Sciatic nerve presentation

1. Sciatic nerve injury in femur
shaft fracture
Amir (5 min talk)

2. causes
•
•
•
•
•
gunshot wound to the thigh or buttock.
posterior dislocation and fracture-
dislocation of the hip
intramuscular injection into the buttock,
surgery around the hip joint.
In the thigh, the nerve usually is injured by
penetrating wounds and fractures of the
femoral shaft

3. •
•
Complete sciatic nerve injury following
closed femur shaft fracture is very rare
When the nerve is injured , the peroneal
half of the nerve is injured much more
often than is the entire nerve.

4. •
•
•
•
Many peroneal nerve deficits after pediatric
femoral shaft fractures will resolve with
time.
In infants, however, the development of an
early contracture of the Achilles tendon is
more likely.
Because of the rapid growth in younger
children, this contracture can develop quite
early;
an ankle-foot orthosis should be used until
the peroneal nerve recovers.

5. •
•
If complete division of the nerve
complicates a femoral shaft fracture or
fracture-dislocation around the knee,
exploration also is justified early when no
signs of recovery are apparent.
Electro diagnostic studies& MRN should
be done before exploration if the nerve
doesn’t recovered with in time

6. •
•
If peroneal, femoral, or sciatic nerve deficit
is present at initial evaluation of a closed
fracture, no exploration is indicated.
Persistent nerve loss without recovery
over a 4- to 6-month period is an indication
for exploration.

7. Medical management
•
•
generally begins with the prescription of
pain medication (usually narcotics) to
treat the dysesthesias and pain.
Medications to stabilize the membrane of
the injured nerve, such as gabapentin, may
be used to decrease the hyperesthesia felt
during nerve recovery.

8. exploration
•
•
•
intraoperative nerve
action potential
recordings
if distal transmission of
signal, neurolysis may
be helpful
Grafting the damaged
sciatic nerve by using
the sural nerve has
been studied in adult
and pediatric
populations

9. permanent peroneal nerve palsy



anterior transfer of the posterior tibialis
tendon through the interosseous membrane
to the middorsum of the foot
restores some dorsiflexion, or at least
serve as a tenodesis and improve the
steppage gait from the foot drop
30% of ankle dorsiflexion power, as
measured by dynamometry, is restored with
this transfer.

10. •
•
In cases where no recovery of the sciatic
nerve after nerve repair, may result in flail
ankle ,infection, foot ulcers
Arthrodesis will be the last option to
preserve some function and alleviate pain

22. Soreti bekele,12/f 082881
• Tree fall 3days

23. references

24. • Thank u