Early palsy of the sciatic nerve due to heterotopic ossification after surgery for fracture of the posterior wall of the acetabulum

Manidakis, Nikolaos; Kanakaris, Nikolaos K.; Nikolaou, Vassilios S.; Giannoudis, Peter V.

doi:10.1302/0301-620x.91b2.21183

Cited by 12 publications

(11 citation statements)

References 32 publications

(39 reference statements)

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“…Sciatic nerve injuries secondary to heterotopic ossification have been reported in the literature as case reports (6,8). The main characteristic of our case is heterotopic ossification was seen in the computed tomography taken at 6 weeks postoperatively, but symptoms occurred in the fourth month.…”

Section: Discussionmentioning

confidence: 99%

“…Iatrogenic nerve injuries may also occur in patients treated surgically due to acetabular posterior wall / column fractures (4,5). In addition, the sciatic nerve can be trapped under pressure due to heterotopic ossification (HO), which develops at high rate after acetabulum fractures (6,7). In the sciatic nerve palsy developed by HO, there may be signs of weakness in the thigh region, in the tibialis anterior, extensor hallucis longus and peroneal muscle groups accompanying pain and paresthesia in the foot dorsum following the surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

“…In the sciatic nerve palsy developed by HO, there may be signs of weakness in the thigh region, in the tibialis anterior, extensor hallucis longus and peroneal muscle groups accompanying pain and paresthesia in the foot dorsum following the surgical treatment. Two cases have been reported in which the sciatic nerve symptoms were cured by the excision of heterotopic bones (6,8). In this article, we will discuss about a patient with sciatic nerve palsy that occurred due to heterotopic ossification arised after open reduction and internal fixation of acetabulum posterior wall fracture and hip dislocation, and then successfully treated surgically by excision of heterotopic bones.…”

Section: Introductionmentioning

confidence: 99%

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Sciatic nerve palsy secondary to heterotopic bone formation occurred after surgery for posterior acetabulum fracture and hip dislocation

Karakaplan¹,

Ergen²,

Aslantürk³

et al. 2018

Med-Science

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Sciatic nerve paralysis can be seen after hip joint traumatic dislocations and fractures of the posterior wall of acetabulum. In this article, we report sciatic nerve palsy due to heterotopic bone formation in early postoperative phase that was treated with heterotopic bone resection and sciatic nerve neurolysis in a patient who underwent open reduction and internal fixation for hip dislocation and fracture of posterior wall of right acetabulum.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sciatic nerve palsy secondary to heterotopic bone formation occurred after surgery for posterior acetabulum fracture and hip dislocation

Karakaplan¹,

Ergen²,

Aslantürk³

et al. 2018

Med-Science

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“…Issack ha studiato retrospettivamente l'effetto del release del nervo sciatico associato a fratture acetabolari e chirurgia ricostruttiva acetabolare, concludendo che la neurolisi del nervo sciatico diminuisce con grande probabilità i sintomi sensitivi della neuropatia sciatica, mentre i deficit motori si risolvono con meno probabilità [25]. Poptodorov [26] e Manidakis [27] hanno documentato l'effetto positivo di una decompressione del nervo sciatico tramite neurolisi associata a rimozione delle ossificazioni.…”

