The epidemiology and management of iliopsoas hematoma with femoral nerve palsy: A descriptive systematic review of 174 cases

Guild, Theodore; Crawford, Alexander M; Striano, Brendan M; Mortensen, Sharri J.; Wixted, John J.

doi:10.1016/j.injury.2022.11.057

Cited by 2 publications

(3 citation statements)

References 101 publications

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“…Guild et al [14] indicated that patients with IPH commonly experience long-term impairment of lower limb motor function, congruent with the current study ndings. Several factors may contribute to this phenomenon, including the following:…”

Section: Discussionsupporting

confidence: 92%

“…Rodriguez-Merchan et al [7] have emphasized that long-term replacement therapy with clotting factors is crucial for dealing with hemophilia-related IPHs. Meta-analysis studies [8,14] have demonstrated that conservative treatment was administered in 57% of patients, including interventions based on blood products, analgesics, hemostatic drugs, hormones, and neurotrophic factors [15] . In contrast, the proportion of conservative treatment was higher in our study, possibly due to the prevalence of clotting disorders in 64.28% (18/28) of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…The appropriate treatment methods for IPH remain debated, but they primarily involve surgical intervention and conservative medical treatment [14] . The associated factors generally include age, condition severity, disease progression, hematoma volume, the underlying causes of the hematoma, and the extent of nerve damage [7] .…”

Section: Introductionmentioning

confidence: 99%

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Clinical Case Analysis of Iliopsoas Hematoma Causing with Femoral Nerve Compression

Li,

Peng,

Gong

et al. 2023

Preprint

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Background: To investigate the clinical manifestation and prognosis of iliopsoas hematoma (IPH) associated with femoral nerve compression and enhance the current understanding of IPH. Methods: Patients diagnosed with IPH from March 2014 to January 2023 at the Affiliated Hospital of Southwest Medical University were assessed. The main clinical indicator observed was visual analog scale (VAS) score before treatment as well as at 1 week and 1, 3, and 6 months after treatment. Secondary indicators included the degree of lower limb numbness before and after treatment, muscle strength, hip flexion degree, the distribution of affected nerves, hematoma size, and hematoma distribution. Results: A total of 28 patients were included, among which 24 were men, and the average age (median [interquartile range]) was 48 (20.25, 63) years. The average duration of disease onset was 3 (1.25, 7) days, and 16 patients (57.14%) exhibited coagulation dysfunction. After 1 week of treatment, a 50% reduction in the VAS score was noted in 18 patients (64.28%). Furthermore, VAS score at 1 week and 1, 3, and 6 months after treatment were significantly lower than the baseline VAS score (P < 0.05). Baseline lower limb sensation was grade I in two patients, followed by grades II, III, and IV in five, 11, and 10 patients, respectively. After 6 months, 22 patients (78.57%) recovered to grade I. Baseline muscle strength of the lower limb was grade II in one patient, while grades III, IV, and V were in 10, eight, and nine patients, respectively. After 6 months, 19 patients (67.85%) exhibited improvement to grade V. The baseline degree of hip flexion was graded I and II in 53.57% of the patients, with enhancement to grade III after 6 months in 25 (89.28%). Hematoma distribution was localized in the mid-zone in 21% of the patients; upper-mid zone, 29%; mid-lower zone, 29%; and upper-mid-lower zone, 21%. In terms of affected nerves, femoral nerve involvement was revealed in 25 patients (89.28%), whereas lateral femoral cutaneous nerve involvement in 15 (53.57%). Conclusions: IPH is mainly caused by coagulation dysfunction and is often accompanied by pain and femoral nerve involvement that result in slow neurological recovery. Furthermore, the timely detection and causal treatment of IPH may help achieve a favorable prognosis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Clinical Case Analysis of Iliopsoas Hematoma Causing with Femoral Nerve Compression

Li,

Peng,

Gong

et al. 2023

Preprint

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Retroperitoneal and lower extremities muscle bleeding in acquired haemophilia A (AHA): Risk factors and implications in disability and survival

Pardos‐Gea,

Benítez

2024

European J of Haematology

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AimTo assess risk factors of retroperitoneal and lower extremity musculoskeletal bleed in acquired haemophilia (AHA) and perform an objective assessment of disability and influence on survival.MethodsWe included 49 patients with AHA from November 2017 to May 2023. The occurrence of any retroperitoneal or/and lower extremities bleeding manifestation was investigated. On clinical follow‐up, we search for compressive femoral neuropathy and quadriceps amyotrophy. The lower extremity functional scale (LEFS) was carried out one year after the last bleeding event in all AHA patients.ResultsA 61.2% of patients in our AHA cohort presented with any retroperitoneal and/or lower extremities musculoskeletal manifestation. Those patients had higher percentage of major bleeding EACH2/ISTH criteria (90% vs. 57%, p = .01), needs of blood transfusions (86% vs. 57% of patients, p = .03), and haemostatic by‐pass products (90% vs. 63%, p = .02). Hypertension (HR 2.6, 95% CI 1.1–5.9, p = .02), presence of autoimmune disease (HR 13, 95% CI 1.7–99, p = .01), and inhibitor level > 20 BU (HR 2.6 95% CI 1.0–6.8, p = .04) significantly predicted retroperitoneal/lower extremities clinical manifestations. Most frequent sequelae were quad atrophy (30.6%) and femoral nerve palsy (20.4%). Quad atrophy and LEFS scores under 50 were associated with increased mortality (HR 3, 95% CI 1.1–8.6 and HR 12, 95% CI 3.3–45, respectively).ConclusionAHA with retroperitoneal/lower extremities bleeding involvement is of greater severity and shows high disability and worst survival outcomes. Quadriceps atrophy and LEFS scale scoring under 50 predicted mortality in our AHA patients.

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The epidemiology and management of iliopsoas hematoma with femoral nerve palsy: A descriptive systematic review of 174 cases

Cited by 2 publications

References 101 publications

Clinical Case Analysis of Iliopsoas Hematoma Causing with Femoral Nerve Compression

Clinical Case Analysis of Iliopsoas Hematoma Causing with Femoral Nerve Compression

Retroperitoneal and lower extremities muscle bleeding in acquired haemophilia A (AHA): Risk factors and implications in disability and survival

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