Top

European Journal of Trauma and Emergency Surgery

Published in:

16-02-2022 | Acetabular Fracture | Review Article

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

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

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2022

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.

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.View ArticlePubMed
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.View Article
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.View Article
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.View Article
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.View ArticlePubMed
Epstein HC. Posterior fracture-dislocations of the hip; long-term follow-up. J Bone Jt Surg Am. 1974;56(6):1103–27.View Article
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.View Article
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.View ArticlePubMed
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.View ArticlePubMedPubMed Central
Pollock A, Berge E. How to do a systematic review. Int J Stroke. 2018;13(2):138–56. https://doi.org/10.1177/1747493017743796.View ArticlePubMed
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.View ArticlePubMedPubMed Central
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.View ArticlePubMed
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.View ArticlePubMed
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.View Article
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.View ArticlePubMedPubMed Central
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.View ArticlePubMedPubMed Central
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.View ArticlePubMedPubMed Central
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.View ArticlePubMed
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.View ArticlePubMedPubMed Central
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.View ArticlePubMedPubMed Central
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.View ArticlePubMedPubMed Central
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.View Article
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.View ArticlePubMedPubMed Central
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.View ArticlePubMedPubMed Central
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.View ArticlePubMedPubMed Central
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.View ArticlePubMed
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.View ArticlePubMed
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.View ArticlePubMed
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.View Article
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.View ArticlePubMedPubMed Central
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.View Article
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.View ArticlePubMedPubMed Central
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.View Article
Letournel E, Judet R. Early Complications of operative treatment. In: Fractures of the acetabulum. Springer, Berlin, Heidelberg; 1981. pp. 311–5.
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.View ArticlePubMed
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.View ArticlePubMed
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.View ArticlePubMed
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.View ArticlePubMed
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.
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.View ArticlePubMedPubMed Central
Omer GE, Spinner M. Management of peripheral nerve problems. Philadelphia: WB Saunders Company; 1998.
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.View Article
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.View ArticlePubMedPubMed Central
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.View ArticlePubMed
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.View ArticlePubMedPubMed Central

Title: Sciatic nerve injury after acetabular fractures: a meta-analysis of incidence and outcomes
Authors: Ioannis M. Stavrakakis
Evangelos I. Kritsotakis
Peter V. Giannoudis
Petros Kapsetakis
Rozalia Dimitriou
Johannes D. Bastian
Theodoros H. Tosounidis
Publication date: 16-02-2022
Publisher: Springer Berlin Heidelberg
Keywords: Acetabular Fracture
Nerve Injury
Published in: European Journal of Trauma and Emergency Surgery / Issue 4/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-01896-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2022

The COVID-19 pandemic reduced the trauma incidence and modified its pattern in Al-Ain City, United Arab Emirates

Frailty in elderly patients with acute appendicitis

Focus on craniomaxillofacial injuries in trauma patients

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”

Impact of a geriatric consultation service on outcomes in older trauma patients: a before–after study

Delayed haemorrhage and pseudoaneurysms following liver trauma