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.
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