Surgical Treatment of Vertical Shear Pelvic Fracture Associated with a Lumbosacral Plexus Injury through the Lateral‐Rectus Approach: Surgical Techniques and Preliminary Outcomes

OBJECTIVE: To examine the surgical techniques and preliminary outcomes of the lateral rectus approach (LRA) for treating vertical shear (VS) pelvic fracture associated with lumbosacral plexus (LSP) injury. METHODS: This study was a retrospective trial. From August 2010 to October 2017, 29 patients with VS pelvic fractures involving LSP injury who were treated with the LRA were included in this study. The patients were 18–61 years old, with a mean age of 36.2 years. All patients underwent neurolysis, open reduction, and internal fixation (ORIF) through the LRA. The fracture reduction was evaluated using the Matta criteria, and the neural recovery was evaluated by muscle strength grading proposed by the British Medical Research Council (BMRC). RESULTS: All 29 patients underwent the surgery successfully. The mean operating time was 155.2 ± 32.1 min (range: 105–220 min). The mean operative blood loss was 1021.4 ± 363.4 mL (range: 400–2000 mL). All patients were followed‐up for at least 24 months (mean, 32.8 ± 13.5 months; range: 24–96 months). According to the Matta criteria, there were 17 excellent cases, nine good cases, and three fair cases in 29 patients. The ratio of excellent‐to‐good cases was 89.66%. According to the criteria of the Nerve Injuries Committee of the British Medical Research Council (BMRC), the recovery of nerve and muscle strength achieved to M5 (full recovery of neurological symptoms) was 14 cases, M4 (fine recovery of neurological symptoms), seven cases; M1, M2, and M3 (partial recovery of neurological symptoms), five cases, and M0 (no recovery of neurological symptoms), three cases. CONCLUSIONS: LRA is a safe and feasible surgical approach for treating VS pelvic fractures with LSP injury, which can be used to perform nerve exploration and release from the front, reduce the fracture, and fix it with the anterior iliac plates and/or sacroiliac screws.