Citation

Simske NM, Krebs JC, Heimke IM, Scarcella NR, Vallier HA. J. Orthop. Trauma 2019; ePub(ePub): ePub.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/BOT.0000000000001604

PMID

31397735

Abstract

OBJECTIVES: To determine factors associated with nerve injury after acetabulum fracture and to evaluate recovery and outcomes DESIGN:: Retrospective cohort study SETTING:: Level 1 trauma center PATIENTS AND PARTICIPANTS:: 975 skeletally mature patients with acetabulum fracture INTERVENTION:: Operative and non-operative management MAIN OUTCOME MEASUREMENTS:: Nerve injuries, categorized as traumatic or iatrogenic, recovery (none, partial or complete) and patient-reported functional outcomes with the Musculoskeletal Function Assessment (n=353, 36.2%) RESULTS:: Thirty-two patients (3.3%) experienced nerve injury with 24 (78%) resulting from trauma and 23 with an associated posterior hip dislocation. Eight injuries (25%) were iatrogenic. 31 (97%) occurred in patients with operative fractures (n=738). The most common fracture pattern associated with nerve injury was transverse posterior wall (31% of injuries). Obesity was more common in patients with nerve injuries (59% vs. 30% in those without nerve injury (p=0.001), but was not related to age or gender. 65% of sciatic nerve injuries were to the common peroneal division only, while none were isolated to the tibial division. All iatrogenic injuries occurred after the ilioinguinal approach (p<0.001). Overall, 50% experienced partial nerve recovery and 22% had complete recovery. However, 24% of patients with sciatic or common peroneal injuries had no recovery. 33% of tobacco smokers experienced no recovery (vs 26% of nonsmokers). Average MFA scores for patients with nerve injuries was 32, similar to those without (33).

CONCLUSIONS: Posterior acetabulum fracture dislocations are associated with traumatic nerve injury, although 25% of nerve injuries were iatrogenic. Nerve injuries are more common in obese patients. Over one quarter of patients had no recorded nerve recovery. LEVEL OF EVIDENCE: Level 3 prognostic.

Language: en