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.
JenkinsDBHollinshead's functional anatomy of the limbs and back,19987th edn.PhiladephiaSaunders,
2.
PokornyDJahodaDVeiglDTopographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplastySurg Radiol Anat20062888–9110.1007/s00276-005-0056-x
3.
BensonERSchutzerSFPosttraumatic piriformis syndrome: diagnosis and results of operative treatmentJ Bone Joint Surg Am199981941–94910.1302/0301-620X.81B6.10474
4.
UchioYNishikawaUOchiMBilateral piriformis syndrome after total hip arthroplastyArch Orthop Trauma Surg1998117177–17910.1007/s004020050224
5.
SunderlandSThe relative susceptibility to injury of the medial and lateral popliteal divisions of the sciatic nerveBr J Surg195341300–30210.1002/bjs.18004116714
6.
TornettaP3rdDisplaced acetabular fractures: indications for operative and nonoperative managementJ Am Acad Orthop Surg2001918–28
7.
FasslerPRSwiontkowskiMFKilroyAWInjury of the sciatic nerve associated with acetabular fractureJ Bone Joint Surg Am1993751157–1166
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.
KleimanSGStevensJKolbLLate sciatic-nerve palsy following posterior fracture–dislocation of the hip. A case reportJ Bone Joint Surg Am197153781–782
11.
SchmelingGJPerlewitzTJHelfetDLTileMHelfetDLKellamJFEarly complications of acetabular fracturesFractures of the pelvis and acetabulum,20033rd edn.PhiladelphiaLippincott Williams and Wilkins729–740
12.
HaidukewychGJScadutoJHerscoviciDJrIatrogenic nerve injury in acetabular fracture surgery: a comparison of monitored and unmonitored proceduresJ Orthop Trauma200216297–30110.1097/00005131-200205000-00002
13.
LetournelEJudetRElsoRAEarly complications of operative treatment within three weeks of injuryFractures of the acetabulum19932BerlinSpringer535–540
14.
LetournelEJudetRElsoRALate complications of operative treatment within three weeks of injuryFractures of the acetabulum19932BerlinSpringer541–564
15.
MearsDCRubashHESawaguchiTFractures of the acetabulumHip1985198595–113
16.
TileMFractures of the acetabulumOrthop Clin North Am198011481–506
17.
ButtAJMcCarthyTKellyIPSciatic nerve palsy secondary to postoperative haematoma in primary total hip replacementJ Bone Joint Surg Br2005871465–146710.1302/0301-620X.87B11.16736
18.
FlemingREJrMichelsenCBStinchfieldFESciatic paralysis. A complication of bleeding following hip surgeryJ Bone Joint Surg Am19796137–39
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.
BeauchesneRPSchutzerSFMyositis ossificans of the piriformis muscle: an unusual cause of piriformis syndrome. A case reportJ Bone Joint Surg Am199779906–910
21.
CrawfordJRVan RensburgLMarxCCompression of the sciatic nerve by wear debris following total hip replacement: a report of three casesJ Bone Joint Surg Br2003851178–118010.1302/0301-620X.85B8.13638
22.
FischerSRChristDJRoehrBASciatic neuropathy secondary to total hip arthroplasty wear debrisJ Arthroplasty199914771–77410.1016/S0883-5403(99)90237-1
23.
IsiklarZULindseyRWTullosHSSciatic neuropathy secondary to intrapelvic migration of an acetabular cup. A case reportJ Bone Joint Surg Am1997791395–1397
24.
StiehlJBStewartWALate sciatic nerve entrapment following pelvic plate reconstruction in total hip arthroplastyJ Arthroplasty199813586–58810.1016/S0883-5403(98)90060-2
25.
DerianPSBibighausAJSciatic nerve entrapment by ectopic bone after posterior fracture–dislocation of the hipSouth Med J197467209–210
26.
ThakkarDHPorterRWHeterotopic ossification enveloping the sciatic nerve following posterior fracture–dislocation of the hip: a case reportInjury198113207–20910.1016/0020-1383(81)90240-0
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.
RouttMLJrSwiontkowskiMFOperative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedureJ Bone Joint Surg Am199072897–904
29.
GriffinDBBeaulePEMattaJMSafety and efficacy of the extended iliofemoral approach in the treatment of complex fractures of the acetabulumJ Bone Joint Surg Br2005871391–139610.1302/0301-620X.87B10.16538
30.
MoedBRKargesDEProphylactic indomethacin for the prevention of heterotopic ossification after acetabular fracture surgery in high-risk patientsJ Orthop Trauma1994834–3910.1097/00005131-199402000-00008
31.
MoedBRMaxeyJWThe effect of indomethacin on heterotopic ossification following acetabular fracture surgeryJ Orthop Trauma1993733–3810.1097/00005131-199302000-00007
32.
BurdTALowryKJAnglenJOIndomethacin compared with localized irradiation for the prevention of heterotopic ossification following surgical treatment of acetabular fracturesJ Bone Joint Surg Am200183-A1783–1788
33.
EpsteinHCPosterior fracture–dislocations of the hip; long-term follow-upJ Bone Joint Surg Am1974561103–1127
34.
YuenECOlneyRKSoYTSciatic neuropathy: clinical and prognostic features in 73 patientsNeurology1994441669–1674
35.
HelfetDLHissaEASergaySSomatosensory evoked potential monitoring in the surgical management of acute acetabular fracturesJ Orthop Trauma19915161–16610.1097/00005131-199105020-00007
MiddlebrooksESSimsSHKellamJFIncidence of sciatic nerve injury in operatively treated acetabular fractures without somatosensory evoked potential monitoringJ Orthop Trauma199711327–32910.1097/00005131-199707000-00004
38.
KumarABhattacharyaAMakhijaNEvoked potential monitoring in anaesthesia and analgesiaAnaesthesia200055225–24110.1046/j.1365-2044.2000.01120.x
39.
ManninenPHMonitoring evoked potentials during spinal surgery in one institutionCan J Anaesth199845460–46510.1007/BF03012582
40.
PadbergAMBridwellKHSpinal cord monitoring: current state of the artOrthop Clin North Am199930407–43310.1016/S0030-5898(05)70095-X
41.
HelfetDLAnandNMalkaniALIntraoperative monitoring of motor pathways during operative fixation of acute acetabular fracturesJ Orthop Trauma1997112–610.1097/00005131-199701000-00002
42.
BrownDMMcGinnisWCMesghaliHNeurophysiologic intraoperative monitoring during revision total hip arthroplastyJ Bone Joint Surg Am200284-ASuppl 256–61
43.
PerelesTRStuchinSAKastenbaumDMSurgical maneuvers placing the sciatic nerve at risk during total hip arthroplasty as assessed by somatosensory evoked potential monitoringJ Arthroplasty199611438–44410.1016/S0883-5403(96)80034-9
44.
SatcherRLNossRSYinglingCDThe use of motor-evoked potentials to monitor sciatic nerve status during revision total hip arthroplastyJ Arthroplasty200318329–33210.1054/arth.2003.50055
45.
BrookerAFBowermanJWRobinsonRAEctopic ossification following total hip replacement. Incidence and a method of classificationJ Bone Joint Surg Am1973551629–1632
46.
MoedBRLetournelELow-dose irradiation and indomethacin prevent heterotopic ossification after acetabular fracture surgeryJ Bone Joint Surg Br199476895–900
47.
IssackPSToroJBBulyRLSciatic nerve release following fracture or reconstructive surgery of the acetabulumJ Bone Joint Surg Am20078971432–143710.2106/JBJS.F.00904
