Iatrogenic sciatic nerve injury due to cerclage wiring for proximal periprosthetic femoral fracture: A rare case report

Abstract

Summary: Cerclage wiring is used to reinforce the stability of fractures and optimize plate fixations for femoral fractures such as periprosthetic fractures. However, cerclage wiring requires attention to neurovascular structures to prevent injuries. We have presented a case of iatrogenic sciatic nerve injury after osteosynthesis with cerclage wiring. A 71-year-old woman underwent osteosynthesis with cerclage wiring for a proximal periprosthetic femoral fracture. Immediately after the operation, the patient developed motor and sensory disorders, particularly in the sciatic nerve area, leading to a suspicion of nerve injury. Consequently, reoperation showed that the right sciatic nerve was strangulated by the cerclage wire, but the nerve was functional. Since the sciatic nerve was partially continuous and retained sensation to some extent, strangulation release was performed. Subsequently, both sensory and motor disorders improved. This case suggests that attention should be given to not only the blood vessels in the anterior region but also the sciatic nerve in the posterior region when performing cerclage wiring for femoral fractures.

Keywords

• Iatrogenic sciatic nerve injury
• Cerclage wiring
• Proximal periprosthetic femoral fracture
• Functional recovery of the peroneal and tibial nerve branch