Salvage of Iatrogenic Sciatic Nerve Injury Caused by Operatively Treated Acetabular Fractures: Two Cases and Literature Review

TL;DR

This paper reports two cases of sciatic nerve injury caused by surgical treatment of acetabular fractures and discusses effective interventions for recovery.

Contribution

The study highlights the importance of electrophysiologic monitoring and surgical decompression in treating iatrogenic sciatic nerve injuries.

Findings

Surgical exploration and nerve decompression successfully alleviated symptoms in both patients.

Residual deficits were observed in one patient at the L5/S1 root level.

Sciatic nerve injury was likely caused by reduction techniques and internal fixation with the hip flexed.

Abstract

While sciatic nerve injury has been described as a complication of acetabular fractures, iatrogenic nerve injury remains sparsely reported. This study aims to assess iatrogenic sciatic nerve injuries occurring during acetabular fracture surgery, tracking their neurological recovery and clinical outcomes, and investigating any correlation between recovery and the severity of neurologic injury to facilitate physicians in providing prediction of prognosis.

We present two cases of male patients, aged 56 and 22, who developed sciatic palsy due to iatrogenic nerve injury during acetabular fracture surgery. Iatrogenic sciatic nerve injury resulted from operatively treated acetabular fractures. Surgical exploration, involving internal fixation removal and nerve decompression, successfully alleviated symptoms in both cases postoperatively. At the latest follow‐up, one patient achieved full recovery with excellent function, while the other exhibited residual deficits at the L5/S1 root level along with minimal pain.

Sciatic nerve injury likely stemmed from reduction techniques and internal fixation procedures for the posterior column, particularly when performed with the hip flexed, thereby placing tension on the sciatic nerve. Our case reports underscore the significance of liberal utilization of electrophysiologic examinations and intraoperative monitoring for the prediction of prognosis. Surgical exploration, encompassing internal fixation removal and nerve decompression, represents an effective intervention for resolving sciatic palsy, encompassing both sensory neuropathy and motor symptoms.

(A) The anteroposterior radiograph reveals the placement of both screws from anterior to posterior; (B) the computed tomography scan illustrates the anterior‐to‐posterior placement of both screws, with their ends impinging on the sciatic nerve, and the sciatic nerve compression site is adjacent to the two screws and the surrounding soft tissue proliferates (arrows); (C) intraoperative photograph depicting the anterior‐to‐posterior positioning of two screws, with their ends causing slight damage to the sciatic nerve; and (D) postoperative anteroposterior radiograph demonstrating satisfactory reduction and internal fixation following revision surgery.

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