Atraumatic gluteal compartment syndrome-an unusual presentation of a rare syndrome.

ABSTRACT: Atraumatic gluteal compartment syndrome is a limb- and potentially life-threatening emergency. It is rare, with few reported cases, and can be difficult to diagnosis; a high index of suspicion is required for prompt diagnosis and management. This paper presents the case of a 36-year-old female who was brought into the emergency department following a prolonged period of unconsciousness. She had a delayed diagnosis of gluteal compartment syndrome associated with sciatic nerve palsy and underwent surgical decompression. Following surgery, the patient's symptoms resolved completely. This case highlights that in cases of delayed diagnosis, surgical decompression can still address patient morbidity and improve outcomes.

Is intraoperative neuromonitoring effective in hip and pelvis orthopedic and trauma surgery? A systematic review.

INTRODUCTION: Sciatic nerve injury is an uncommon but potentially devastating complication in hip and pelvis surgery. Intraoperative nerve monitoring (IONM) was applied since the seventies in neurosurgery and spine surgery. Nowadays, IONM has gained popularity in other surgical specialities including orthopaedic and trauma surgery. Aim of this systematic review is to resume the literature evidences about the effectiveness of intraoperative monitoring of sciatic nerve during pelvic and hip surgery. METHODS: Two reviewers (GC and MD) independently identified studies by a systematic search of PubMed and Google Scholar from inception of database to 10 January 2021. Inclusion criteria were: (a) English written papers, (b) use of any type of intraoperative nerve monitoring during traumatic or elective pelvic and hip surgery, (c) comparison of the outcomes between patients who underwent nerve monitoring and patient who underwent standard procedures, (d) all study types including case reports. The present review was conducted in accordance with the 2009 PRISMA statement. RESULTS: The literature search produced 224 papers from PubMed and 594 from Google Scholar, with a total amount of 818 papers. The two reviewer excluded 683 papers by title or duplicates. Of the 135 remaining, 72 were excluded after reading the abstract, and 31 by reading the full text. Thus, 32 papers were finally included in the review. CONCLUSIONS: The use of IONM during hip and pelvis surgery is debated. The review results are insufficient to support the routine use of IONM in hip and pelvis surgery. The different IONM techniques have peculiar advantages and disadvantages and differences in sensitivity and specificity without clear evidence of superiority for any. Results from different studies and different interventions are often in contrast. However, there is general agreement in recognizing a role for IONM to define the critical maneuvers, positions or pathologies that could lead to sciatic nerve intraoperative damage. LEVEL OF EVIDENCE: Level 2.

[Gluteal compartment syndrome after immobilization following opioid abuse]. / Gluteales Kompartmentsyndrom nach Liegetrauma bei Opiatabusus.

This article reports the case of a 42-year-old male patient, who sustained a gluteal compartment syndrome after drug-induced immobilization with subsequent rhabdomyolysis and sciatic nerve palsy. Unlike compartment syndrome of the forearm or lower leg, this is a rare condition. After immediate surgical decompression and installation of negative pressure wound treatment, hemofiltration in acute renal failure could be averted using forced diuresis. The sensorimotor function of the lower extremity improved already after the first treatment and secondary wound closure was possible after 1 week. The patient was discharged 11 days after admission with complete recovery of sensorimotor and renal functions.

Nerve Decompression Surgery After Total Hip Arthroplasty: What Are the Outcomes?

