Presentation
History of penetrating right thigh injury a few days prior. Complaining of foot drop. Nerve conduction study suggested injury to the sciatic nerve or its divisions. Referred for sciatic nerve tracing.
Patient Data
Sciatic nerve
- cut injury in mid-thigh involving about 80% diameter
- full-thickness defect involving lateral fibres ( about 10 mm length )
- few medial most fibres show continuity
Tibial nerve and common peroneal nerve in proximal length
- normal
Vastus lateralis muscle
- partial rupture: defect filled with haematoma measuring about 38 x 29 x 22 mm
Biceps femoris short head muscle
- partial rupture near the origin
Femur
- a detached long bone fragment ( 40 mm length ) from the femur; deep to the sciatic nerve
There is an elongated bone flake detached from the posterior medial cortex of the femur. It involves half the thickness of the femoral cortex.
Case Discussion
A young male presented with a foot drop with a recent history of a penetrating injury to the thigh. Ultrasound shows a sciatic nerve injury along with biceps femoris and vastus lateralis muscle injuries. There is also a fracture of the underlying femur cortex.
While doing the musculoskeletal ultrasound, the depth should be adjusted to include the underlying bone cortex which should be looked for in any abnormality.
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