Sciatic nerve injury

Case contributed by Maulik S Patel
Diagnosis certain

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

Age: 20 years
Gender: Male
ultrasound

Sciatic nerve

  • cut injury in mid-thigh involving about 80% diameter
  • full-thickness defect involving lateral fibers ( about 10 mm length )
  • few medial most fibers show continuity

Tibial nerve and common peroneal nerve in proximal length

  • normal

Vastus lateralis muscle

  • partial rupture: defect filled with hematoma 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
x-ray

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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