Sciatic Nerve Palsy following Curved Periacetabular Osteotom
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Curved periacetabular osteotomy (CPO) is a procedure used for the treatment of dysplastic hips. Several studies have reported that acetabular reorientation and improvement of acetabular coverage contribute to the decline of dysplastic hip instability. Satisfying long-term results were reported for the traditional procedure. However, various severe complications such as nerve palsy, necrosis of the femoral head, and delayed union or absence of union have been reported in a few cases. In contrast, severe complications are rare after CPO.

Here describe a case of postoperative sciatic nerve palsy following CPO due to nerve strangulation by scar tissue without direct injury. A female patient had severe buttock pain and posterior leg numbness after she underwent left-side CPO. Postoperative magnetic resonance imaging showed that the sciatic nerve was strangulated by the surrounding soft tissue. There was no bone fragment, active infection, bone necrosis, tumor, or spine disease. Therefore, the author diagnosed nerve palsy by soft tissue strangulation, and revision surgery was indicated. During revision surgery, the sciatic nerve was observed to be strangulated by the scarring soft tissue, and the nerve had no mobility. After detachment, the pain and numbness disappeared. Direct injury of the sciatic nerve should not be caused by CPO; however, there is a possibility of postoperative sciatic nerve palsy due to the scarring soft tissue. Early diagnosis and appropriate treatment are important for optimal postoperative clinical outcomes.

In conclusion, a rare case of sciatic nerve palsy following CPO and accomplished pain relief by surgical nerve detachment was managed. Direct injury of the sciatic nerve should not be caused while performing CPO. However, there is a possibility of postoperative sciatic nerve palsy due to soft tissue scarring. Early diagnosis and appropriate treatment are important for optimal postoperative clinical outcomes.

source:https://www.hindawi.com/journals/crior/2020/8569285/
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