BACKGROUND: The purpose of our study was to compare (1) muscle strength; (2) pain; (3) sensation; (4) various outcome measurement scales between post-total hip arthroplasty (THA) patients who had a sciatic nerve injury and did or did not receive decompression surgery for this condition; and (5) to compare these findings with current literature. METHODS: Nineteen patients who had nerve injury after THA were reviewed. Patients were stratified into those who had a nerve decompression (n = 12), and those who had not (n = 7). Motor strength was evaluated using the Muscle Strength Testing Scale. Pain was evaluated by using the visual analogue scale. Systematic literature search was performed to compare the findings of this study with others currently published. RESULTS: The decompression group had a significant improvement in motor strength and the visual analog scale scores as compared with nonoperative group. Patients in decompression group had a significant larger increase in the mean Harris hip score and University of California Los Angeles score. There was no significant difference in the increase of Short Form-36 physical and mental scores between the 2 groups. Literature review for nonoperative management yielded 5 studies (93 patients), with 33% improvement. There were 7 studies (81 patients) on nerve decompression surgery, with 75% improvement. CONCLUSION: This study demonstrates the benefits of nerve decompression surgery in patients who had sciatic nerve injury after THA, as evidenced by results of standardized outcome measurement scales. It is possible to achieve improvements in terms of strength, pain, and clinical outcomes. Comparative studies with larger cohorts are needed to fully assess the best candidates for this procedure.

Multimodal nerve monitoring during periacetabular osteotomy identifies surgical steps associated with risk of injury.

PURPOSE: Sciatic nerve palsy after periacetabular osteotomy (PAO) is a serious complication. The purpose of this study was to determine whether a multimodal sciatic monitoring technique allows for identification of surgical steps that place the sciatic nerve at risk. METHODS: Transcranial electrical motor evoked potentials (TcMEPs), somatosensory evoked potentials (SSEPs), and spontaneous electromyography (EMG) were monitored in a consecutive series of 34 patients (40 hips) who underwent PAO for the treatment of symptomatic hip dysplasia between January 2012 and November 2014. There were 29 females (85%) and five males (15%) with an average age of 19 years (range, 12-36 years) at the time of surgery. RESULTS: We detected eight temporary sciatic nerve monitoring alerts in six patients (incidence of 15%). The events included decrease in amplitude of the TcMEPs related to the position of the hip during incomplete ischium osteotomy and placement of a retractor in the sciatic notch during the posterior column osteotomy (N = 3), generalized bilateral decrease in TcMEPs during fragment manipulation and fixation in association with acute blood loss (N = 2), and a change in SSEPs during a superior pubic osteotomy and supra-acetabular osteotomy (N = 1). At the end of the procedure, TcMEPs and SSEPs were at baseline and there was no abnormal pattern on EMG in all patients. Post-operatively, at two, six, 12 weeks, and six and 12 months, no motor weakness or sensory deficits were noted. CONCLUSION: Multimodal neuromonitoring allowed for identification of intra-operative steps and maneuvers that potentially place the sciatic nerve at higher risk of injury.

Similar incidence of postoperative sciatic nerve palsy in direct anterior and posterior approach total hip arthroplasty.

BACKGROUND: Sciatic nerve palsy is a rare but devastating complication following total hip arthroplasty (THA). While the use of the direct anterior approach is increasing, limited data exist regarding sciatic nerve palsy and surgical approach. The purpose of this study was to determine the factors and outcomes associated with sciatic nerve palsy (SNP) after THA. METHODS: A retrospective analysis was performed at a single institution of 7 SNP that occurred in 4045 THA via direct anterior approach and 10 SNP in 8854 THA via posterior approach, being operated between 01 January 2017 and 12 December 2021. SNP patients were matched 1:5 to patients without SNP. Medical records were reviewed for demographics including age, gender, body mass index (BMI), comorbidities, and preoperative indication. Additional workup of SNP patients including advanced imaging and reoperation were documented. Recovery grades were assigned to all SNP patients at most recent clinical follow-up. RESULTS: 5 of the SNP were complete and 12 partial. They occurred as frequently with the direct anterior (0.17%) and posterior approach (0.11%, p = 0.5). The presence of femur cables and reoperations were associated with SNP (p = 0.04 and p = 0.002, respecitvely). Age, gender, BMI, comorbidities, and surgical indication had no effect on SNP. 4 of the 17 affected patients had almost complete recovery at latest follow-up. CONCLUSIONS: The incidence of SNP was similar in direct anterior and posterior approach. Surgeons should counsel patients regarding the risks of SNP regardless of the used approach.

