Sciatic Nerve Injury and Bone Defect on Subtrochanteric Region on a Young Male Patient after Injury with a Military Gun-Treatment with Acute Shortening and End to End Neuroraphy - Case Report

Introduction: A 34 years old man, suffered from a severe injury from a military gun. The entry side was on buttocks and the exit side on the upper third of the anterior thigh. The bullet course provoked a comminuted femoral subtrochanteric fracture with a bone defect of 7 cm and a sciatic nerve injury.

Methodology and Material: The patient was treated with an LRS external fixator, acute fracture shortening to resolve the bone defect and with the future possibility for a lengthening osteotomy. The surgical exploration of the wound was performed on prone position and an extensive surgical debridement of necrotic tissues also. The tibial part of the sciatic nerve presented thermal injury. The perineurium was debrided. The nerve was found not ruptured but with edema and hyperemia. The peroneal part was severely damaged. Due to acute shortening of the limb, we performed a dissection and end to end suture without tension, and the tibial nerve has been left on loop (looping technique).

Results: On day 25 the patient showed signs of tibial nerve functional improvement. On 1 month was performed a diaphyseal femoral osteotomy. On 2 months, while the gastrocnemius muscles had a motor function, the femoral lengthening started. On 4.5 months the lengthening was completed and was succeeded an isoskely. The patient is walking wearing a drop foot splint. On 5 months was noticed an active extension of the foot due to regeneration of peroneal nerve. During hospitalization the patient was treated with electrotherapy and physiotherapy.

Conclusions: On severe gunshot injuries with bone defects and nerve injury the acute shortening is a good solution which makes possible the end to end suture of the nerves and the acute wound closure