Section: Gestione Delle Strutture Nervoseunclassified

Total hip arthroplasty for post-traumatic arthritis after acetabular fractures

et al. 2015

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TOTAL HIP ARTHROPLASTY FOR POST-TRAUMATIC ARTHRITIS AFTER ACETABULAR FRACTURESTotal hip arthroplasty (THA) for post-traumatic osteoarthritis is a challenging surgery. Several factors should be considered to achieve a successful result: infection risk, surgical approach, possibly hardware removal, ectopic ossification, acetabular bone loss, nonunion and deformity. Different strategies are present in literature. This paper provides a wide revision of available literature. A personal diagnostic and treatment algorithm is proposed to guide surgeons in this atypical decision-making process. Pubblicato online: 22 ottobre 2015 © Springer-Verlag Italia 2015Introduzione L'artrosi post-traumatica in esiti di frattura acetabolare presenta delle peculiarità tali da rendere più complesso un intervento di protesi totale dell'anca (PTA). Pianificare accuratamente l'intervento di protesi è essenziale. Devono essere valutati a priori diversi fattori: il tipo di approccio chirurgico, l'eventuale necessità di rimozione dei mezzi di sintesi e/o di calcificazioni eterotopiche, eventuali conflitti nervosi, la presenza di una pseudoartrosi della pregressa frattura e il tipo di perdita ossea/deformità dell'acetabolo residuo. Questo articolo si prefigge lo scopo di focalizzare l'argomento partendo dall'epidemiologia dell'artrosi post-traumatica acetabolare, passando attraverso la pianificazione preoperatoria (diagnosi, planning, scelta dell'approccio chirurgico), fino all'atto chirurgico in sé (rimozione dei mezzi di sintesi, gestione delle strutture nervose, ecc.) e ai risultati attesi e presenti in letteratura. Il tutto filtrato dall'esperienza maturata negli anni nel nostro Dipartimento di Chirurgia dell'anca e Traumatologia. Epidemiologia dell'artrosi post-traumatica in esiti di frattura dell'acetaboloDa sempre la prima complicazione, in termini percentuali, di una frattura acetabolare è l'artrosi post-traumatica [1]. Questa può essere provocata da una condrolisi posttraumatica, dalla perdita della congruenza articolare o dagli esiti di una osteonecrosi. Storicamente un'artrosi posttraumatica in assenza di osteonecrosi veniva riportata fino al 46% dei casi [1]. Più di recente, una metanalisi su 3670 fratture trattate chirurgicamente e valutate in media dopo 5 anni, ha dimostrato un tasso inferiore, oscillante dal 26 al 36,8%, a seconda del metodo classificativo utilizzato per determinare la presenza di artrosi [2]. Non sempre, fortunatamente, l'artrosi post-traumatica esita in una protesizzazione. La percentuale di PTA dopo artrosi post-traumatica (escludendo l'osteonecrosi) si attesta, almeno nei primi 5 anni, intorno al 10% (8,5-11%) dei casi [2,3]. La percentuale si alza se si considerano follow-up più lunghi, pattern fratturativi peggiori e una persistente incongruenza articolare. Tannast [4] riporta, in una casistica di 816 pazienti con follow-up tra i 2 e i 26 anni, una percentuale cumulativa del 21%. Que-204

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“…Recently, interest in HO has increased as a result of its high prevalence in combat-related extremity injuries and amputations [9,10,14,15,17]. Studies have reported the prevalence of HO to be as high as 65% in combat-related amputations, and HO can result in pain, wound breakdown, difficulty with prosthesis wear, entrapment of neurovascular structures, and limited ROM [2,4,6,16,18,20,22,23,26,29,31,32,35]. Before operative excision, nonsurgical modalities such as pain control and serial prosthetic socket adjustments should be exhausted; however, up to 41% of affected patients who have undergone amputation will choose to have surgical excision to treat persistent symptoms and failed nonsurgical treatments [7,8,24,27,28].…”

Section: Introductionmentioning

confidence: 99%

What Risk Factors Predict Recurrence of Heterotopic Ossification After Excision in Combat-related Amputations?

Pavey

Polfer

Nappo

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Heterotopic ossification (HO) is common after combat-related amputations and surgical excision remains the only definitive treatment for persistently symptomatic HO. There is no consensus in the literature regarding the timing of surgery, and recurrence frequency, reexcision, and complications have not been reported in large numbers of patients. Questions/purposes (1) What are the rates of symptomatic recurrence resulting in reexcision and other complications resulting in reoperation in patients with HO? (2) Is either radiographic or symptomatic recurrence dependent on timing and type of initial surgery, the experience of the surgeon in performing the procedure, the severity of preexcision HO, the presence of concomitant neurologic injury, or the use of postoperative HO prophylaxis? Methods Between March 2005 and March 2013 our institution treated 994 patients with 1377 combat-related major extremity amputations; of those, 172 amputations underwent subsequent excision of symptomatic HO. The mechanism of injury resulting in nearly all amputations (n = 168) was blast-related trauma. We reviewed medical records and radiographs to collect initial grade of HO, radiographic recurrence, complete compared with partial excision, concomitant neurologic injury, timing to initial surgery, surgeon experience, and use of postexcision prophylaxis with our primary study outcome being a return to the operating room (OR) for repeat excision of symptomatic HO. All 172 combat-related amputations were considered for this study irrespective of followup, which was noted to be robust, with 157 (91%) amputations having Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. All of the authors are employees of the US Government and this work was prepared as part of their official duties. As such, there is no copyright to transfer. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of the Army, Department of Defense, nor the US Government. Nothing in the presentation implies any Federal/Department of Defense/Department of the Navy endorsement. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at Walter Reed National Military Medical Center, Bethesda, MD, USA. Conclusions HO is common after combat-related amputations, and patients undergoing surgical excisio...

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Early palsy of the sciatic nerve due to heterotopic ossification after surgery for fracture of the posterior wall of the acetabulum

Cited by 12 publications

References 32 publications

Sciatic nerve palsy secondary to heterotopic bone formation occurred after surgery for posterior acetabulum fracture and hip dislocation

Sciatic nerve palsy secondary to heterotopic bone formation occurred after surgery for posterior acetabulum fracture and hip dislocation

Total hip arthroplasty for post-traumatic arthritis after acetabular fractures

What Risk Factors Predict Recurrence of Heterotopic Ossification After Excision in Combat-related Amputations?

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