Skip to main content
SpringerLink
Log in

Sciatic Nerve Injury Associated with Acetabular Fractures

  •  
  • Published:
HSS Journal

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.

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.

Fig. 1
Fig. 2

Similar content being viewed by others

References

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

    Google Scholar 

  2. 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 28:88–91

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  8. 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

  9. 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 53:781–782

    PubMed  CAS  Google Scholar 

  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

    Google Scholar 

  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 16:297–301

    Article  PubMed  Google Scholar 

  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

    Google Scholar 

  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

    Google Scholar 

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

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

  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 87:1465–1467

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  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 79:906–910

    PubMed  CAS  Google Scholar 

  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 85:1178–1180

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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 79:1395–1397

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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 72:897–904

    PubMed  Google Scholar 

  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 87:1391–1396

    Article  PubMed  CAS  Google Scholar 

  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 8:34–39

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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:1783–1788

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  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 5:161–166

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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 11:327–329

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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 11:2–6

    Article  PubMed  CAS  Google Scholar 

  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):56–61

    PubMed  Google Scholar 

  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 11:438–444

    Article  PubMed  CAS  Google Scholar 

  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 18:329–332

    Article  PubMed  Google Scholar 

  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 55:1629–1632

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  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):1432–1437

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Trauma and Adult Reconstructive Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Paul S. Issack MD, PhD

  2. Orthopaedic Trauma Service, Hospital for Special Surgery and Weill Cornell Medical Center, New York, USA

    David L. Helfet MD

Authors
  1. Paul S. Issack MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David L. Helfet MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul S. Issack MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Issack, P.S., Helfet, D.L. Sciatic Nerve Injury Associated with Acetabular Fractures. HSS Jrnl 5, 12–18 (2009). https://doi.org/10.1007/s11420-008-9099-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11420-008-9099-y

Keywords

Search

Navigation