Incidence of sciatic nerve injury in operatively treated acetabular fractures without somatosensory evoked potential monitoring

Objective: The authors investigated the incidence of sciatic nerve injury associated with the operative repair of acetabular fractures without somatosensory evoked potential(SSEP) monitoring. Design: Retrospective case review of prospectively documented pre-and postoperative physical examinations. Setting: A level I trauma hospital. Patients: All the cases were reviewed of patients with open reduction and internal fixation of acetabular fractures who underwent posterior or extensile approaches (129) performed by the three senior authors from January 1991 through March 1995. Intervention: Intraoperative SSEP monitoring was not used during any of the procedures. The procedures included sixty-five Kocher-Langenbeck approaches, thirty-four combined Kocher-Langenbeck and iliofemoral approaches, four extended iliofemoral approaches, and four triradiate approaches. Results: One case of iatrogenic nerve injury resulted in a sensory deficit. No patient suffered an exacerbation of a preexisting nerve injury. Conclusion: The results of this study indicate that open reduction and internal fixation of acetabular fractures, using current techniques with visualization and protection of the sciatic nerve, can reduce the incidence of neurologic injury to a negligible level. There does not appear to be justification for the addition of SSEP or electromyograph modalities to the operative routine of experienced surgeons.