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HSS Journal ®

Erschienen in:

01.02.2009 |

Sciatic Nerve Injury Associated with Acetabular Fractures

verfasst von: Paul S. Issack, MD, PhD, David L. Helfet, MD

Erschienen in: HSS Journal ® | Ausgabe 1/2009

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Abstract

Sciatic nerve injuries associated with acetabular fractures may be a result of the initial trauma or injury at the time of surgical reconstruction. Patients may present with a broad range of symptoms ranging from radiculopathy to foot drop. There are several posttraumatic, perioperative, and postoperative causes for sciatic nerve palsy including fracture–dislocation of the hip joint, excessive tension or inappropriate placement of retractors, instrument- or implant-related complications, heterotopic ossification, hematoma, and scarring. Natural history studies suggest that nerve recovery depends on several factors. Prevention requires attention to intraoperative limb positioning, retractor placement, and instrumentation. Somatosensory evoked potentials and spontaneous electromyography may help minimize iatrogenic nerve injury. Heterotopic ossification prophylaxis can help reduce delayed sciatic nerve entrapment. Reports on sciatic nerve decompression are not uniformly consistent but appear to have better outcomes for sensory than motor neuropathy.

Jenkins DB (1998) Hollinshead’s functional anatomy of the limbs and back, 7th edn. Saunders, Philadephia

Pokorny D, Jahoda D, Veigl D et al (2006) Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat 28:88–91PubMedCrossRef

Benson ER, Schutzer SF (1999) Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am 81:941–949PubMedCrossRef

Uchio Y, Nishikawa U, Ochi M et al (1998) Bilateral piriformis syndrome after total hip arthroplasty. Arch Orthop Trauma Surg 117:177–179PubMedCrossRef

Sunderland S (1953) The relative susceptibility to injury of the medial and lateral popliteal divisions of the sciatic nerve. Br J Surg 41:300–302PubMedCrossRef

Tornetta P 3rd (2001) Displaced acetabular fractures: indications for operative and nonoperative management. J Am Acad Orthop Surg 9:18–28PubMed

Fassler PR, Swiontkowski MF, Kilroy AW et al (1993) Injury of the sciatic nerve associated with acetabular fracture. J Bone Joint Surg Am 75:1157–1166PubMed

Helfet DL, Schmeling GJ (1994) Somatosensory evoked potential monitoring in the surgical treatment of acute, displaced acetabular fractures. Results of a prospective study. Clin Orthop Relat Res (301):213–220

Jacob JR, Rao JP, Ciccarelli C (1987) Traumatic dislocation and fracture dislocation of the hip. A long-term follow-up study. Clin Orthop Relat Res (214):249–263

10.

Kleiman SG, Stevens J, Kolb L et al (1971) Late sciatic-nerve palsy following posterior fracture–dislocation of the hip. A case report. J Bone Joint Surg Am 53:781–782PubMed

11.

Schmeling GJ, Perlewitz TJ, Helfet DL (2003) Early complications of acetabular fractures. In: Tile M, Helfet DL, Kellam JF (eds) Fractures of the pelvis and acetabulum, 3rd edn. Lippincott Williams and Wilkins, Philadelphia, pp 729–740

12.

Haidukewych GJ, Scaduto J, Herscovici D Jr et al (2002) Iatrogenic nerve injury in acetabular fracture surgery: a comparison of monitored and unmonitored procedures. J Orthop Trauma 16:297–301PubMedCrossRef

13.

Letournel E, Judet R (1993) Early complications of operative treatment within three weeks of injury. In: Elso RA (ed) Fractures of the acetabulum, 2nd edn. Springer, Berlin, pp 535–540

14.

Letournel E, Judet R (1993) Late complications of operative treatment within three weeks of injury. In: Elso RA (ed) Fractures of the acetabulum, 2nd edn. Springer, Berlin, pp 541–564

15.

Mears DC, Rubash HE, Sawaguchi T (1985) Fractures of the acetabulum. Hip 1985:95–113

16.

Tile M (1980) Fractures of the acetabulum. Orthop Clin North Am 11:481–506PubMed

17.

Butt AJ, McCarthy T, Kelly IP et al (2005) Sciatic nerve palsy secondary to postoperative haematoma in primary total hip replacement. J Bone Joint Surg Br 87:1465–1467PubMedCrossRef

18.

Fleming RE Jr, Michelsen CB, Stinchfield FE (1979) Sciatic paralysis. A complication of bleeding following hip surgery. J Bone Joint Surg Am 61:37–39PubMed

19.

Asnis SE, Hanley S, Shelton PD (1985) Sciatic neuropathy secondary to migration of trochanteric wire following total hip arthroplasty. Clin Orthop Relat Res (196):226–228

20.

Beauchesne RP, Schutzer SF (1997) Myositis ossificans of the piriformis muscle: an unusual cause of piriformis syndrome. A case report. J Bone Joint Surg Am 79:906–910PubMed

21.

Crawford JR, Van Rensburg L, Marx C (2003) Compression of the sciatic nerve by wear debris following total hip replacement: a report of three cases. J Bone Joint Surg Br 85:1178–1180PubMedCrossRef

22.

Fischer SR, Christ DJ, Roehr BA (1999) Sciatic neuropathy secondary to total hip arthroplasty wear debris. J Arthroplasty 14:771–774PubMedCrossRef

23.

