title: Neurologic Injury in Operatively Treated Acetabular Fractures.
abstract: OBJECTIVE
  The purpose of this study is to evaluate a series of operatively treated acetabular fractures with neurologic injury and to track sensory and motor recovery.
  
  
  METHODS
  Operatively treated acetabular fractures with neurologic injury from 8 trauma centers were reviewed. Patients were followed for at least 6 months or to neurologic recovery. Functional outcome was documented at 3 months, 6 months, and final follow-up. Outcomes included motor and sensory recovery, brace use, development of chronic regional pain syndrome, and return to work.
  
  
  RESULTS
  One hundred thirty-seven patients (101 males and 36 females), average age 42 (17-87) years, met the criteria. Mechanism of injury included MVC (67%), fall (11%), and other (22%). The most common fracture types were transverse + posterior wall (33%), posterior wall (23%), and both-column (23%). Deficits were identified as preoperative in 57%, iatrogenic in 19% (immediately after surgery), and those that developed postoperatively in 24%. A total of 187 nerve deficits associated with the following root levels were identified: 7 in L2-3, 18 in L4, 114 in L5, and 48 in S1. Full recovery occurred in 54 (29%), partial recovery in 69 (37%), and 64 (34%) had no recovery. Forty-three percent of S1 deficits and 29% of L5 deficits had no recovery. Fifty-five percent of iatrogenic injuries did not recover. Forty-eight patients wore a brace at the final follow-up, all for an L5 root level deficit. Although 60% (42/70) returned to work, chronic regional pain syndrome was seen to develop in 19% (18/94).
  
  
  CONCLUSIONS
  Peripheral neurologic injury in operatively treated acetabular fractures occurs most commonly in the sciatic nerve distribution, with L5 root level deficits having only a 26% chance of full recovery.
  
  
  METHODS
  Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA; †Department of Orthopaedic Surgery, Orthopaedic Associates of Michigan, Grand Rapids, MI; ‡Department of Orthopaedic Surgery, St Michael's Hospital, Toronto, Ontario Canada; §Department of Orthopaedic Surgery, Geisinger, Danville, PA; ‖Department of Orthopaedic Surgery, London Health Science Center, London, Ontario Canada; ¶Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA; **Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia Canada; ††Department of Orthopaedic Surgery, Lahey Health, Burlington, MA; and ‡‡Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Bogdan
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
authors.forename: Clifford
authors.initials: C
authors.lastname: Jones
authors.forename: Alex K
authors.initials: AK
authors.lastname: Gilde
authors.forename: Emil
authors.initials: E
authors.lastname: Schemitsch
authors.forename: Milena
authors.initials: M
authors.lastname: Vicente
authors.forename: Daniel
authors.initials: D
authors.lastname: Horwitz
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.forename: Reza
authors.initials: R
authors.lastname: Firoozabadi
authors.forename: Ross
authors.initials: R
authors.lastname: Leighton
authors.forename: Juan
authors.initials: J
authors.lastname: de Dios Robinson
authors.forename: Andrew
authors.initials: A
authors.lastname: Marcantonio
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hamilton
mesh_terms: D000077:Acetabulum / Q000293:injuries* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D005260:Female; D017102:Fracture Healing; D050723:Fractures, Bone / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D059348:Peripheral Nerve Injuries / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult