Surgical treatment of shotgun injuries of the sciatic nerve

Objective: To explore the clinical characteristics and the effect of surgical therapy for shotgun injuries of the sciatic nerve.

Methods: From 1996 to 2000, 19 sciatic nerve injuries resulted from shotgun were observed. Among 19 cases of shotgun sciatic nerve wounds, the gluteal wound was in 2 cases, thigh wound in 15 cases, and knee wound in 2 cases. The firing distance was between 0.5-9 m. According to Shermen classification of shotgun injury, 4 cases belonged to type I injury, 11 cases type II, 4 cases type III. The time from injury to admission was between 2 months-14 months except 1 patient who underwent emergency operation 4 hours after injury, and 1 patient was treated with debridement and epineurial neurorrhaphy, 7 cases with nerve trunk grafting, 6 cases with nerve cable grafting, 4 cases with neurolysis, 1 case with arthrodesis of ankle.

Results: Nineteen cases were followed-up for 0.8-3.5 years (mean, 19 months). The excellent and good nerve functional recovery was found in 52.6% according to MCRR.

Conclusions: Shotgun injuries of the sciatic nerve are very severe and complicated, and injuries in most patients were usually complicated by open fracture, vascular injury, soft-tissue loss and infection; the character of nerve injury was classified as 4-5 degree according to Sunderland Standard, nerve transfer is effective in the treatment of shotgun injuries of the sciatic nerve, but outcome is poor; the recovery of the sciatic nerve should be observed continually after injury; selecting correct initial treatment after injury, strict minimally invasive surgical procedure, physical therapy and reasonable preoperative and postoperative medication can improve the surgical results.