Background: The value of direct decompression of neural structures to treat lumbosacral plexus injury associated with sacral fractures is still debatable. Direct decompression allows decompression of nerve roots by sacral laminectomy and removal of bone fragments in the spinal canal. In contrast, indirect decompression may offer similar neurological outcomes if good fracture reduction and correction of sacral kyphosis are achieved. In this comparative retrospective study, we analyzed differences between direct and indirect neurological decompression in terms of neurological recovery, complications, and functional outcome. Methods: This study included 33 cases with spinopelvic dissociation with variable degrees of lumbosacral plexus injury. All cases were managed by spinopelvic fixation. Eighteen patients (group 1) had direct decompression of lumbosacral nerve roots while 15 patients (group 2) had indirect decompression. Results: Initial sacral kyphosis, quality of fracture reduction, and postoperative residual kyphosis were the main factors that significantly affected functional and neurological outcome in both groups. The final neurological improvement was similar in both groups. No significant difference was observed between both groups in the residual Gibbons’ score recorded in the last visit (p = 0.206). The final Majeed score also showed no significant difference between the two groups (p = 0.869). Conclusions Indirect decompression of sacral fractures showed similar final functional outcome and neurological recovery compared to direct decompression. Restoration of lumbosacropelvic stability and anatomic reduction seem to be the cornerstone for better functional outcome and neurological recovery rather than direct decompression of neural elements.

PURPOSE: Outcomes following total knee arthroplasty (TKA), whether clinical, radiological or survival analysis, have been well-studied. Still, there are some concerns about patient satisfaction with the outcome of the surgery and factors that might contribute to a suboptimal result. This study aims to determine if there is correlation between primary TKA malalignment and early patient-reported outcome measures (PROMs). MATERIALS AND METHODS: Sixty patients, who had primary TKA and a minimum of 2 years of follow up, were recruited for a detailed clinical and radiological examination. Knee alignment was measured in the coronal, sagittal and axial planes. Normal and the outlier measurements of the patients' knees were defined and the clinical results (PROMs) compared to see if there was a statistically significant difference. RESULTS: Correlation between postoperative limb malalignment in the coronal and the sagittal planes and PROMs was not significant. Conversely, there was significant negative correlation between all types of malrotation and PROMs. CONCLUSIONS Although malalignment has been linked to inferior outcome and implant survival, our results showed that coronal and sagittal limb malalignment has no significant effect on early PROMs. However, all types of component rotational malalignment significantly worsen early PROMs.