Intraoperative monitoring of motor pathways during operative fixation of acute acetabular fractures

Journal of Orthopaedic Trauma
D L HelfetS Burga

Abstract

To determine whether intra-operative spontaneous electromyography (EMG) was superior to somatosensory evoked potentials (SSEP) in the prevention of iatrogenic sciatic nerve injury. Prospective, consecutive. Tertiary referral, teaching Hospital in New York City. Seventy-four patients with acutely displaced acetabular fractures. Group A consisted of 24 patients who underwent intraoperative sciatic nerve monitoring using SSEP only. Group B consisted of 50 patients who underwent monitoring using both SSEP and spontaneous EMG. Motor potentials were recorded from the tibialis anterior, peroneus longus, abductor hallucis, and flexor hallucis longus muscles. All patients had independent preoperative and postoperative evaluations by the same neurologist. One iatrogenic sciatic nerve injury occurred in group A and none in group B. Prolonged sciatic nerve compromise, demonstrated by significant intraoperative SSEP changes, occurred 2.4 times per case in group A and only 0.8 times per case in group B. In group B, spontaneous EMG noted compromise an average of 3.6 times per case (p < 0.0001). The results of this study support spontaneous EMG as feasible and superior to SSEP monitoring in detecting intraoperative sciatic nerve comprise in ac...Continue Reading

References

Jan 1, 1983·Anesthesiology·B L Grundy
Feb 1, 1995·Journal of Orthopaedic Trauma·D L HelfetR Sanders

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Citations

Dec 18, 2008·HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery·Paul S Issack, David L Helfet
Jan 16, 2014·HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery·Manny PoratAlvin Ong
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Oct 15, 2021·Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology·Luigi MurenaGianluca Canton

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