Iliacus haematoma causing femoral nerve palsy: an unusual trampolining injury

Abstract

We report the case of a 15-year-old boy who presented to accident and emergency following a trampolining injury. Initially, the patient was discharged, diagnosed with a soft tissue injury, but he re-presented 48 h later with worsening low back pain and neurological symptoms in the left leg. Subsequent MRI revealed a left iliacus haematoma causing a femoral nerve palsy. The patient was managed conservatively and by 6 months post injury all symptoms had resolved. This is the first reported case of an iliacus haematoma causing a femoral nerve palsy, after a trampolining injury. We believe this case highlights to our fellow clinicians the importance of a detailed history when assessing patients with trampolining injuries to evaluate the true force of injury. It also acts as a reference for clinicians in managing similar cases in future.

Successful Transcatheter Arterial Embolisation for a Traumatic Iliacus Hematoma: A Case Report

“…A traumatic iliacus hematoma is rare and usually occurs in patients after a fall involving a lower back injury 1 . The hematoma may compress the femoral nerve causing femoral nerve palsy, which results in severe pain and sensory disturbance along the distribution of the femoral nerve, and weakness or paralysis of the quadriceps muscle 1 .…”

“…A traumatic iliacus hematoma is rare and usually occurs in patients after a fall involving a lower back injury 1 . The hematoma may compress the femoral nerve causing femoral nerve palsy, which results in severe pain and sensory disturbance along the distribution of the femoral nerve, and weakness or paralysis of the quadriceps muscle 1 . To date, the gold standard treatment for this condition has not been established, and reports in the available literature describing femoral nerve palsy secondary to a traumatic iliacus hematoma recommend operative or conservative treatments 1,2 .…”

“…The hematoma may compress the femoral nerve causing femoral nerve palsy, which results in severe pain and sensory disturbance along the distribution of the femoral nerve, and weakness or paralysis of the quadriceps muscle 1 . To date, the gold standard treatment for this condition has not been established, and reports in the available literature describing femoral nerve palsy secondary to a traumatic iliacus hematoma recommend operative or conservative treatments 1,2 . Patel et al reported a similar case in terms of their patient's age and the mechanism of traumatic iliacus hematoma treated by non-operative management 3 .…”

Nerve Entrapment in the Hip Region: Current Concepts Review

“…Subacute compartment syndrome resulting from pelvic trauma during contact sports can cause femoral nerve entrapment with progressive edema, swelling, and ischemia in the iliacus compartment. [26][27][28] With femoral nerve entrapment pain, numbness, and paresthesias may be noted in the anterior thigh and when the saphenous branch is involved symptoms may be noted in the anteromedial knee joint, medial leg, and foot. 4 In contrast, the lateral femoral cutaneous nerve is exclusively a sensory nerve with entrapment causing symptoms of paresthesia, numbness, stinging, or burning sensation in the anterior lateral thigh associated with hypersensitivity to touch.…”

Complete femoral nerve palsy secondary to a traumatic iliacus haematoma

“…A recent systematic review identified only 16 cases of femoral neuropathy secondary to traumatic iliopsoas haematomas over a 40‐year period to 2012 . A reading of the cases reveals a trend towards conservative management of partial palsies and surgical decompression of complete palsies; however, it remains controversial when surgical intervention should be pursued over a conservative approach. The current authors freely admit that they were faced with a management uncertainty on initial presentation.…”