Nerve Injuries are quite common in acetabular fractures. Most common nerve involved is sciatic nerve. Incidence of injury to other nerves is quite less.

It is pertinent that every case of acetabular fractures should be evaluated for nerve injuries so that such injuries are not missed.

Sciatic Nerve

Thirty percent of acetabular fractures have associated sciatic nerve injury . This high incidence mandates a careful neurologic evaluation in every case.

The peroneal division is injured most commonly, but both divisions can be involved.

Partial injuries increase the risk that the nerve will be injured during surgery.

There is also risk of nerve getting injured during the exposure for surgery. The risk for iatrogenic injury is substantial for posterior approaches.

Intraoperative monitoring of nerve function may help to reduce the incidence.

Femoral Nerve

Femoral nerve injury is rare either from the injury or surgery. This nerve is at risk during ilioinguinal approach to acetabulum.

Superior Gluteal Nerve

This nerve is vulnerable in the greater sciatic notch, where it may be injured during trauma or during surgery, resulting in paralysis of the hip abductors, creating a major disability.

Other nerves which can be injured are pudendal nerve and femoral cutaneous nerve. Pudendal nerve can be compressed on the traction table, but it usually recovers.

Lateral femoral cutaneous nerve is commonly stretched or cut during anterior approaches. The patient should be warned preoperatively about the likelihood of it occurring.

Related posts:

1. An Introduction To Acetabular Fractures

The anterior column, which consists of the iliac wing and pelvic brim, extends to the pubic symphysis and contains the anterior one half of the acetabular articular surface.

The posterior column consists of the greater and lesser sciatic notches, the retroacetabular surface, and the majority of the quadrilateral surface.

Similarly, the posterior column contains the posterior one half of the acetabular articular surface.

The goal of surgical treatment of fractures of acetabulum is an accurate reconstruction of the articular surface.

The internal iliac fossa, the quadrilateral surface, and the retroacetabular surface describe large cortical surface of the innominate bone.

The pelvic brim marks the junction of the intenral iliac fossa and quadrilateral surface.

The sciatic notch marks the junction of the quadrilateral surface and the retroacetabular surface.

Apart from plain radiographs and special views of xrays computerized tomography (CT) can also be used to visualize acetabular fractures.

In the majority of cases, the fracture pattern can be identified and thus classified from plain films alone.

Plain films are usually best for assessing the congruence between the femoral head and the roof of the acetabulum.

Plain film radiography has been the standard by which articular displacement has been measured, both before and after surgery.

In the emerging age of digital radiography, however, the CT image is fast becoming a more reliable method of articular assessment.

CT is better suited for evaluating certain fracture characteristic including

• Marginal impaction
• Rotation of major fragments
• Coronal fracture lines
• Incarcerated osteochondral fragments.

Related posts:

1. Nerve Injuries In Acetabular Fractures