A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions

Işın, Yağmur; Hapa, Onur; Kara, Yavuz Selim; Kılıç, Ali İhsan; Balcı, Ali

doi:10.1186/s13018-020-01937-7

Cited by 6 publications

(9 citation statements)

References 10 publications

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“…Isin et al performed a computed tomography (CT) study to examine the distance from the sciatic nerve to the middle of the femoral head and lower border of the triradiate cartilage in varying hip positions. 8 They found that hip flexion decreased the distance from the sciatic nerve to the lower edge of the triradiate cartilage but not the center of the femoral head. However, they pointed out that cadaver studies would be needed to more confidently evaluate the position of the nerve during various hip positions due to difficulty in assessing soft tissue structures on CT.…”

Section: Discussionmentioning

confidence: 97%

Anatomy of the Sciatic Nerve in Relation to the Bernese Periacetabular Osteotomy: A Cadaveric Study

Kanakamedala

Mahure

Bloom

et al. 2021

The Journal of Hip Surgery

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Prior studies have examined the role of hip and knee positioning, specifically hip extension and knee flexion, to reduce the risk of sciatic nerve palsy during the Bernese periacetabular osteotomy. They have qualitatively noted that the sciatic nerve moves farther from the connection between the ischial and posterior column osteotomies in hip extension than flexion but has not precisely measured this change in position. This cadaveric study aimed to quantitatively evaluate how hip positioning affects the location of the sciatic nerve relative to the connection between the ischial and posterior column osteotomies. We dissected four cadaveric specimens (three females and one male) with a mean age of 83.0 ± 7.8. An anterior Smith–Peterson approach was performed to allow the cuts for the periacetabular osteotomy (PAO). A posterolateral approach was taken to identify the sciatic nerve and its emergence from the pelvis. Measurements were performed on the width of the posterior column and, in both hip flexion and extension, the distance from the emergence of the sciatic nerve from the pelvis to the connection point between the ischial and posterior column osteotomies. Each measurement was performed independently by two observers. All data are reported as a mean ± standard deviation (range). The width of the posterior column was 4.84 ± 0.48 cm (range: 4.20–5.35 cm). The distances from the sciatic nerve's emergence to the osteotomy connection point in extension and flexion were 4.73 ± 0.79 and 2.93 ± 0.85 cm, respectively. The distance from the sciatic nerve's emergence to the osteotomy connection point was significantly greater in hip extension than hip flexion (p = 0.021). When the hip is flexed, the distance from the sciatic nerve to the posterior column osteotomy connection point is significantly less than when it is in extension. This anatomic finding is essential for surgical safety, as it provides further evidence on the importance of positioning for reducing the risk of sciatic nerve injury during a PAO.

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Section: Discussionmentioning

confidence: 97%

Anatomy of the Sciatic Nerve in Relation to the Bernese Periacetabular Osteotomy: A Cadaveric Study

Kanakamedala

Mahure

Bloom

et al. 2021

The Journal of Hip Surgery

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“…The degree of recovery after sciatic nerve injury was not related to sex, age, cause of injury, type of fracture, dislocation of the hip joint, or injury to the femoral head (P>0.05). However, patients in whom the injured nerve showed partial recovery had a signi cantly longer mean recovery time (13.78 months [range, 6-23] vs 6.70 months [range, [3][4][5][6][7][8][9][10][11][12]; P<0.05) (Table 7).…”

Section: Partial Recovery Vs Complete Recovery After Sciatic Nerve In...mentioning

confidence: 99%

“…It is the motor nerve of the hamstrings and calf and foot muscles and is an important sensory nerve of the calf and foot. The sensory and motor functions of almost all areas below the knee are innervated by the sciatic nerve [6,7] . This nerve is highly susceptible to injury as a result of displaced acetabular fracture or a dislocated femoral head.…”

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confidence: 99%

Incidence of traumatic sciatic nerve injury in patients with acetabular fractures and factors affecting recovery: a retrospective study

