J Korean Fract Soc.  2017 Oct;30(4):198-202. 10.12671/jkfs.2017.30.4.198.

Delayed Sciatic Nerve Palsy due to Hematoma Related with Anticoagulants Prophylaxis in the Femur Intramedullary Nailing: A Case Report

• Kim YM
• Joo YB
• Song SH

• KMID: 2424132
• DOI: http://doi.org/10.12671/jkfs.2017.30.4.198

Abstract

Femur intramedullary nailing can be one of the most predictable procedures in orthopedic traumatology. The advantage of this method is that the fracture site does not have to be widely exposed for reduction, which can minimize soft tissue damage. For this reason, the incidence of complications related to hematoma has been rare. We experienced only one case of sciatic nerve palsy due to hematoma after intramedullary nailing; the patient was receiving an anticoagulant therapy. Therefore, we report this case with literature review.

Keyword

Femoral fracture; Intramedullary nailing; Anticoagulants; Hematoma; Sciatic nerve palsy

MeSH Terms

Anticoagulants*
Femoral Fractures
Femur*
Fracture Fixation, Intramedullary*
Hematoma*
Humans
Incidence
Methods
Orthopedics
Sciatic Nerve*
Sciatic Neuropathy*
Traumatology
Anticoagulants

Figure

• 

  Fig. 1 Plain radiographs of a 75-year-old female with femur shaft fracture. Anteroposterior (A) and lateral (B) view.

• 

  Fig. 2 Internal fixation was performed using a standard intramedullary nail, Anteroposterior (A) and lateral (B) view.

• 

  Fig. 3 Postoperative 10 days, acute sciatic nerve palsy symptoms appeared related to a huge hematoma lesion. (A) Axial computed tomography images showing a hematoma with a size of greater than 10 cm on the gluteus medius muscle. (B) Coronal computed tomography angiography showed bleeding (white arrow) at the branch of the superior gluteal artery.

• 

  Fig. 4 Bleeding at the branch of the superior gluteal artery was observed (white arrow). Transarterial embolization was performed using a coil.

• 

  Fig. 5 Intraoperative photographs. Hematoma existed between gluteus maximus and medius muscle. A large amount of hematoma was evacuated.

Reference

1. Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P III. Rockwood and Green's fractures in adults. 8th ed. Philadelphia: Wolters Kluwer Health;2015. p. 2149–2228.

2. Shane E, Burr D, Ebeling PR, et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010; 25:2267–2294.

3. Karkos CD, Hughes R, Prasad V, D'Souza SP. Thigh compartment syndrome as a result of a false aneurysm of the profunda femoris artery complicating fixation of an intertrochanteric fracture. J Trauma. 1999; 47:393–395.

4. Grimaldi M, Courvoisier A, Tonetti J, Vouaillat H, Merloz P. Superficial femoral artery injury resulting from intertrochanteric hip fracture fixation by a locked intramedullary nail. Orthop Traumatol Surg Res. 2009; 95:380–382.

5. Weil Y, Mattan Y, Goldman V, Liebergall M. Sciatic nerve palsy due to hematoma after thrombolysis therapy for acute pulmonary embolism after total hip arthroplasty. J Arthroplasty. 2006; 21:456–459.

6. Beksaç BP, Della Valle AG, Salvati EA. Acute sciatic nerve palsy as a delayed complication of low-molecular-weight heparin prophylaxis after total hip arthroplasty. Am J Orthop (Belle Mead NJ). 2009; 38:E28–E30.

7. Butt AJ, McCarthy T, Kelly IP, Glynn T, McCoy G. Sciatic nerve palsy secondary to postoperative haematoma in primary total hip replacement. J Bone Joint Surg Br. 2005; 87:1465–1467.

8. Ben-David B, Joshi R, Chelly JE. Sciatic nerve palsy after total hip arthroplasty in a patient receiving continuous lumbar plexus block. Anesth Analg. 2003; 97:1180–1182.

9. Leonard MA. Sciatic nerve paralysis following anticoagulant therapy. J Bone Joint Surg Br. 1972; 54:152–153.

10. Uzun M, Beksaç B, Tözün R. Delayed acute sciatic nerve palsy as a complication of bridging chemothromboprophylaxis following hip hemiarthroplasty: a case report. JBJS Case Connect. 2013; 3:e134.