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

Affiliations
  • 1Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea. ybjoo@cnu.ac.kr

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

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