumbosacral plexus injuries

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Lumbosacral plexus injuries usually occur in patients with severe, multiple traumas requiring intensive care, affecting gait function. The purpose of the present study was to identify the initial factors associated with gait outcome in lumbosacral plexus injuries caused by traumas.

Methods

We retrospectively identified 664 patients with pelvic fractures caused by trauma between 2006 and 2017. The lumbosacral plexus injuries were electrodiagnostically confirmed in 30 patients (4.5%). Demographic, injury-related, fracture-related and electrodiagnostic factors were compared between patients with long-term unassisted gait outcomes to those with assisted gait outcomes, with an average of 27 months elapsing after the trauma.

Results

Eleven patients (36.7%) remained in the assisted gait group during the follow-up period. Complex pelvic trauma, rather than the severity of trauma to the entire body, was associated with a poor gait outcome. Among the various causes of injury, pedestrians struck by vehicles were associated with assisted gait outcomes. The number of anatomic locations involved in pelvic fractures, pelvic ring instability by Tile classification, and the proportion of unstable sacral fractures were higher in patients with assisted gait outcomes compared with those having unassisted gait outcomes. Weaknesses in the initial hip extensor, knee flexor, ankle dorsiflexor and ankle plantar flexor were observed significantly more often in patients with assisted gait outcomes. The Dumitru and Wilbourn’s scale of the anterior and posterior sacral plexus was significantly higher in the assisted gait group.

Conclusions

Gait outcome after lumbosacral plexus injury is associated with the range and stability of the pelvic fracture and the severity of the anterior and posterior sacral plexus injury. Poor gait outcome was associated with the severity of the trauma to the pelvis rather than that to the entire body.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wilbourn AJ. Plexopathies. Neurol Clin. 2007;25(1):139–71. https://doi.org/10.1016/j.ncl.2006.11.005.

    Article  PubMed  Google Scholar 

  2. Lindahl J, Hirvensalo E. Outcome of operatively treated type-C injuries of the pelvic ring. Acta Orthop. 2005;76(5):667–78. https://doi.org/10.1080/17453670510041754.

    Article  PubMed  Google Scholar 

  3. Stoehr M. Traumatic and postoperative lesions of the lumbosacral plexus. Arch Neurol. 1978;35(11):757–60.

    Article  CAS  Google Scholar 

  4. Lang EM, Borges J, Carlstedt T. Surgical treatment of lumbosacral plexus injuries. J Neurosurg Spine. 2004;1(1):64–71. https://doi.org/10.3171/spi.2004.1.1.0064.

    Article  PubMed  Google Scholar 

  5. Chiodo A. Neurologic injury associated with pelvic trauma: radiology and electrodiagnosis evaluation and their relationships to pain and gait outcome. Arch Phys Med Rehabil. 2007;88(9):1171–6. https://doi.org/10.1016/j.apmr.2007.06.004.

    Article  PubMed  Google Scholar 

  6. Chiou-Tan FY, Kemp K Jr, Elfenbaum M, Chan KT, Song J. Lumbosacral plexopathy in gunshot wounds and motor vehicle accidents: comparison of electrophysiologic findings. Am J Phys Med Rehabil. 2001;80(4):280–5.

    Article  CAS  Google Scholar 

  7. Hauschild O, Strohm PC, Culemann U, Pohlemann T, Suedkamp NP, Koestler W, et al. Mortality in patients with pelvic fractures: results from the German pelvic injury register. J Trauma. 2008;64(2):449–55. https://doi.org/10.1097/TA.0b013e31815982b1.

    Article  PubMed  Google Scholar 

  8. Schmal H, Hauschild O, Culemann U, Pohlemann T, Stuby F, Krischak G, et al. Identification of risk factors for neurological deficits in patients with pelvic fractures. Orthopedics. 2010. https://doi.org/10.3928/01477447-20100625-13.

    Article  PubMed  Google Scholar 

  9. Sugimoto Y, Ito Y, Tomioka M, Tanaka M, Hasegawa Y, Nakago K, et al. Risk factors for lumbosacral plexus palsy related to pelvic fracture. Spine (Phila Pa 1976). 2010;35(9):963–6. https://doi.org/10.1097/brs.0b013e3181bb85d0.

    Article  Google Scholar 

  10. Jang DH, Byun SH, Jeon JY, Lee SJ. The relationship between lumbosacral plexopathy and pelvic fractures. Am J Phys Med Rehabil. 2011;90(9):707–12. https://doi.org/10.1097/PHM.0b013e31821f6bd9.

