nach oben

European Journal of Trauma and Emergency Surgery

Erschienen in:

16.02.2022 | Review Article

Sciatic nerve injury after acetabular fractures: a meta-analysis of incidence and outcomes

verfasst von: Ioannis M. Stavrakakis, Evangelos I. Kritsotakis, Peter V. Giannoudis, Petros Kapsetakis, Rozalia Dimitriou, Johannes D. Bastian, Theodoros H. Tosounidis

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 4/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To investigate the incidence and the outcome of post-traumatic and iatrogenic sciatic nerve palsy (SNP) associated with fractures of the acetabulum. The results of sciatic nerve grafting for treatment were also investigated.

Methods

PUBMED, SCOPUS and COCHRANE databases were searched for longitudinal observational studies reporting sciatic nerve palsy related to acetabular fractures in adult patients over the last 20 years. Data regarding patients demographics, type of acetabular fracture, rate of post traumatic and iatrogenic sciatic nerve palsies as well as recovery rate are reported. Studies were assessed for their quality. Random effects meta-analyses were carried out to pool overall proportions of SNP incidence and complete recovery. Variations in SNP incidence by main study characteristics were assessed by subgroup analysis and meta-regression. A narrative review of sciatic nerve grafting was also conducted.

Results

Twenty studies reporting 44 post-operative and 18 iatrogenic SNPs in 651 patients were reviewed. The pooled incidence of posttraumatic SNP was 5.1% (95% CI 2.7–8.2%). The pooled incidence of iatrogenic SNP was 1.4% (95% CI 0.3–2.9%). Complete recovery of post-traumatic and iatrogenic SNP occurred in 64.7% (95% CI 41.7–85.4%) and 74.1% (95% CI 31.5–100%), respectively.

Conclusion

A favorable outcome of both post-traumatic and iatrogenic SNP related to acetabular fractures has been found. Due to the poor results of sciatic nerve grafting, a "wait and see" approach may be the best option, in cases of a contused but anatomically intact sciatic nerve.

Nur mit Berechtigung zugänglich

Issack PS, Helfet DL. Sciatic nerve injury associated with acetabular fractures. HSS J. 2009;5(1):12–8. https://doi.org/10.1007/s11420-008-9099-y.CrossRefPubMed

Fassler PR, Swiontkowski MF, Kilroy AW, et al. Injury of the sciatic nerve associated with acetabular fracture. J Bone Jt Surg Am. 1993;75(8):1157–66. https://doi.org/10.2106/00004623-199308000-00005.CrossRef

Meccariello L, Razzano C, De Dominicis C, et al. A new prognostic pelvic injury outcome score. Med Glas (Zenica). 2021;18(1):299–308. https://doi.org/10.17392/1298-21.CrossRef

Issack PS, Toro JB, Buly RL, et al. Sciatic nerve release following fracture or reconstructive surgery of the acetabulum. JBJS. 2007;89(7):1432–7. https://doi.org/10.2106/JBJS.F.00904.CrossRef

Koenig RW, Schmidt TE, Heinen CP, et al. Intraoperative high-resolution ultrasound: a new technique in the management of peripheral nerve disorders. J Neurosurg. 2011;114(2):514–21. https://doi.org/10.3171/2010.9.JNS10464.CrossRefPubMed

Epstein HC. Posterior fracture-dislocations of the hip; long-term follow-up. J Bone Jt Surg Am. 1974;56(6):1103–27.CrossRef

Schmeling GJ, Perlewitz TJ, Helfet DL. Early complications of acetabular fractures. In: Tile M, Helfet DL, Kellam JF, editors. Fractures of the pelvis and acetabulum. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2003. p. 729–40.

