Long-term functional outcome of penetrating sciatic nerve injury
Yoram A Weil1, Andrew D Pearle, Lampros Palladas
1Hadassah Hebrew University Medical School, Jerusalem, Israel. weily@hadassah.org.il
Background:
Penetrating sciatic nerve injuries resulting from gunshot wounds (GSW) or blast injuries are rare. The role of operative treatment of these injuries remains obscure, and to date, specific outcome measures after this type of injury are still missing.
Methods:
We retrospectively studied 29 patients with penetrating sciatic nerve injuries mostly resulting from GSW or blast, during the years 1990 to 2002, and compared those who where treated operatively versus nonoperatively, with minimal follow-up period of 2 years. Fourteen patients were operated and 15 treated nonoperatively.
Results:
Functional outcomes included neurologic recovery (Clawson and LSUHSC) and functional outcome (Brooks & Healey score, SF-36) scores. The functional neurologic recovery of the peroneal division of the sciatic nerve when compared with the tibial division was worse in both groups. No significant differences were found among the two groups in the rate of neurologic recovery, use of walking aids, and SF-36 scores. However, there was a tendency for lesser pain and better walking ability among the operated group. Seven patients who sustained blast injury had no neurologic recovery of the peroneal division of the nerve. These also had multiple injury sites in the involved sciatic nerve.
Conclusion:
High-energy injury to the sciatic nerve, although devastating, can result in a reasonable long-term functional level.