Isiklar ZU, Lindsey RW, Tullos HS (1997) Sciatic neuropathy secondary to intrapelvic migration of an acetabular cup. A case report. J Bone Joint Surg Am 79:1395–1397PubMed

24.

Stiehl JB, Stewart WA (1998) Late sciatic nerve entrapment following pelvic plate reconstruction in total hip arthroplasty. J Arthroplasty 13:586–588PubMedCrossRef

25.

Derian PS, Bibighaus AJ (1974) Sciatic nerve entrapment by ectopic bone after posterior fracture–dislocation of the hip. South Med J 67:209–210PubMed

26.

Thakkar DH, Porter RW (1981) Heterotopic ossification enveloping the sciatic nerve following posterior fracture–dislocation of the hip: a case report. Injury 13:207–209PubMedCrossRef

27.

Hirasawa Y, Oda R, Nakatani K (1977) Sciatic nerve paralysis in posterior dislocation of the hip. A case report. Clin Orthop Relat Res (126):172–175

28.

Routt ML Jr, Swiontkowski MF (1990) Operative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedure. J Bone Joint Surg Am 72:897–904PubMed

29.

Griffin DB, Beaule PE, Matta JM (2005) Safety and efficacy of the extended iliofemoral approach in the treatment of complex fractures of the acetabulum. J Bone Joint Surg Br 87:1391–1396PubMedCrossRef

30.

Moed BR, Karges DE (1994) Prophylactic indomethacin for the prevention of heterotopic ossification after acetabular fracture surgery in high-risk patients. J Orthop Trauma 8:34–39PubMedCrossRef

31.

Moed BR, Maxey JW (1993) The effect of indomethacin on heterotopic ossification following acetabular fracture surgery. J Orthop Trauma 7:33–38PubMedCrossRef

32.

Burd TA, Lowry KJ, Anglen JO (2001) Indomethacin compared with localized irradiation for the prevention of heterotopic ossification following surgical treatment of acetabular fractures. J Bone Joint Surg Am 83-A:1783–1788PubMed

33.

Epstein HC (1974) Posterior fracture–dislocations of the hip; long-term follow-up. J Bone Joint Surg Am 56:1103–1127PubMed

34.

Yuen EC, Olney RK, So YT (1994) Sciatic neuropathy: clinical and prognostic features in 73 patients. Neurology 44:1669–1674PubMed

35.

Helfet DL, Hissa EA, Sergay S et al (1991) Somatosensory evoked potential monitoring in the surgical management of acute acetabular fractures. J Orthop Trauma 5:161–166PubMedCrossRef

36.

Helfet DL, Koval KJ, Hissa EA et al (1995) Intraoperative somatosensory evoked potential monitoring during acute pelvic fracture surgery. J Orthop Trauma 9:28–34PubMedCrossRef

37.

Middlebrooks ES, Sims SH, Kellam JF et al (1997) Incidence of sciatic nerve injury in operatively treated acetabular fractures without somatosensory evoked potential monitoring. J Orthop Trauma 11:327–329PubMedCrossRef

38.

Kumar A, Bhattacharya A, Makhija N (2000) Evoked potential monitoring in anaesthesia and analgesia. Anaesthesia 55:225–241PubMedCrossRef

39.

Manninen PH (1998) Monitoring evoked potentials during spinal surgery in one institution. Can J Anaesth 45:460–465PubMedCrossRef

40.

Padberg AM, Bridwell KH (1999) Spinal cord monitoring: current state of the art. Orthop Clin North Am 30:407–433, viiiPubMedCrossRef

41.

Helfet DL, Anand N, Malkani AL et al (1997) Intraoperative monitoring of motor pathways during operative fixation of acute acetabular fractures. J Orthop Trauma 11:2–6PubMedCrossRef

42.

Brown DM, McGinnis WC, Mesghali H (2002) Neurophysiologic intraoperative monitoring during revision total hip arthroplasty. J Bone Joint Surg Am 84-A(Suppl 2):56–61PubMed

43.

Pereles TR, Stuchin SA, Kastenbaum DM et al (1996) Surgical maneuvers placing the sciatic nerve at risk during total hip arthroplasty as assessed by somatosensory evoked potential monitoring. J Arthroplasty 11:438–444PubMedCrossRef

44.

Satcher RL, Noss RS, Yingling CD et al (2003) The use of motor-evoked potentials to monitor sciatic nerve status during revision total hip arthroplasty. J Arthroplasty 18:329–332PubMedCrossRef

45.

Brooker AF, Bowerman JW, Robinson RA et al (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55:1629–1632PubMed

46.

Moed BR, Letournel E (1994) Low-dose irradiation and indomethacin prevent heterotopic ossification after acetabular fracture surgery. J Bone Joint Surg Br 76:895–900PubMed

47.

Issack PS, Toro JB, Buly RL et al (2007) Sciatic nerve release following fracture or reconstructive surgery of the acetabulum. J Bone Joint Surg Am 89(7):1432–1437PubMedCrossRef

Titel: Sciatic Nerve Injury Associated with Acetabular Fractures
verfasst von: Paul S. Issack, MD, PhD
David L. Helfet, MD
Publikationsdatum: 01.02.2009
Verlag: Springer-Verlag
Erschienen in: HSS Journal ® / Ausgabe 1/2009
Print ISSN: 1556-3316
Elektronische ISSN: 1556-3324
DOI: https://doi.org/10.1007/s11420-008-9099-y

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