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Delayed-Onset Sciatic Nerve Palsy After Periacetabular Osteotomy: A Case Report.

Michael Leunig¹, Jonathan M Vigdorchik², Aidin Eslam Pour³

¹Department of Orthopaedics, Schulthess Klinik, Zürich, Switzerland.

JBJS Case Connector

|December 16, 2017

Summary

Severe hip dysplasia surgery can lead to delayed sciatic nerve injury, often caused by bone spurs. Careful surgical technique minimizes this risk during periacetabular osteotomy.

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Area of Science:

Orthopedic Surgery
Neuroscience
Pediatric Orthopedics

Background:

Severe hip dysplasia necessitates complex surgical correction.
Periacetabular osteotomy is a common surgical procedure for hip dysplasia.
Sciatic nerve injury is a potential complication, though typically low risk.

Observation:

A case of delayed-onset sciatic nerve injury in an adolescent following hip dysplasia surgery is presented.
The injury was indirectly caused by a cortical bone spur on the acetabular fragment.
Symptoms manifested during patient mobilization post-surgery.

Findings:

The cortical bone spur created pressure or irritation on the sciatic nerve.
Delayed presentation of symptoms suggests a gradual or cumulative injury mechanism.
Surgical correction of hip dysplasia can have unforeseen neurological sequelae.

Implications:

Highlights the importance of vigilant neurological monitoring after hip dysplasia surgery.
Suggests considering potential sources of indirect nerve injury, such as bone spurs.
Emphasizes the need for meticulous surgical technique to avoid nerve impingement during osteotomy and retraction.