Gluteal compartment syndrome secondary to prolonged immobilization following carbon monoxide poisoning associated with leukoencephalopathy: A case report.

Introduction: Gluteal compartment syndrome (GCS) is a rare diagnosis that results mostly from a non-traumatic etiology. We describe a case of a gluteal compartment syndrome, complicated with sciatic nerve palsy. Case presentation: This paper reported a case of gluteal compartment syndrome caused by prolonged immobilization due to carbon monoxide poisoning. The case was complicated with sciatic nerve palsy and a sequala of leukoencephalopathy. Discussion and conclusion: This case report highlighted the importance of having a high suspicion for gluteal compartment syndrome in patients with history of lying down with prolonged immobilization. The diagnosis can be made solely on clinical examination and a fasciotomy must be performed with no delay.

Delayed Presentation of Sciatic Nerve Palsy Due to Post-traumatic Pseudoaneurysm Following Pelvis Fracture: A Case Report.

Introduction: Pseudoaneurysms are vascular lesions occurring after injury to a blood vessel wall. Peripheral artery pseudoaneurysms as a fracture complication are uncommon and typically appear immediately after trauma or surgery. We report a unique case of sciatic nerve palsy associated with external iliac artery pseudoaneurysm arising 20 years after pelvic trauma, presenting within the fracture site as an erosive bone lesion masquerading as a possible malignancy. To the best of our knowledge, no cases of delayed external iliac artery pseudoaneurysm involving sciatic pain have been reported. Case Report: We present a 78-year-old female who sustained an acetabular fracture with an uneventful recovery for 20 years. The patient presented post-injury with symptoms and physical examination findings consistent with sciatic nerve palsy. Computed tomography angiography and duplex imaging revealed a pseudoaneurysm of the external iliac artery. The patient was taken to the operating room for endovascular repair of the external iliac artery using a covered stent. Conclusion: This case of sciatic nerve palsy is a unique contribution to the literature concerning the specific vascular injury observed and the delayed presentation of pseudoaneurysm causing sciatic nerve palsy. Orthopedic surgeons must consider a wide differential when confronted with suspicious pelvic masses. Failure to diagnose these as a vascular etiology could prove catastrophic should the surgeon attempt an open debridement or sampling.

Near-Complete Transection of the Sciatic Nerve After Closed Reduction Attempt of a Dislocated Total Hip Arthroplasty.

Sciatic nerve injuries are rare and devastating complications that can occur following total hip dislocations. These injuries are even more uncommon when resulting from a closed reduction attempt. In the literature, only one other case of sciatic nerve palsy secondary to sciatic nerve laceration has been reported. Conducting a careful neurovascular examination following a closed reduction procedure is crucial in determining the presence of sciatic nerve injury. We present a case of sciatic nerve palsy following a closed reduction attempt of a dislocated total hip arthroplasty (THA). Surgical exploration revealed a near-complete sciatic nerve laceration. The patient subsequently underwent neurolysis and nerve repair. This case highlights the importance of thorough neuromuscular examination following closed reduction of THA, with consideration for surgical exploration when necessary.

Sciatic nerve injury after acetabular fractures: a meta-analysis of incidence and outcomes.

