Disclosures: Jared R. Levin, MD: Nothing to disclose

Case Description: Late sciatic nerve graft in a pediatric patient.

Setting: Independent Children’s Specialty Hospital

Patient: 13-year-old female was pedestrian-struck on 2/10/18 and transported to the nearest level one trauma center. She was found to have a right T-type acetabular fracture with femoral head incarceration and right lower extremity sensorimotor deficits. While undergoing ORIF, surgeon reported evidence of sciatic nerve stretch injury. After medical stabilization, she was discharged for rehabilitation 2/26/18. She presented for rehabilitation with no active knee flexion or ankle movement, and trace knee extension. Electrodiagnostic studies on 6/13 indicated a proximal axonal sciatic nerve injury. Eventually, the patient underwent cadaveric sciatic nerve grafting on 10/4, and returned for rehabilitation 10/10.

Assessment/Results: At the time of re-admission, she had antigravity knee movements and ankle inversion, but no ankle sagittal movement or eversion. She had diminished sensation of the medial foot compared to absent sensation of the lateral foot and first web space. She developed trace ankle movement, which improved to near anti-gravity plantarflexion by discharge on 10/29/18. The patient continued with outpatient therapy following discharge, and 2 months later showed improved sensation in the lateral foot and near anti-gravity ankle dorsiflexion, improved plantar flexion strength and trace toe extension. The recovery pattern was consistent with improvement in the tibial component of the sciatic nerve before the fibular component.

Discussion: This case contributes to the paucity of literature regarding cadaveric lower extremity nerve grafts in pediatric patients. Although there is very limited data in sciatic nerve grafting as late as 6 months after injury, grafting appears successful in this patient 8 months after injury. The recovery pattern of tibial before fibular nerve is consistent with the current literature.

Conclusion: This is a unique case of cadaveric sciatic nerve grafting that provided functional benefits in a pediatric patient, even with delayed surgery 8 months after injury.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/successful-sciatic-nerve-grafting-in-a-teenager-8-months-after-pedestrian-struck-injury-a-case-report/