Iatrogenic Sciatic Nerve Injury in Posterior Acetabular Surgery: Surgeon More Predictive Than Position

Area of Science:

• Orthopaedic Surgery
• Neurosurgery
• Trauma Surgery

Background:

• Iatrogenic sciatic nerve palsy is a risk during acetabular surgery.
• The Kocher-Langenbeck approach is commonly used for posterior acetabular fracture fixation.
• Factors influencing nerve injury, including surgeon variation and patient positioning, require further investigation.

Purpose of the Study:

• To identify factors contributing to iatrogenic sciatic nerve palsy during acetabular surgery via a Kocher-Langenbeck approach.
• To evaluate surgeon-specific variations in the occurrence of sciatic nerve palsy.
• To assess the impact of patient positioning (prone vs. lateral) on palsy rates.

Main Methods:

• Retrospective cohort study of 644 adult acetabular fractures (AO/OTA 62) treated with a posterior approach.
• Analysis included 9 orthopaedic traumatologists over 12 years.
• Logistic regression was used to evaluate the association of patient position, transverse fracture patterns, and individual surgeon with palsy risk.

Main Results:

• The overall prevalence of iatrogenic sciatic nerve palsy was 3.1% (20/644).
• No significant difference in palsy rates was observed between prone (3.1%) and lateral (3.3%) positions.
• Transverse fracture patterns (OR 3.0) and individual surgeon (P < 0.02) were significantly associated with increased palsy risk, while position was not.

Conclusions:

• Surgeon and transverse fracture lines are significant predictors of iatrogenic sciatic nerve palsy following posterior acetabular surgery.
• Patient positioning (prone or lateral) did not significantly impact the rate of sciatic nerve palsy in this cohort.
• Surgeons can select their preferred position for the Kocher-Langenbeck approach without compromising patient safety regarding sciatic nerve injury.