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Sciatic nerve injection palsy in the child: early microsurgical treatment and long-term results
Filippo M Senes1, Riccardo Campus, Flavio Becchetti
1Orthopedic Unit, IRCCS Giannina Gaslini, Genova, Italy. filipposenes@ospedale-gaslini.ge.it
Insights
Early microsurgical exploration and treatment of sciatic nerve palsy in children following gluteal intramuscular injections can significantly improve outcomes, preventing long-term sensory-motor deficits and deformities.
Area of Science:
- Pediatric Surgery
- Neurology
- Orthopedics
Background:
- Sciatic nerve injury in children, often from gluteal intramuscular injections, can lead to sensory-motor palsy and foot deformities.
- In preterm or critically ill infants, this injury may be overlooked or misdiagnosed as congenital clubfoot.
Purpose of the Study:
- To report on the authors' experience with early microsurgical exploration of sciatic nerve injuries in children.
- To evaluate the effectiveness of early surgical intervention versus conservative treatment for post-injection sciatic nerve palsy.
Main Methods:
- Retrospective review of 17 children diagnosed with sciatic nerve palsy after intramuscular injection between 1990 and 2004.
- Surgical intervention (neurolysis or nerve grafting) was performed on nine children; conservative treatment was used for others.
Main Results:
- Complete recovery was achieved in five cases treated early; late-treated cases showed only mild improvement.
- Conservative treatment was successful in only three cases with early recovery signs.
- Surgical exploration revealed anatomical variations predisposing to injury.
Conclusions:
- Early diagnosis and microsurgical intervention are crucial for optimal recovery from sciatic nerve palsy in children.
- Prompt therapeutic decisions can prevent or limit foot deformities, sensory deficits, and growth discrepancies.
Abstract:
Sciatic nerve injury caused by intramuscular injection in the gluteal region in the child seems as a sensory-motor palsy of the lower limb of variable degree. In preterm children or in children with severe perinatal distress, requiring intensive care, a drop foot is often missed or misdiagnosed as a malformative clubfoot or late diagnosed. Intramuscular drug injection (mainly antibiotics) during early infancy is another cause of injury. There are very few literature reports on postinjection trauma and on therapeutic indications in the child. The Authors report their experience in early microsurgical exploration of the sciatic nerve. From 1990 to 2004, we observed at different times from diagnosis 17 children with sciatic nerve palsy following intramuscular injection. Nine of them underwent nerve exploration surgery in the gluteal region (neurolysis in seven and nerve grafting in two). Conservative treatment was successful in only three cases showing early signs of recovery (at about 3 months of life). Complete recovery was observed only in five early treated cases, while late treated cases had only mild improvement after surgery. During surgery, anatomical variations predisposing to nerve injury were observed. The authors havingobserved better results and faster recovery in the early treated patients, stress the importance of a rapid therapeutic decision to avoid or limit foot deformities, sensory defects and lower limb length discrepancy due to paralysis during growth.