External iliac artery thrombus masquerading as sciatic nerve palsy in anterior column fracture of the acetabulum

Abstract

We report a case of ischemic neuropathy of the sciatic nerve in a patient with an anterior column fracture of the acetabulum operated by ilioinguinal approach. It resulted from occlusion of the blood supply to the sciatic nerve. There were no signs of a vascular insult until ischemic changes ensued on the 6th postoperative day on the lateral part of great toe. The patient underwent crossover femoro-femoral bypass grafting and there was a complete reversal of the ischemic changes at 6 months. The sciatic nerve palsy continued to recover until the end of 1 year; by which time the only deficit was a Grade 4 power in the extensor hallucis longus (EHL) and the extensor digitorum longus (EDL). There was no further recovery at 2 years followup.

External iliac artery thrombosis following open reduction of acetabular fracture: a case report and literature review

“…These are divided into two groups, as follows: (1) uncorrectable factors such as past history, injury mechanism, and fracture type, and (2) preventable factors such as treatment strategy, perioperative management, and intraoperative procedure. To our knowledge, only five cases of postoperative EIA occlusion for acetabular fracture have been reported (Table 1) [1][2][3][4][5]. The present case was found to be the fourth case among cases with postoperative EIA thrombosis, based on our literature review.…”

“…The fracture type included anterior column or anterior wall fracture in all cases. The cause of thrombosis was speculated as an inappropriate surgical procedure in two cases [1,5] and atherosclerotic plaque rupture in two cases [2,4]. In one case, the EIA was thrombosed at the time of injury, and the graft was placed before acetabular surgery; however, ischemic External iliac artery thrombosis 7 symptoms mimicking EIA thrombosis due to EIA spasm occurred at the end of acetabular surgery [3].…”

“…Major vascular injuries after open reduction of an acetabular fracture are rare, but potentially life-threatening. To our knowledge, only five cases regarding postoperative external iliac artery (EIA) occlusion have been reported [1][2][3][4][5].…”

Spontaneous ischemic neuropathy of the sciatic nerve due to arterial occlusion – a rare cause of acute neuropathy not to be missed, a report of two cases

“…In a study on 92 consecutive patients evaluated for sciatic neuropathy, nerve infarction was the third most important cause (10% of patients) after hip arthroplasty and acute external compression [ 3 ]. Ischemic sciatic neuropathies have been described in the context of aneurysms with formation of arterial thrombosis on the basis of arteriosclerosis [ 5 ], arterial thrombosis after acetabulum fracture and surgery with ilioinguinal approach [ 6 ] or intra-operative arterial occlusion during total hip arthroplasty [ 7 ]. McManis described six cases of sciatic neuropathy after cardiac surgery.…”