Intraoperative monitoring of motor pathways during operative fixation of acute acetabular fractures.
OBJECTIVE
To determine whether intra-operative spontaneous electromyography (EMG) was superior to somatosensory evoked potentials (SSEP) in the prevention of iatrogenic sciatic nerve injury.


METHODS
Prospective, consecutive.


METHODS
Tertiary referral, teaching Hospital in New York City.


METHODS
Seventy-four patients with acutely displaced acetabular fractures.


METHODS
Group A consisted of 24 patients who underwent intraoperative sciatic nerve monitoring using SSEP only. Group B consisted of 50 patients who underwent monitoring using both SSEP and spontaneous EMG. Motor potentials were recorded from the tibialis anterior, peroneus longus, abductor hallucis, and flexor hallucis longus muscles. All patients had independent preoperative and postoperative evaluations by the same neurologist.


RESULTS
One iatrogenic sciatic nerve injury occurred in group A and none in group B. Prolonged sciatic nerve compromise, demonstrated by significant intraoperative SSEP changes, occurred 2.4 times per case in group A and only 0.8 times per case in group B. In group B, spontaneous EMG noted compromise an average of 3.6 times per case (p < 0.0001).


CONCLUSIONS
The results of this study support spontaneous EMG as feasible and superior to SSEP monitoring in detecting intraoperative sciatic nerve comprise in acute acetabular fracture surgery. Spontaneous EMG permits earlier detection of intraoperative sciatic nerve comprise, allowing a more rapid response of the surgical team to noxious nerve stimuli. This may prevent permanent neurologic sequellae.
Helfet
D L
DL
Hospital for Special Surgery, Orthopaedic Trauma Services, New York, NY 10021, USA.
Anand
N
N
Malkani
A L
AL
Heise
C
C
Quinn
T J
TJ
Green
D S
DS
Burga
S
S
D000077:Acetabulum / Q000293:injuries*; D000328:Adult; D004576:Electromyography; D005069:Evaluation Studies as Topic; D005073:Evoked Potentials, Somatosensory; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012584:Sciatic Nerve / Q000293:injuries*; D012680:Sensitivity and Specificity