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Al F, Köroglu M, Özdeş HU, Aslantürk O. Iliacus hematoma causing late femoral nerve palsy. Clin Case Rep 2024; 12:e8654. [PMID: 38464580 PMCID: PMC10920301 DOI: 10.1002/ccr3.8654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
Femoral nerve palsy is rare and may progress insidiously, leading to late clinical presentation. Identifying the underlying cause is very important for treatment. An iliacus hematoma causing nerve palsy is perhaps the most innocent etiology. However, this hematoma sometimes causes only abdominal pain and may even be misdiagnosed as a late intra-abdominal pathology.
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Affiliation(s)
- Fırat Al
- Department of Orthopedics and TraumatologyInonu University Faculty of MedicineMalatyaTurkey
| | - Muhammed Köroglu
- Department of Orthopedics and TraumatologyInonu University Faculty of MedicineMalatyaTurkey
| | - Hüseyin Utku Özdeş
- Yesilyurt Hasan Çalık State Hospital Orthopedics and TraumatologyMalatyaTurkey
| | - Okan Aslantürk
- Department of Orthopedics and TraumatologyInonu University Faculty of MedicineMalatyaTurkey
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Oueslati MW, Kamoun K, Arfa W, Jenzri M, Chaabouni M, Riahi H. Traumatic iliac muscle hematoma: A rare etiology of quadriceps palsy (case report). Int J Surg Case Rep 2024; 115:109124. [PMID: 38245946 PMCID: PMC10831809 DOI: 10.1016/j.ijscr.2023.109124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Quadriceps palsy is a sign of femoral nerve injury. Classically it is a compression of the nerve by a haematoma of the iliopsoas muscle in haemophiliacs and patients on anticoagulants. Could this haematoma form after a trauma in a healthy athlete? CASE PRESENTATION We report a case of 16-year-old kickboxer with no previous history who had been complaining of the left groin for 3 weeks after being struck in the left iliac fossa. The examination revealed a complete palsy of the left quadriceps with anesthesia of the anterior aspect of the thigh. Femoral nerve involvement was suspected. MRI of the pelvis revealed a large hematoma of the left iliac muscle compressing the femoral nerve. Blood tests did not show any abnormalities. Surgical evacuation of the hematoma with neurolysis of the femoral nerve was performed. Six months postoperatively, the patient had fully recovered from their neurological deficit and was able to return to all his normal activities. CLINICAL DISCUSSION The post-traumatic etiology of iliopsoas muscle hematoma compressing the femoral nerve in the absence of any hematological cause is rare. Few cases have been published (39 in 75 years). According to the literature, treatment is conservative if the paralysis is partial, but it must be surgical in case of complete paralysis. CONCLUSION This rare pathology of the adolescent must be known to avoid any prejudicial diagnostic error for the often athletic patient. Whatever the diagnostic delay, a surgical procedure is necessary in case of complete paralysis of the femoral nerve.
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Affiliation(s)
- Mohamed Wajih Oueslati
- Pediatric Orthopedics Department of Mohammed Kassab National Institute of Orthopaedics, Tunisia.
| | - Khaled Kamoun
- Pediatric Orthopedics Department of Mohammed Kassab National Institute of Orthopaedics, Tunisia.
| | - Wajdi Arfa
- Pediatric Orthopedics Department of Mohammed Kassab National Institute of Orthopaedics, Tunisia.
| | - Mourad Jenzri
- Pediatric Orthopedics Department of Mohammed Kassab National Institute of Orthopaedics, Tunisia.
| | - Mohamed Chaabouni
- Radiology Department of Mohammed Kassab National Institute of Orthopaedics, Tunisia.
| | - Hend Riahi
- Radiology Department of Mohammed Kassab National Institute of Orthopaedics, Tunisia.
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Guild TT, Crawford AM, Striano BM, Mortensen S, Wixted JJ. The epidemiology and management of iliopsoas hematoma with femoral nerve palsy: A descriptive systematic review of 174 cases. Injury 2023; 54:280-287. [PMID: 36586813 DOI: 10.1016/j.injury.2022.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Iliopsoas hematoma with femoral nerve palsy is a rare phenomenon with no consensus treatment algorithm. The objective of this study was to perform a systematic review of all reported cases of femoral nerve palsy secondary to iliopsoas hematoma to better elucidate it's optimal treatment. MATERIALS AND METHODS Queries of the PubMed, Embase, and Cochrane databases were performed for reports available in English of femoral nerve palsy secondary to iliopsoas, psoas, or iliacus hematoma. 1491 articles were identified. After removal of duplicated publications and review of abstract titles via a majority reviewer consensus, 217 articles remained for consideration. Dedicated review of the remaining articles (including their reference sections) yielded 122 articles representing 174 distinct cases. Clinical data including patient age, sex, medical history, use of pharmacologic anticoagulation, sensory and motor examination at presentation and follow-up, hematoma etiology and location, time to intervention, and type of intervention were collected. Descriptive statistics were generated for each variable. RESULTS Femoral nerve palsy secondary to iliopsoas hematoma occurred at a mean age of 44.5 years old. A majority of patients (60%) were male, and a majority of hematomas (54%) occurred due to pharmacologic anticoagulation. Most hematomas (57%) were treated conservatively, and almost half (49%) - regardless of treatment modality - resulted in persistent motor deficits at final follow-up. A minority of patients treated surgically (34%) had residual motor deficit at final follow-up, while 66% of those treated medically had resultant motor deficits, although no direct statistical comparison was able to be performed. DISCUSSION AND CONCLUSIONS The disparate available data on iliopsoas hematoma with femoral nerve palsy precludes the completion of a true metanalysis, and therefore any conclusions on an optimal treatment algorithm. Based on review of the literature, small to moderate hematomas are often treated conservatively, while larger hematomas with progressive neurological symptoms are usually managed with a percutaneous decompression or surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Theodore T Guild
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA.
| | - Alexander M Crawford
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Sharri Mortensen
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Boston, MA
| | - John J Wixted
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Crawford AM, Guild TT, Striano BM, Von Keudell AG. Spontaneous iliacus haematoma with femoral nerve palsy: an appeal to involve surgical teams early. BMJ Case Rep 2021; 14:14/1/e239024. [PMID: 33462039 PMCID: PMC7816894 DOI: 10.1136/bcr-2020-239024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We report the case of a 68-year-old man who was placed on heparin as bridge therapy and subsequently developed an iliacus haematoma with associated femoral nerve palsy. His team involved the orthopaedic surgery team in delayed fashion after his symptom onset. Due to his active medical conditions, he did not undergo surgical decompression of his haematoma until late into his hospital course. Unfortunately, this patient did not regain meaningful function from his femoral nerve deficit. We believe this case highlights the high index of suspicion necessary for making this diagnosis as well as the repercussions of an untimely decompression for this acute, compressive neuropathy. Although we are surgeons and this is a surgical case, we hope to publish this case in a medical journal to raise awareness that surgical decompression does have a role in this diagnosis and should ultimately be pursued early in its course for optimal patient benefit.
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Affiliation(s)
| | - Theodore T Guild
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA
| | - Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA
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Abstract
RATIONALE Hematoma of the iliopsoas muscle is a rare condition. Prolonged pressure conditions due to hematoma of the femoral nerve can cause severe pain in the affected groin, hip, and thigh, and quadriceps weakness. We report a rare case of a spontaneous iliopsoas muscle hematoma that caused sudden femoral neuropathy. PATIENT CONCERNS A 71-year-old woman presented sudden left hip pain and knee extensor weakness. The pain was aggravated with left hip extension. She had a bilateral total hip replacement surgery due to avascular necrosis. She was diagnosed as mild stenosis of the cerebral artery and took aspirin to prevent cerebral artery atherosclerosis. DIAGNOSIS A hip computed tomography scan demonstrated a suspicious fluid collection at the left iliopsoas bursa. We considered the possibility of lower limb weakness due to neuralgic amyotrophy and performed electromyography and enhanced lumbosacral magnetic resonance imaging (MRI). Electromyography finding showed left femoral neuropathy of moderate severity around the inguinal area was diagnosed. On MRI, left iliopsoas bursitis or hematoma, and displacement of the left femoral nerve due to the iliopsoas bursitis/hematoma were observed. INTERVENTION Ultrasonography (US)-guided aspiration of the left iliopsoas hematoma was performed. We started steroid pulse therapy for 8 days. OUTCOMES After US-guided aspiration and steroid pulse therapy, the patient's knee extension motor grade improved from grade 1 to 2, and the pain was slightly reduced. At 3 weeks after the aspiration procedure, her hip flexion motor grade had improved from grade 3+ to 4 at follow-up. LESSONS Imaging studies are fundamental to diagnose of iliopsoas hematoma. Electromyography examination plays an important role in determining the prognosis of patients and lesion site. Despite the negligible change in sitting position, hematoma can develop. Physicians should consider hematoma that cause femoral neuropathy.
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Affiliation(s)
- Jae Hoon Kim
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Dong Hwan Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young Rok Han
- Department of Physical Medicine and Rehabilitation, Kyung Hee University Hospital at Gangdong
| | - Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Kato T, Chinzei N, Katayama N, Hirota S, Takahashi M. Successful Transcatheter Arterial Embolisation for a Traumatic Iliacus Hematoma: A Case Report. Malays Orthop J 2020; 14:92-95. [PMID: 32296490 PMCID: PMC7156174 DOI: 10.5704/moj.2003.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A traumatic iliacus hematoma is rare and usually occurs in patients after a fall involving a lower back injury. Although the hematoma may compress the femoral nerve causing femoral nerve palsy, the gold standard treatment for this condition has not been established. Here we report transcatheter arterial embolisation as a useful treatment strategy for a traumatic iliacus hematoma.