    Article  PubMed  Google Scholar 

  11. Lindahl J, Makinen TJ, Koskinen SK, Soderlund T. Factors associated with outcome of spinopelvic dissociation treated with lumbopelvic fixation. Injury. 2014;45(12):1914–20. https://doi.org/10.1016/j.injury.2014.09.003.

    Article  PubMed  Google Scholar 

  12. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51.

    Article  CAS  Google Scholar 

  13. Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.

    Article  CAS  Google Scholar 

  14. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29(5):623–9.

    Article  CAS  Google Scholar 

  15. Gansslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury. 1996;27(Suppl 1):S-A13-20.

    PubMed  Google Scholar 

  16. Tile M. Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg. 1996;4(3):143–51.

    Article  CAS  Google Scholar 

  17. Totterman A, Glott T, Madsen JE, Roise O. Unstable sacral fractures: associated injuries and morbidity at 1 year. Spine (Phila Pa 1976). 2006;31(18):E628–35. https://doi.org/10.1097/01.brs.0000231961.03527.00.

    Article  Google Scholar 

  18. Dumitru D, Amata AA, Zwarts MJ. Electrodiagnostic medicine. Philadelphia: Hanley & Belfus; 2002.

    Google Scholar 

  19. Lee HJ, Delisa JA. Manual of nerve conduction study and surface anatomy for needle electromyography. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2004.

    Google Scholar 

  20. Perotto AO. Anatomical guide for the electromyographer. 5th ed. Illinois: Charles C Thomas; 2011.

    Google Scholar 

  21. Dumitru D, Zwarts MJ. Brachial plexopathies and proximal mononeuropathies. In: Dumitru D, Amata AA, Zwarts MJ, editors. Electrodiagnostic medicine. Philadelphia: Hanley & Belfus; 2002. p. 788–98.

    Google Scholar 

  22. Lim SH, Lee JS, Kim YH, Kim TW, Kwon KM. Spontaneous recovery of non-operated traumatic brachial plexus injury. Eur J Trauma Emerg Surg. 2018;44(3):443–9. https://doi.org/10.1007/s00068-017-0810-x.

    Article  CAS  PubMed  Google Scholar 

  23. Dvir Z. Grade 4 in manual muscle testing: the problem with submaximal strength assessment. Clin Rehabil. 1997;11(1):36–41. https://doi.org/10.1177/026921559701100106.

    Article  CAS  PubMed  Google Scholar 

  24. Snedeker JG, Muser MH, Walz FH. Assessment of pelvis and upper leg injury risk in car-pedestrian collisions: comparison of accident statistics, impactor tests and a human body finite element model. Stapp Car Crash J. 2003;47:437–57.

    PubMed  Google Scholar 

  25. Kutsy RL, Robinson LR, Routt ML Jr. Lumbosacral plexopathy in pelvic trauma. Muscle Nerve. 2000;23(11):1757–60.

    Article  CAS  Google Scholar 

  26. Weis EB Jr. Subtle neurological injuries in pelvic fractures. J Trauma. 1984;24(11):983–5.

    Article  Google Scholar 

  27. Khan JM, Marquez-Lara A, Miller AN. Relationship of sacral fractures to nerve injury: Is the Denis Classification Still Accurate? J Orthop Trauma. 2017;31(4):181–4. https://doi.org/10.1097/BOT.0000000000000772.

    Article  PubMed  Google Scholar 

  28. Bellabarba C, Stewart JD, Ricci WM, DiPasquale TG, Bolhofner BR. Midline sagittal sacral fractures in anterior-posterior compression pelvic ring injuries. J Orthop Trauma. 2003;17(1):32–7.

    Article  Google Scholar 

  29. Babaei-Ghazani A, Eftekharsadat B, Samadirad B, Mamaghany V, Abdollahian S. Traumatic lower extremity and lumbosacral peripheral nerve injuries in adults: electrodiagnostic studies and patients symptoms. J Forensic Leg Med. 2017;52:89–92. https://doi.org/10.1016/j.jflm.2017.08.010.

    Article  PubMed  Google Scholar 

  30. Anderson FC, Pandy MG. Individual muscle contributions to support in normal walking. Gait Posture. 2003;17(2):159–69.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Jung Soo Lee & Yeo Hyung Kim

Authors
  1. Jung Soo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yeo Hyung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yeo Hyung Kim.

Ethics declarations

Conflict of interest

There are no conflicts of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J.S., Kim, Y.H. Factors associated with gait outcomes in patients with traumatic lumbosacral plexus injuries. Eur J Trauma Emerg Surg 46, 1437–1444 (2020). https://doi.org/10.1007/s00068-019-01137-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-019-01137-x

Keywords

Search

Navigation