Femoral nerve paralysis complicating a post-traumatic iliopsoas haematoma

Abstract

Paralysis of the femoral nerve secondary to iliopsoas haematoma is a rare post-traumatic complication. Because of the large differential diagnosis, a high level of suspicion is required for its early recognition. Treatment modalities are controversial due to the rarity of this entity. An 18-year-old student presented with complete paralysis of the knee extensors and a sensory deficit on the anterior side of the thigh 5 weeks after a sport accident. MRI of the lesser pelvis showed an iliopsoas haematoma. Surgical decompression was performed and recovery was complete at 6 months of follow-up.

Traumatic iliac muscle hematoma: A rare etiology of quadriceps palsy (case report)

“…The compression of the femoral nerve due to an iliopsoas hematoma is a well-documented condition in patients with blood coagulation disorders [ [4] , [5] , [6] ] and those receiving anticoagulant treatment [ [1] , [2] , [3] ]. However, femoral nerve palsy caused by traumatic iliopsoas hematoma in the absence of coagulopathy is rarely reported in the literature [ 9 , 12 ].…”

“…According to the literature, a conservative approach is recommended if the diagnosis is made early and there is only partial palsy. However, if the diagnosis is delayed or there is complete palsy, surgical intervention is deemed necessary to evacuate the hematoma [ 9 , 12 ]. An alternative less invasive way to treat an iliopsoas hematoma is percutaneous drainage, which has the potential to effectively relieve pressure on the femoral nerve and promote quick functional recovery [ 21 ].…”

“…Femoral nerve palsy resulting from compressive hematoma of the iliopsoas muscle is a recognized complication in patients on anticoagulant therapy [ [1] , [2] , [3] ] or suffering from hemophilia [ [4] , [5] , [6] ], it has also been reported after hip and pelvic surgery [ 7 , 8 ]. However, it is relatively uncommon in traumatic context, with only 39 cases during 75 years reported in the literature most of them due to sport accident (Physical exercise class, running, gymnastic, Taekwondo…) [ 9 ]. We report the case of, complete femoral nerve palsy secondary to a traumatic iliacus muscle hematoma in a 16-year-old patient, which resolved after surgical treatment.…”

Spontaneous iliacus haematoma with femoral nerve palsy: an appeal to involve surgical teams early

“…More recent literature has come in the form of individual case reports, which are quite diverse in terms of inciting aetiologies and management of this condition 4–14. Within BMJ Case Reports , for example, seven instances of this diagnosis have been published 4–10.…”

“…Femoral nerve palsy is a serious although rare complication of iliacus haematomas. Cases of femoral nerve palsy secondary to iliacus haematoma have been described as a result of bleeding diatheses (eg, haemophilia), anticoagulation, trauma, total hip arthroplasty and pseudoaneurysm 1–14. There is often a delay in diagnosing this syndrome as it presents subtly and non-specifically with hip or groin pain, hip flexion contracture, and femoral nerve paresthesias.…”