title: Neurophysiologic monitoring can predict iatrogenic injury during acetabular and pelvic fracture fixation.
abstract: BACKGROUND
  Nerve injury during acetabular and pelvic fracture fixation can have devastating consequences for trauma patients already in a compromised situation.
  
  
  OBJECTIVE
  This study aims to evaluate the efficacy of multimodality intraoperative neurophysiologic monitoring during acetabular and pelvic fracture fixation in identifying emerging iatrogenic nerve injury.
  
  
  METHODS
  Sixty patients were retrospectively identified after surgical fixation following acetabular or pelvic fracture. Neuromonitoring during surgery was performed using three different modalities, transcranial electric motor evoked potential (tceMEP), somatosensory evoked potential (SSEP), and electromyographic (EMG) monitoring. Each modality was evaluated for sensitivity and specificity of detecting an intraoperative nerve injury.
  
  
  RESULTS
  tceMEP monitoring was found to be 100% sensitive and 86% specific at detecting an impending nerve injury. The sensitivity and specificity of SSEP were 75% and 94%, while EMG sensitivity was unacceptably low at 20% although specificity was 93%.
  
  
  CONCLUSIONS
  Multimodality neuromonitoring of transcranial electric motor and peroneal nerve somatosensory evoked potentials with or without spontaneous EMG monitoring is a safe and effective method for detecting impending nerve injury during acetabular and pelvic surgery.
authors.affiliation: Reconstructive Orthopedics, 737 Main Street, Suite 6, Lumberton, NJ 08048 USA ; 200 Bowman Drive, Suite E-100, Voorhees, NJ 08043 USA.
authors.forename: Manny
authors.initials: M
authors.lastname: Porat
authors.affiliation: Rothman Institute, 2500 English Creek Avenue, Building 1300, Egg Harbor Township, NJ 08234 USA.
authors.forename: Fabio
authors.initials: F
authors.lastname: Orozco
authors.affiliation: Anderson Orthopaedic Clinic, 2445 Army Navy Drive, Arlington, VA 22206 USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Goyal
authors.affiliation: Rothman Institute, 2500 English Creek Avenue, Building 1300, Egg Harbor Township, NJ 08234 USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Post
authors.affiliation: Rothman Institute, 2500 English Creek Avenue, Building 1300, Egg Harbor Township, NJ 08234 USA.
authors.forename: Alvin
authors.initials: A
authors.lastname: Ong
keywords: acetabular fracture; neurophysiologic monitoring; pelvic fracture