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Affiliation(s)
- T Kato
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, Japan
| | - N Chinzei
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, Japan
| | - N Katayama
- Department of Radiology, Konan Hospital, Kobe, Japan
| | - S Hirota
- Department of Radiology, Konan Hospital, Kobe, Japan
| | - M Takahashi
- Department of Orthopaedic Surgery, Konan Hospital, Kobe, Japan
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Takenaka S, Hamada KI, Tanaka H, Outani H, Naka N, Yoshikawa H. Silent subperiosteal iliac hematoma with bone radiolucency in adolescent male athletes. J Orthop 2019; 17:198-202. [PMID: 31879504 DOI: 10.1016/j.jor.2019.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/11/2019] [Indexed: 11/26/2022] Open
Abstract
Background Subperiosteal hematoma of the iliac bone is reported as a rare disorder that specifically occurs in young patients after obvious trauma. This report presents seven cases of male adolescent athletes with subperiosteal iliac hematoma without blunt trauma that was identified as an incidental radiolucent lesion on the iliac bone mimicking neoplasm. The purpose of this report is to describe clinical features and radiological findings of silent subperiosteal hematoma of the iliac bone. Subjects and methods We retrospectively reviewed the clinical data and radiological appearance of 7 patients who presented with subperiosteal hematoma of iliac bone. Results All seven patients had no obvious trauma and no serious symptoms. All patients were middle school or high school male students who regularly participated in vigorous sports activity; five soccer players, one baseball catcher, and one basketball player. The X-ray showed radiolucent lesion on the iliac bone. Lens-shaped mass without involvement of psoas muscle with ghost native cortex sign and overlying periosteal calcification on CT scan was characteristic radiological finding on subperiosteal iliac hematoma. Conclusion Subperiosteal iliac hematomas can be caused by vigorous sports activity in adolescence. This condition is not always associated with serious symptom. It can be identified as a radiolucent lesion mimicking a neoplasm.
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Affiliation(s)
- Satoshi Takenaka
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Japan
| | - Ken-Ichiro Hamada
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Japan
| | - Hisashi Tanaka
- Department of Radiology, Osaka University Graduate School of Medicine, Japan
| | - Hidetatsu Outani
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Japan
| | - Norifumi Naka
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Japan
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8
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Nefiss M, Tebourbi A, Ben Maatoug A, Bouzidi R. Femoral nerve paralysis complicating a post-traumatic iliopsoas haematoma. BMJ Case Rep 2018; 2018:bcr-2017-220446. [PMID: 29930178 DOI: 10.1136/bcr-2017-220446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paralysis of the femoral nerve secondary to iliopsoas haematoma is a rare post-traumatic complication. Because of the large differential diagnosis, a high level of suspicion is required for its early recognition. Treatment modalities are controversial due to the rarity of this entity. An 18-year-old student presented with complete paralysis of the knee extensors and a sensory deficit on the anterior side of the thigh 5 weeks after a sport accident. MRI of the lesser pelvis showed an iliopsoas haematoma. Surgical decompression was performed and recovery was complete at 6 months of follow-up.
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Affiliation(s)
- Mouadh Nefiss
- Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia
| | - Anis Tebourbi
- Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia
| | - Aymen Ben Maatoug
- Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia
| | - Ramzi Bouzidi
- Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia
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9
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Khattar NK, Parry PV, Agarwal N, George HK, Kretz ES, Larkin TM, Gruen GS, Abla AA. Total Hip Arthroplasty Complicated by a Gluteal Hematoma Resulting in Acute Foot Drop. Orthopedics 2016; 39:e374-6. [PMID: 26966944 DOI: 10.3928/01477447-20160307-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/23/2015] [Indexed: 02/03/2023]
Abstract
Total hip arthroplasty is a prevalent orthopedic intervention in the United States. Massive postoperative hematomas are a rare albeit serious complication of the procedure. Sequelae of these hematomas can include lower extremity paralysis from compression of the sciatic nerve. A 66-year-old woman taking aspirin and clopidogrel for coronary stents presented with a complete foot drop, paresthesias, and lower extremity pain 10 days after a total hip arthroplasty. The patient was initially seen by a neurology service at another hospital and thought to have lateral recess stenosis. At the authors' center, magnetic resonance imaging of the lumbar spine failed to show lateral recess stenosis. Urgent pelvic computed tomography showed a large hematoma and raised suspicion of sciatic nerve compression. Hip magnetic resonance imaging showed a right gluteal hematoma compressing the sciatic nerve. The patient was then taken to the operating room for the clot to be evacuated and was later referred for rehabilitation. Massive hematomas after total hip arthroplasty are an important consideration in the differential diagnosis of nontraumatic acute foot drop. Prompt diagnosis may correlate with improved neurological outcome and help reduce overall morbidity.
