Complete Traumatic Laceration of the Sciatic Nerve Secondary to Acetabular Fracture: A Case Report

Abstract

BACKGROUND Sciatic nerve injury in acetabular fractures is a rare event, with the majority of cases being transient neuropraxias. To date there are no published cases of complete traumatic sciatic nerve lacerations due to acetabular fracture with associated hip dislocation. We describe a case of such an event confirmed at the time of acetabular fracture fixation. CASE PRESENTATION The patient was a 37-year-old polytraumatized victim involved in a motor vehicle accident who presented with multiple injuries including left acetabular fracture with associated femoral head dislocation. The patient had absent function of both divisions of the sciatic nerve on initial evaluation. She was hemodynamically unstable on arrival requiring multidisciplinary intervention and transfer to the intensive care unit after temporization of her multiple system injuries. Following adequate resuscitation and improved hemodynamic status she was taken to the operating room for definitive orthopaedic fixation of her pelvis, acetabulum, and multiple long bones. Intraoperatively the sciatic nerve was identified, found to be completely lacerated. Direct repair was performed. Following discharge to a long term rehabilitation facility on post-trauma day 53 she was lost to follow up for 6 months when she presented to the emergency department for abdominal pain. Her pelvic and acetabular hardware was radiographically stable showing fracture union, and her lower extremity neurological examination was unchanged from her preoperative exam. CONCLUSION Injury to the sciatic nerve associated with pelvic and acetabular trauma is relatively rare and is most often neuropraxic. To our knowledge there is no reports in the literature on complete lacerations in this context, and there is a paucity in the literature on managing such injuries. Orthopaedic traumatologist must be aware of the possibility of this presentation in order to manage it appropriately and counsel patients accordingly.