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Double-crush syndrome after acetabular fractures

A SIGN OF POOR PROGNOSIS

Injury to the sciatic nerve is one of the more serious complications of acetabular fracture and traumatic dislocation of the hip, both in the short and long term. We have reviewed prospectively patients, treated in our unit, for acetabular fractures who had concomitant injury to the sciatic nerve, with the aim of predicting the functional outcome after these injuries.

Of 136 patients who underwent stabilisation of acetabular fractures, there were 27 (19.9%) with neurological injury. At initial presentation, 13 patients had a complete foot-drop, ten had weakness of the foot and four had burning pain and altered sensation over the dorsum of the foot. Serial electromyography (EMG) studies were performed and the degree of functional recovery was monitored using the grading system of the Medical Research Council. In nine patients with a foot-drop, there was evidence of a proximal acetabular (sciatic) and a distal knee (neck of fibula) nerve lesion, the double-crush syndrome.

At the final follow-up, clinical examination and EMG studies showed full recovery in five of the ten patients with initial muscle weakness, and complete resolution in all four patients with sensory symptoms (burning pain and hyperaesthesia). There was improvement of functional capacity (motor and sensory) in two patients who presented initially with complete foot-drop. In the remaining 11 with foot-drop at presentation, including all nine with the double-crush lesion, there was no improvement in function at a mean follow-up of 4.3 years.

 

Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 3, 401-407.
doi: 10.1302/0301-620X.87B3.15253  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery

P. V. Giannoudis, MD, BSc, MB, EEC(Orth), Consultant Orthopaedic Surgeon, Professor1; A. A. Da Costa, MD, FRCP, Consultant Neurophysiologist2; R. Raman, MRCS, Specialist Registrar1; A. K. Mohamed, FRCS, Research Fellow1; and R. M. Smith, MD, Associate Professor3

1 Department of Trauma and Orthopaedics
2 Department of Neurophysiology, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK.
3 Department of Orthopaedics, Massachusetts General Hospital, 55 Fruit Street, WACC 5-525, Boston 02144, USA.

Correspondence should be sent to Professor P. V. Giannoudis; e-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it