PURPOSE: To investigate the incidence and the outcome of post-traumatic and iatrogenic sciatic nerve palsy (SNP) associated with fractures of the acetabulum. The results of sciatic nerve grafting for treatment were also investigated. METHODS: PUBMED, SCOPUS and COCHRANE databases were searched for longitudinal observational studies reporting sciatic nerve palsy related to acetabular fractures in adult patients over the last 20 years. Data regarding patients demographics, type of acetabular fracture, rate of post traumatic and iatrogenic sciatic nerve palsies as well as recovery rate are reported. Studies were assessed for their quality. Random effects meta-analyses were carried out to pool overall proportions of SNP incidence and complete recovery. Variations in SNP incidence by main study characteristics were assessed by subgroup analysis and meta-regression. A narrative review of sciatic nerve grafting was also conducted. RESULTS: Twenty studies reporting 44 post-operative and 18 iatrogenic SNPs in 651 patients were reviewed. The pooled incidence of posttraumatic SNP was 5.1% (95% CI 2.7-8.2%). The pooled incidence of iatrogenic SNP was 1.4% (95% CI 0.3-2.9%). Complete recovery of post-traumatic and iatrogenic SNP occurred in 64.7% (95% CI 41.7-85.4%) and 74.1% (95% CI 31.5-100%), respectively. CONCLUSION: A favorable outcome of both post-traumatic and iatrogenic SNP related to acetabular fractures has been found. Due to the poor results of sciatic nerve grafting, a "wait and see" approach may be the best option, in cases of a contused but anatomically intact sciatic nerve.

Course of the sciatic nerve on magnetic resonance imaging in patients with osteoarthritis of the hip.

BACKGROUND: Sciatic nerve palsy is a serious complication after total hip arthroplasty (THA). This is the first study to report the relationship between the sciatic nerve and the acetabulum on magnetic resonance imaging (MRI) before THA. METHODS: 235 patients underwent 261 elective, primary THAs via the mini-incision posterolateral approach. We measured the horizontal distance (mm) and vertical distance (mm) from the posterior edge of the acetabulum to the sciatic nerve by T1-weighted imaging on an axial section of the centre of the femoral head. We defined the Dysplastic Group as having a posterior acetabular sector angle (PASA) <90° and the Non-dysplastic Group as having a PASA ⩾ 90°. We compared anatomical distances and angles between the 2 groups. RESULTS: The horizontal and vertical distances were (mean ± SD) 8.0 ± 9.2 mm and 14 ± 5.0 mm from the posterior edge of the acetabulum to the lateral edge of the sciatic nerve, respectively. The acetabular anteversion (AA), anterior acetabular sector angle (AASA), and PASA were (mean ± SD) 19 ± 6.7°, 49 ± 8.4°, and 87 ± 8.6°, respectively. The horizontal and vertical distances were positively correlated (p < 0.0001). AA and PASA were positively correlated with the horizontal distances (p < 0.0001) as well as with the vertical distances (p = 0.0017 and p = 0.0438, respectively). The horizontal and vertical distances were significantly shorter in the Dysplastic Group than in the Non-dysplastic Group (p < 0.0001 and p = 0.021, respectively). CONCLUSIONS: In cases of posterior acetabular dysplasia we have to be mindful of the course of the sciatic nerve.

Myositis ossificans of the hip joint causing sciatic nerve palsy following Guillain-barré syndrome: A case report.

INTRODUCTION AND IMPORTANCE: Myositis ossificans of the hip is a rare entity caused by trauma and neurological conditions which lead to lamellar bone formation around the joint. CASE PRESENTATION: We present a 47 years old patient with myositis ossificans of the left and the piriformis muscle following Guillain Barré syndrome causing sciatic nerve palsy (Piriformis syndrome). CLINICAL DISCUSSION: Clinical assessment revealed global limitation of the left hip movements and palpable bony mass on the lateral aspect of the left hip. Radiographs and computed tomography showed extensive myositis ossificans of the left hip and non-bridging calcification noted on the asymptomatic right side. During initial medical management and physiotherapy patient developed sciatic nerve palsy due to piriformis syndrome and ankylosis of the hip on the left side. Surgical exploration of the sciatic nerve and debridement of the hip. The left hip was found ankylosed and not salvageable. Uncemented total hip arthroplasty was carried out in the session. The patient recovered completely from sciatic nerve palsy and regained the range of motion of the hip. He is under follow-up for the recurrence of myositis ossificans. CONCLUSION: Guillain-barré syndrome causing piriformis syndrome is a rare entity. Extensive myositis ossificans causing sciatic nerve palsy is even rarer. An awareness of this entity, early detection, and intervention of this condition may help to preserve the native hip.

