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J Orthop Trauma. 2015 Mar;29(3):138-43. doi: 10.1097/BOT.0000000000000193.

Femoral nerve palsy after pelvic fracture treated with INFIX: a case series.

Author information

1
*Department of Orthopaedic Surgery, Queens University, Kingston, Ontario, Canada; †Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA; ‡Los Angeles Orthopaedic Specialists, Los Angeles, CA; §Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD; ‖Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN; and ¶Harris Methodist Fort Worth Hospital, Fort Worth, TX.

Abstract

OBJECTIVE:

The treatment of some pelvic injuries has evolved recently to include the use of a subcutaneous anterior pelvic fixator (INFIX). We present 8 cases of femoral nerve palsy in 6 patients after application of an INFIX to highlight this potentially devastating complication to pelvic surgeons using this technique and discuss how it might be avoided in the future.

DESIGN:

Retrospective chart review. Case series.

SETTING:

Five level 1 and 2 trauma centers, tertiary referral hospitals.

PATIENTS/PARTICIPANTS:

Six patients with anterior pelvic ring injury treated with an INFIX who experienced 8 femoral nerve palsies (2 bilateral).

INTERVENTION:

Removal of internal fixator, treatment for femoral nerve palsy.

MAIN OUTCOME MEASUREMENTS:

Clinical and electromyographic evaluation of patients.

RESULTS:

All 6 patients with a total of 8 femoral nerve palsies had their INFIX removed. Variable resolution of the nerve injuries was observed.

CONCLUSIONS:

Application of an INFIX for the treatment of pelvic ring injury carries a potentially devastating risk to the femoral nerve(s). Despite early implant removal after detection of nerve injury, some patients had residual quadriceps weakness, disturbance of the thigh's skin sensation, and/or gait disturbance attributable to femoral nerve palsy at the time of early final follow-up.

LEVEL OF EVIDENCE:

Therapeutic level IV. See Instructions for Authors for a complete description of levels of evidence.

PMID:
24983430
DOI:
10.1097/BOT.0000000000000193
[Indexed for MEDLINE]
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