Giannoudis P, Da Costa A, Raman R, et al. Double-crush syndrome after acetabular fractures: a sign of poor prognosis. J Bone Jt Surg Br. 2005;87(3):401–7. https://doi.org/10.1302/0301-620x.87b3.15253.CrossRef

Yeremeyeva E, Kline DG, Kim DH. Iatrogenic sciatic nerve injuries at buttock and thigh levels: the Louisiana State University experience review. Neurosurgery. 2009;65(suppl_4):A63–6. https://doi.org/10.1227/01.NEU.0000346265.17661.1E.CrossRefPubMed

10.

Sénès FM, Catena N, Sénès J. Use of tubulization (nerve conduits) in repairing nerve defects in children. Indian J Orthop. 2015;49(5):554–60. https://doi.org/10.4103/0019-5413.164045.CrossRefPubMedPubMedCentral

11.

Pollock A, Berge E. How to do a systematic review. Int J Stroke. 2018;13(2):138–56. https://doi.org/10.1177/1747493017743796.CrossRefPubMed

12.

Moher D, Liberati A, Tetzlaff J, Prisma Group, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097.CrossRefPubMedPubMedCentral

13.

Kim DH, Murovic JA, Tiel R, et al. Management and outcomes in 353 surgically treated sciatic nerve lesions. J Neurosurg. 2004;101(1):8–17. https://doi.org/10.3171/jns.2004.101.1.0008.CrossRefPubMed

14.

Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–6. https://doi.org/10.1046/j.1445-2197.2003.02748.x.CrossRefPubMed

15.

Al Adawy AS, Aziz AHA, El Sherief FA, et al. Modified Stoppa as an alternative surgical approach for fixation of anterior fracture acetabulum: a randomized control clinical trial. J Orthop Surg. 2020;15:154. https://doi.org/10.1186/s13018-020-01660-3.CrossRef

16.

Paksoy AE, Topal M, Aydin A, Zencirli K, Kose A, Yildiz V. Outcomes of surgical management of acetabular fractures treated with anterior approaches. Eurasian J Med. 2019;51(3):257–61. https://doi.org/10.5152/eurasianjmed.2019.0241.CrossRefPubMedPubMedCentral

17.

Gültaç E, İltar S, Özmeriç A, et al. Surgical treatment of acetabulum posterior wall fractures: comparison between undercountering and marginal impaction reconstruction method with odd methods. J Clin Orthop Trauma. 2019;10(5):900–3. https://doi.org/10.1016/j.jcot.2019.01.023.CrossRefPubMedPubMedCentral

18.

Wang S-X, Li B-H, Li J, et al. Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws. Chin J Traumatol. 2018;21(3):170–5. https://doi.org/10.1016/j.cjtee.2017.12.004.CrossRefPubMedPubMedCentral

19.

Gupta S, Mittal N, Virk JS. Use of tricortical iliac crest strut autograft in comminuted posterior wall acetabular fractures: a case series. Chin J Traumatol. 2018;21(1):58–62. https://doi.org/10.1016/j.cjtee.2017.08.005.CrossRefPubMed

20.

Gupta S, Singh J, Virk JS. The role of trochanteric flip osteotomy in fixation of certain acetabular fractures. Chin J Traumatol. 2017;20(3):161–5. https://doi.org/10.1016/j.cjtee.2016.11.006.CrossRefPubMedPubMedCentral

21.

Gupta RK, Jindal N, Pruthi M. Acetabular fractures labelled poor surgical choices: analysis of operative outcome. J Clin Orthop Trauma. 2015;6(2):94–100. https://doi.org/10.1016/j.jcot.2015.03.003.CrossRefPubMedPubMedCentral

22.

Kim HY, Yang DS, Park CK, et al. Modified Stoppa approach for surgical treatment of acetabular fracture. Clin Orthop Surg. 2015;7(1):29–38. https://doi.org/10.4055/cios.2015.7.1.29.CrossRefPubMedPubMedCentral

23.

Magu NK, Gogna P, Singh A, et al. Long term results after surgical management of posterior wall acetabular fractures. J Orthop Traumatol Off J Ital Soc Orthop Traumatol. 2014;15(3):173–9. https://doi.org/10.1007/s10195-014-0297-8.CrossRef

24.