Congenital Pseudarthrosis of Femur and Sciatic Nerve Palsy with Congenital Constriction Band Syndrome: Report of the First Case in Literature.

Congenital constriction band syndrome has varied clinical presentations ranging from small, incomplete skin deep constriction band to in utero amputation. Pseudarthrosis of underlying bone most commonly tibia has been reported by many authors. We report the first case of congenital pseudarthrosis of the femur with congenital constriction band syndrome. Nine-day-old female presented with the constriction band in the left thigh with open pseudarthrosis of the femur. The left femur had gross recurvatum deformity and the posterior apex of the pseudarthrosis was exposed via skin ulceration. She had an ipsilateral paralytic clubfoot. She was treated with single-stage excision of constriction band and Z-plasty. Spontaneous union of the femur was achieved at 3 months. Procurvatum deformity of the femur improved gradually over 3 years. This happens to be the first and only reported case of congenital pseudarthrosis of the femur with sciatic nerve palsy due to congenital constriction band.

Treatment of postoperative sciatic nerve palsy after total hip arthroplasty for postoperative acetabular fracture: A case report.

Acetabular fracture is usually treated with osteosynthesis. However, in the case of an intra-articular fracture, osteosynthesis can result in arthropathy of the hip joint and poor long-term results, hence, total hip arthroplasty is required. However, in total hip arthroplasty for postoperative acetabular fracture, sciatic nerve palsy tends to develop more commonly than after primary total hip arthroplasty. This is a case report of a 57-year-old Japanese male who had internal skeletal fixation for a left acetabular fracture that had occurred 2 years earlier. One year later, he developed coxarthrosis and severe pain of the hip joint and total hip arthroplasty was performed. After the second surgery, he experienced pain along the distribution of the sciatic nerve and weakness of the muscles innervated by the peroneal nerve, indicating sciatic nerve palsy. We performed a third operation, and divided adhesions around the sciatic nerve. Postoperatively, the anterior hip joint pain and the buttocks pain when the hip was flexed were improved. Abduction of the fifth toe was also improved. However, the footdrop and sensory disturbance were not improved. A year after the third operation, sensory disturbance was slightly improved but the footdrop was not improved. We believe the sciatic nerve palsy developed when we dislocated the hip joint as the sciatic nerve was excessively extended as the hip joint flexed and internally rotated. Sciatic nerve adhesion can occur easily in total hip replacement for postoperative acetabular fracture; hence, adhesiotomy should be conducted before performing hip dislocation to prevent injury caused by nerve tension. The patient agreed that the details of this case could be submitted for publication. The work has been reported in line with the CARE criteria and cite.

Thigh compartment syndrome complicated by sciatic nerve palsy, rhabdomyolysis, and acute renal failure.

We reported a rare case of thigh compartment syndrome (TCS) complicated by sciatic nerve palsy, rhabdomyolysis, and acute renal failure in an alcoholic patient. Intensive care measures and immediate posteromedial decompressive fasciotomy were performed. These timely interventions resulted in improvement of the nerve injury and restoration of the kidney function.

Sciatic nerve injuries following femoral shaft fractures: Does the time interval from injury to surgery matter?

OBJECTIVES: Sciatic nerve injuries following fractures of femoral shaft are uncommon complications. The patients with such deficits present with sciatic nerve palsy. A few cases of sciatic nerve injuries secondary to femoral shaft fractures have thus far been reported. If such patients fail to improve spontaneously, they may require surgical exploration. The present paper gives an account of surgical exploration in patients presenting with sciatic nerve injuries following femoral shaft fractures. PATIENTS AND METHODS: Clinical outcomes were assessed in 14 patients undergoing surgical exploration of sciatic nerve injuries following femoral shaft fractures. RESULTS: There was a significant negative correlation between the time interval from injury to surgery and motor function recovery. Furthermore, a negative but non-significant correlation was seen between the time interval from injury to surgery and sensory recovery. CONCLUSIONS: Early exploration of sciatic nerve injuries following femoral shaft fractures can be beneficial if the nerve injury does not improve spontaneously.

