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

Autor:	Schaffer NE; Western Washington Medical Group, Everett, WA., Luther L; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN; and., Ponce RB; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN; and., Wrenn SP; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN; and., Cave JR; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN; and., Moreno-Diaz AF; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN; and., Morris CA; Department of Orthopaedic Surgery, University of Oklahoma College of Medicine, Oklahoma City, OK., Tatman LM; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN; and., Mitchell PM; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN; and.
Jazyk:	angličtina
Zdroj:	Journal of orthopaedic trauma [J Orthop Trauma] 2024 Sep 01; Vol. 38 (9), pp. 477-483.
DOI:	10.1097/BOT.0000000000002860
Abstrakt:	Objectives: To identify factors that contribute to iatrogenic sciatic nerve palsy during acetabular surgery through a Kocher-Langenbeck approach and to evaluate if variation among individual surgeons exists. Design: Retrospective cohort. Setting: Level I trauma center. Patient Selection Criteria: Adults undergoing fixation of acetabular fractures (AO/OTA 62) through a posterior approach by 9 orthopaedic traumatologists between November 2010 and November 2022. Outcome Measures and Comparisons: The prevalence of iatrogenic sciatic nerve palsy and comparison of the prevalence and risk of palsy between prone and lateral positions before and after adjusting for individual surgeon and the presence of transverse fracture patterns in logistic regression. Comparison of the prevalence of palsy between high-volume (>1 patient/month) and low-volume surgeons. Results: A total of 644 acetabular fractures repaired through a posterior approach were included (median age 39 years, 72% male). Twenty of 644 surgeries (3.1%) resulted in iatrogenic sciatic nerve palsy with no significant difference between the prone (3.1%, 95% confidence interval [CI], 1.9%-4.9%) and lateral (3.3%, 95% CI, 1.3%-8.1%) positions (P = 0.64). Logistic regression adjusting for surgeon and transverse fracture pattern demonstrated no significant effect for positions (odds ratio 1.0, 95% CI, 0.3-3.9). Transverse fracture pattern was associated with increased palsy risk (odds ratio 3.0, 95% CI, 1.1-7.9). Individual surgeon was significantly associated with iatrogenic palsy (P < 0.02). Conclusions: Surgeon and the presence of a transverse fracture line predicted iatrogenic nerve palsy after a posterior approach to the acetabulum in this single-center cohort. Surgeons should perform the Kocher-Langenbeck approach for acetabular fixation in the position they deem most appropriate, as the position was not associated with the rate of iatrogenic palsy in this series. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Competing Interests: The authors report no conflict of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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