Incidence of traumatic sciatic nerve injury in patients with acetabular fractures and factors affecting recovery: a retrospective study

Abstract

Abstract Background Reports on traumatic sciatic nerve injury associated with acetabular fracture are rare. In this study, we investigated the demographics of these injuries, their clinical characteristics, management, and factors potentially influencing neurological recovery. Methods We retrospectively reviewed all patients diagnosed to have acetabular fracture at our trauma center between January 2014 and June 2021. Data on patient demographics, characteristics of sciatic nerve injury, neurological recovery, factors potentially influencing neurological recovery were analyzed. Results Eighteen patients met the diagnostic criteria for acetabular fracture combined with sciatic nerve injury (bilateral in one case). All of these injuries involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Four of the 19 sides with traumatic sciatic nerve injury involved the common peroneal nerve division and 15 involved both the common peroneal and tibial nerve divisions. The mean common peroneal and tibial nerve division injury scores were 1.79 ± 0.92 and 2.68 ± 1.57, respectively. Seventeen patients (18 sides) underwent intraoperative nerve exploration, which revealed abnormalities in 7 sides and no obvious abnormality in 11 sides. At the last follow-up, 10 sides (52.6%) had complete recovery and 9 (47.4%) had partial recovery; the difference was statistically significant between those with or without abnormal nerve damage during exploration (P < 0.05). Linear regression analysis showed that a nerve abnormality detected intraoperatively was a predictor of nerve recovery (P < 0.05). The degree of neurological recovery was not related to sex, age, cause of injury, type of fracture, hip dislocation, or femoral head injury in patients whether recovery was partial or complete. The mean recovery time was significantly longer for partial recovery than for complete recovery (13.78 months vs 6.70 months; P < 0.05). Conclusions All the injuries in this series involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. Damage to the common peroneal nerve division was more severe than that to the tibial nerve division preoperatively. However, the degree of recovery of the common peroneal division was not worse than that of the tibial division. There was a relationship between the degree of neurological recovery and whether there was an abnormality at the time of intraoperative nerve exploration. Patients with partial recovery took longer to recover.