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Review Question - QID 3036

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QID 3036 (Type "3036" in App Search)
A 37-year-old male sustains the injury shown in Figure A following a motorcycle crash. During the approach, what limb position minimizes tension placed on the sciatic nerve?
  • A

Hip at 45 degrees, knee flexed to 90 degrees

6%

232/3927

Hip at 60 degrees, knee flexed to 90 degrees

8%

299/3927

Hip at 90 degrees, knee extended

2%

90/3927

Hip at 0 degrees, knee flexed to 90 degrees

80%

3146/3927

Hip at 90 degrees, knee flexed to 90 degrees

3%

126/3927

  • A

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During the Kocher-Langenbeck approach, the sciatic nerve is at the least amount of tension with the hip extended and the knee flexed to 90 degrees.

The CT exhibits a posterior wall acetabular fracture, which is fixed via a Kocher-Langenbeck approach. The sciatic nerve, which comes out of the greater sciatic notch, is at the least amount of tension with the hip extended and knee flexed to 90 degrees.

Borrelli et al examined the intraneural pressure of the sciatic nerve with the hip and knee in various different positions. The authors noted that the highest tension was placed on the sciatic nerve when the hip was flexed to 90 degrees and the knee was fully extended. As a result, the leg is typically position with the hip in extension (or minimal flexion) and the knee in about 90 degrees of flexion when performing acetabular surgery via a posterior approach.

Figure A shows an axial pelvic CT cut with a posterior wall acetabular fracture.

Incorrect answers:
Answer 1,2,3,5: With any degree of hip flexion, it places tension on the sciatic nerve, answer 4 (hip flex to 90 and knee fully extended), specifically places the highest amount of intraneural pressure on the nerve.

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