Complete Sciatic Nerve Transection Associated with a Closed Femoral Shaft Fracture

We report a rare case of a 33-year-old female patient who sustained bilateral closed femoral shaft fractures as a result of motor vehicle collision. The left femoral shaft fracture was associated with primary complete sciatic nerve palsy. The patient underwent intramedullary nail fixation of both femoral shaft fractures. Throughout the postoperative course, no functional recovery was observed. Nerve conduction studies and magnetic resonance imaging studies confirmed the diagnosis of a complete transection of the sciatic nerve at the level of the fracture site. Subsequently, the patient underwent surgical exploration and nerve grafting resulting in improved nerve function. Reports on complete sciatic nerve transections associated with closed femoral shaft fractures are limited. We document a unique injury and illustrate the patient’s management and outcome. absent in the tibial and peroneal nerve distribution. She had dopplerable dorsalis pedis and posterior tibial pulses and the ankle brachial indexes were 0.8. The thigh and leg compartments were soft and compressible and without signs of a compartment syndrome. The neurovascular examination of the right lower extremity was within normal limits. Consecutive neurovascular examinations confirmed lack of motor and sensory function in the left lower extremity. A computer tomography (CT) angiography was completed and showed no damage to the femoral vessels on both sides. Following appropriate resuscitation, the patient was taken to the operating room for intramedullary nailing of her left femoral shaft fracture on the first day after her injury. Perioperative antibiotic prophylaxis was performed with three doses of cefazolin every 8 hours Figure 1: Left femoral shaft fracture with mild comminution and displacement.