Anizar-Faizi A, Hisam A, Sudhagar K, et al. Outcome of surgical treatment for displaced acetabular fractures. Malays Orthop J. 2014;8(3):1–6. https://doi.org/10.5704/MOJ.1411.001.CrossRefPubMedPubMedCentral

25.

Harnroongroj T, Riansuwan K, Sudjai N, et al. Posterior acetabular arc angle of unstable posterior hip fracture–dislocation. Int Orthop. 2013;37(12):2443–9. https://doi.org/10.1007/s00264-013-2090-3.CrossRefPubMedPubMedCentral

26.

Masse A, Aprato A, Rollero L, et al. Surgical dislocation technique for the treatment of acetabular fractures. Clin Orthop. 2013;471(12):4056–64. https://doi.org/10.1007/s11999-013-3228-8.CrossRefPubMedPubMedCentral

27.

Liu X, Xu S, Zhang C, et al. Application of a shape-memory alloy internal fixator for treatment of acetabular fractures with a follow-up of two to nine years in China. Int Orthop. 2010;34(7):1033–40. https://doi.org/10.1007/s00264-009-0867-1.CrossRefPubMed

28.

Gupta RK, Singh H, Dev B, et al. Results of operative treatment of acetabular fractures from the Third World—how local factors affect the outcome. Int Orthop. 2009;33(2):347–52. https://doi.org/10.1007/s00264-007-0461-3.CrossRefPubMed

29.

Ebraheim NA, Patil V, Liu J, et al. Reconstruction of comminuted posterior wall fractures using the buttress technique: a review of 32 fractures. Int Orthop. 2007;31(5):671–5. https://doi.org/10.1007/s00264-006-0246-0.CrossRefPubMed

30.

Malhotra R, Gautam D. Acute total hip arthroplasty in acetabular fractures using modern porous metal cup. J Orthop Surg Hong Kong. 2019;27(2):1–7. https://doi.org/10.1177/2309499019855438.CrossRef

31.

Iqbal F, Taufiq I, Najjad MKR, et al. Fucntional and radiological outcome of surgical management of acetabular fractures in tertiary care hospital. Hip Pelvis. 2016;28(4):217–24. https://doi.org/10.5371/hp.2016.28.4.217.CrossRefPubMedPubMedCentral

32.

Senes FM, Campus R, Becchetti F, et al. Sciatic nerve injection palsy in the child: early microsurgical treatment and long term results. Microsurg Off J Int Microsurg Soc Eur Fed Soc Microsurg. 2009;29(6):443–8. https://doi.org/10.1002/micr.20632.CrossRef

33.

Socolovsky M, Di Masi G. Exposure of the sciatic nerve in the gluteal region without sectioning the gluteus maximus: analysis of a series of 18 cases. Surg Neurol Int. 2012;3:15. https://doi.org/10.4103/2152-7806.92929.CrossRefPubMedPubMedCentral

34.

Maripuu A, Björkman A, Björkman-Burtscher IM, et al. Reconstruction of sciatic nerve after traumatic injury in humans-factors influencing outcome as related to neurobiological knowledge from animal research. J Brachial Plex Peripher Nerve Inj. 2012;7(1):1–13. https://doi.org/10.1186/1749-7221-7-7.CrossRef

35.

Letournel E, Judet R. Early Complications of operative treatment. In: Fractures of the acetabulum. Springer, Berlin, Heidelberg; 1981. pp. 311–5.

36.

Helfet DL, Hissa EA, Sergay S, et al. Somatosensory evoked potential monitoring in the surgical management of acute acetabular fractures. J Orthop Trauma. 1991;5(2):161–6. https://doi.org/10.1097/00005131-199105020-00007.CrossRefPubMed

37.

Helfet DL, Anand N, Malkani AL, et al. Intraoperative monitoring of motor pathways during operative fixation of acute acetabular fractures. J Orthop Trauma. 1997;11(1):2–6. https://doi.org/10.1097/00005131-199701000-00002.CrossRefPubMed

38.

Kumar A, Bhattacharya A, Makhija N. Evoked potential monitoring in anaesthesia and analgesia. Anaesthesia. 2000;55(3):225–41. https://doi.org/10.1046/j.1365-2044.2000.01120.x.CrossRefPubMed

39.

Middlebrooks ES, Sims SH, Kellam JF, et al. Incidence of sciatic nerve injury in operatively treated acetabular fractures without somatosensory evoked potential monitoring. J Orthop Trauma. 1997;11(5):327–9. https://doi.org/10.1097/00005131-199707000-00004.CrossRefPubMed

40.

Letournel E, Judet R, Elson RA. Late complications of operative treatment within three weeks of injury. (Ed) Reginald A. Elson In: Fractures of the acetabulum.Springer, Berlin, Heidelberg; 1993. pp. 541–63.

41.

Grinsell D, Keating CP. Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. BioMed Res Int. 2014. https://doi.org/10.1155/2014/698256.CrossRefPubMedPubMedCentral

42.

Omer GE, Spinner M. Management of peripheral nerve problems. Philadelphia: WB Saunders Company; 1998.

43.

Taha A, Taha J. Results of suture of the sciatic nerve after missile injury. J Trauma Acute Care Surg. 1998;45(2):340–4. https://doi.org/10.1097/00005373-199808000-00022.CrossRef

44.

Kim HT, Ahn J-M, Hur J-O, et al. Reconstruction of acetabular posterior wall fractures. Clin Orthop Surg. 2011;3(2):114–20. https://doi.org/10.4055/cios.2011.3.2.114.CrossRefPubMedPubMedCentral

45.

de Almeida AGI, Garrido CA, Vaz Amaral LE, et al. Prospective study on seventy-six cases of fractured acetabulum with surgical treatment. Rev Bras Ortop. 2011;46(5):520–5. https://doi.org/10.1016/S2255-4971(15)30406-7.CrossRefPubMed

46.

Giordano V, do Amaral NP, Pallottino A, et al. Operative treatment of transverse acetabular fractures: is it really necessary to fix both columns? Int J Med Sci. 2009;6(4):192–9. https://doi.org/10.7150/ijms.6.192.CrossRefPubMedPubMedCentral

Titel: Sciatic nerve injury after acetabular fractures: a meta-analysis of incidence and outcomes
verfasst von: Ioannis M. Stavrakakis
Evangelos I. Kritsotakis
Peter V. Giannoudis
Petros Kapsetakis
Rozalia Dimitriou
Johannes D. Bastian
Theodoros H. Tosounidis
Publikationsdatum: 16.02.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 4/2022
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-01896-0

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

18.04.2024 | Wirbelsäulenmetastase | Nachrichten

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Sciatic nerve injury after acetabular fractures: a meta-analysis of incidence and outcomes

Abstract

Purpose

Methods

Results

Conclusion

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Zwei neue Alternativen zu TNF-Inhibitoren bei axSpA

Update Orthopädie und Unfallchirurgie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2022

Focus on craniomaxillofacial injuries in trauma patients

Response to letter to the editor on: “Open plate fixation versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies”

How relevant is lumbar bone mineral density for the stability of symphyseal implants? A biomechanical cadaver study

Comparison effects of platelet-rich plasma on healing of infected and non-infected excision wounds by the modulation of the expression of inflammatory mediators: experimental research

Early video-assisted thoracoscopic surgery (VATS) for non-emergent thoracic trauma remains underutilized in trauma accredited centers despite evidence of improved patient outcomes

Functional and clinical outcome after operative versus nonoperative treatment of a humeral shaft fracture (HUMMER): results of a multicenter prospective cohort study

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Zwei neue Alternativen zu TNF-Inhibitoren bei axSpA

Update Orthopädie und Unfallchirurgie