Liu

Tao

et al. 2022

Preprint

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Background Reports on traumatic sciatic nerve injury associated with acetabular fracture are rare. In this study, we investigated the demographics of these injuries, their clinical characteristics, management, and factors potentially influencing neurological recovery. Methods We retrospectively reviewed all patients diagnosed to have acetabular fracture at our trauma center between January 2014 and June 2021. Data on patient demographics, characteristics of sciatic nerve injury, neurological recovery, factors potentially influencing neurological recovery were analyzed. Results Eighteen patients met the diagnostic criteria for acetabular fracture combined with sciatic nerve injury (bilateral in one case). All of these injuries involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Four of the 19 sides with traumatic sciatic nerve injury involved the common peroneal nerve division and 15 involved both the common peroneal and tibial nerve divisions. The mean common peroneal and tibial nerve division injury scores were 1.79 ± 0.92 and 2.68 ± 1.57, respectively. Seventeen patients (18 sides) underwent intraoperative nerve exploration, which revealed abnormalities in 7 sides and no obvious abnormality in 11 sides. At the last follow-up, 10 sides (52.6%) had complete recovery and 9 (47.4%) had partial recovery; the difference was statistically significant between those with or without abnormal nerve damage during exploration (P < 0.05). Linear regression analysis showed that a nerve abnormality detected intraoperatively was a predictor of nerve recovery (P < 0.05). The degree of neurological recovery was not related to sex, age, cause of injury, type of fracture, hip dislocation, or femoral head injury in patients whether recovery was partial or complete. The mean recovery time was significantly longer for partial recovery than for complete recovery (13.78 months vs 6.70 months; P < 0.05). Conclusions All the injuries in this series involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Damage to the common peroneal nerve division was more severe than that to the tibial nerve division preoperatively. However, the degree of recovery of the common peroneal division was not worse than that of the tibial division. There was a relationship between the degree of neurological recovery and whether there was an abnormality at the time of intraoperative nerve exploration. Patients with partial recovery took longer to recover.

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“…It is the motor nerve of the hamstrings and calf and foot muscles and is an important sensory nerve of the calf and foot. The sensory and motor functions of almost all areas below the knee are innervated by the sciatic nerve [7,8]. This nerve is highly susceptible to injury as a result of displaced acetabular fracture or a dislocated femoral head.…”

Section: Introductionmentioning

confidence: 99%

Incidence of traumatic sciatic nerve injury in patients with acetabular fractures and factors affecting recovery: a retrospective study

Liu

Tao

et al. 2023

J Orthop Surg Res

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Background Reports on traumatic sciatic nerve injury associated with acetabular fracture are rare. In this study, we investigated the demographics of these injuries, their clinical characteristics, management, and factors potentially influencing neurological recovery. Methods We retrospectively reviewed all patients diagnosed to have acetabular fracture at our trauma center between January 2014 and June 2021. Data on patient demographics, characteristics of sciatic nerve injury, neurological recovery, factors potentially influencing neurological recovery were analyzed. Results Eighteen patients (bilateral in one case) met the diagnostic criteria. All these injuries involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Four of the 19 sides with traumatic sciatic nerve injury involved the common peroneal nerve division and 15 involved both the common peroneal and tibial nerve divisions. Seventeen patients (18 sides) underwent intraoperative nerve exploration, which revealed abnormalities in 7 sides and no obvious abnormality in 11 sides. At the last follow-up, 10 sides (52.6%) had complete recovery and 9 (47.4%) had partial recovery; the difference was statistically significant between those with or without abnormal nerve damage during exploration (P = 0.046). Linear regression analysis showed that a nerve abnormality detected intraoperatively was a predictor of nerve recovery (P = 0.009). The mean recovery time was significantly longer for partial recovery than for complete recovery (13.78 months vs. 6.70 months; P = 0.001). Conclusions All the injuries in this series involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Damage to the common peroneal nerve division was more severe than that to the tibial nerve division preoperatively. However, the degree of recovery of the common peroneal division was not worse than that of the tibial division. There was a relationship between the degree of neurological recovery and whether there was an abnormality at the time of intraoperative nerve exploration. Patients with partial recovery took longer to recover.

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A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions

Cited by 6 publications

References 10 publications

Anatomy of the Sciatic Nerve in Relation to the Bernese Periacetabular Osteotomy: A Cadaveric Study

Anatomy of the Sciatic Nerve in Relation to the Bernese Periacetabular Osteotomy: A Cadaveric Study

Incidence of traumatic sciatic nerve injury in patients with acetabular fractures and factors affecting recovery: a retrospective study

Incidence of traumatic sciatic nerve injury in patients with acetabular fractures and factors affecting recovery: a retrospective study

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