Neurolysis for the treatment of sciatic nerve palsy associated with total hip arthroplasty.

Sciatic nerve palsy following total hip arthroplasty (THA) is a relatively rare yet potentially devastating complication. The purpose of this case series was to report the results of patients with a sciatic nerve palsy who presented between 2000 and 2010, following primary and revision THA and were treated with neurolysis. A retrospective review was made of 12 patients (eight women and four men), with sciatic nerve palsy following THA. The mean age of the patients was 62.7 years (50 to 72; standard deviation 6.9). They underwent interfascicular neurolysis for sciatic nerve palsy, after failing a trial of non-operative treatment for a minimum of six months. Following surgery, a statistically and clinically significant improvement in motor function was seen in all patients. The mean peroneal nerve score function improved from 0.42 (0 to 3) to 3 (1 to 5) (p < 0.001). The mean tibial nerve motor function score improved from 1.75 (1 to 4) to 3.92 (3 to 5) (p = 0.02).The mean improvement in sensory function was a clinically negligible 1 out of 5 in all patients. In total, 11 patients reported improvement in their pain following surgery. We conclude that neurolysis of the sciatic nerve has a favourable prognosis in patients with a sciatic nerve palsy following THA. Our findings suggest that surgery should not be delayed for > 12 months following injury.

Sciatic Nerve Palsy Caused by Ruptured and Contracted Short External Rotator Muscles after Primary Total Hip Arthroplasty.

Although the incidence of sciatic nerve palsy following total hip arthroplasty is low, this complication can cause devastating permanent nerve palsy. The authors experienced a case of sciatic nerve palsy caused by ruptured and contracted external rotator muscles following total hip arthroplasty in a patient suffering from osteonecrosis of the femoral head. We report this unusual case of sciatic nerve palsy with a review of the literature.

External iliac artery thrombus masquerading as sciatic nerve palsy in anterior column fracture of the acetabulum.

We report a case of ischemic neuropathy of the sciatic nerve in a patient with an anterior column fracture of the acetabulum operated by ilioinguinal approach. It resulted from occlusion of the blood supply to the sciatic nerve. There were no signs of a vascular insult until ischemic changes ensued on the 6(th) postoperative day on the lateral part of great toe. The patient underwent crossover femoro-femoral bypass grafting and there was a complete reversal of the ischemic changes at 6 months. The sciatic nerve palsy continued to recover until the end of 1 year; by which time the only deficit was a Grade 4 power in the extensor hallucis longus (EHL) and the extensor digitorum longus (EDL). There was no further recovery at 2 years followup.

Iatrogenic Sciatic Nerve Injury after Total Knee Arthroplasty / 대한정형외과학회잡지

Sciatic nerve palsy after total knee arthroplasty, accompanied by motor power weakness and electromyographic evidence, is a rare occurrence. In a 78-year-old female, pneumatic tourniquet was used for 72 minutes, with a pressure of 300 mmHg. The time and pressure are generally accepted values. We noticed sciatic nerve palsy showing motor power weakness and electromyographic evidence. One year after the operation, she recovered full motor power, but complained about a tingling sensation below the knee. Given that the nerve injury after using tourniquet was due to neural ischemia, and since our patient had vascular circulation problems such as atrial fibrillation and clip insertion due to internal carotid artery aneurysm, our patient can be considered as a high-risk patient with weakness to neural ischemic damage, even with the use of conventional tourniquet. Therefore, surgeons should be cautious when using tourniquet in patients with vascular circulation problems.