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10
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García-Alcázar D, García-Chapinal B, Batllori-Badia E, López-González G, Lorenzo-Hernando E, Jiménez-López JS, Muñoz-Hernando L, Muñoz-González JL. Psoas haematoma as a complication of Veress needle insertion: description of a case and literature review. BMC Surg 2014; 14:104. [PMID: 25488585 PMCID: PMC4268806 DOI: 10.1186/1471-2482-14-104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 12/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In terms of gynaecological laparoscopic surgery, major complications affecting great vessels, and especially the retroperitoneal ones, are unusual. CASE PRESENTATION We introduce a case of a retroperitoneal haematoma associated with psoas muscle pseudoaneurysm, as a side effect of Veress needle insertion, during laparoscopic surgery. Such complication was managed conservatively at first, requiring finally arterial embolisation. CONCLUSION Even though potential complications associated with laparoscopic surgery are infrequent, they must not be underestimated, and in some cases might need a multidisciplinary management.
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Affiliation(s)
| | | | | | | | | | - Jesús S Jiménez-López
- Gynecological Endoscopy Unit, Obstetrics and Gyneacology Service, University Hospital 12 de Octubre, Avda Cordoba s/n 28041, Madrid, Spain.
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11
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Kuo HW, Ku JW, Chiang CJ, Rau G, Chen CY, Chen CH. Complete Femoral Nerve Palsy Following Traumatic Iliacus Hematoma: A Case Report and Literature Review. JBJS Case Connect 2013; 3:e74. [PMID: 29252613 DOI: 10.2106/jbjs.cc.l.00291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Hsiu-Wen Kuo
- Department of Radiology, Buddhist Tzuchi General Hospital Taipei Branch, No. 289, Jianguo Road, Xindian District, New Taipei City 23142, Taiwan
| | - Jan-Wen Ku
- Department of Radiology (J.-W.K.), Department of Orthopaedics (C.-J.C., G.R., C.-Y.C., C.-H.C.), Shuang-Ho Hospital, Taipei Medical University, Taipei, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan.
| | - Chang-Jung Chiang
- Department of Radiology (J.-W.K.), Department of Orthopaedics (C.-J.C., G.R., C.-Y.C., C.-H.C.), Shuang-Ho Hospital, Taipei Medical University, Taipei, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan.
| | - Gary Rau
- Department of Radiology (J.-W.K.), Department of Orthopaedics (C.-J.C., G.R., C.-Y.C., C.-H.C.), Shuang-Ho Hospital, Taipei Medical University, Taipei, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan.
| | - Chih-Yu Chen
- Department of Radiology (J.-W.K.), Department of Orthopaedics (C.-J.C., G.R., C.-Y.C., C.-H.C.), Shuang-Ho Hospital, Taipei Medical University, Taipei, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan.
| | - Chia-Hsien Chen
- Department of Radiology (J.-W.K.), Department of Orthopaedics (C.-J.C., G.R., C.-Y.C., C.-H.C.), Shuang-Ho Hospital, Taipei Medical University, Taipei, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan.
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Frew N, Foster P, Maury A. Femoral nerve palsy following traumatic posterior dislocation of the native hip. Injury 2013; 44:261-2. [PMID: 23026112 DOI: 10.1016/j.injury.2012.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/04/2012] [Indexed: 02/02/2023]
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Guillin R, Moser T, Koob M, Khoury V, Chapuis M, Ropars M, Cardinal E. Subperiosteal hematoma of the iliac bone: imaging features of acute and chronic stages with emphasis on pathophysiology. Skeletal Radiol 2012; 41:667-75. [PMID: 21915652 DOI: 10.1007/s00256-011-1267-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 08/09/2011] [Accepted: 08/21/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of this work is to describe the radiological appearance and clinical presentation of subperiosteal iliac hematoma and present a review of the literature. MATERIALS AND METHODS We retrospectively reviewed the radiological and clinical files of 19 patients (age range: 12-75; mean: 47) who presented with acute or chronic subperiosteal iliac hematomas. Imaging findings and relevant clinical information were recorded. A thorough literature search was performed to find additional cases of this rare condition. RESULTS Three young patients presented with acute subperiosteal iliac hematoma following a fall. Clinical presentation was characterized by pain and gait disturbance presumed to result from crural nerve compression. Unilateral or bilateral lenticular hematomas deep in the iliacus muscle were demonstrated by CT for all patients while MRI was also available for two of them. In 16 asymptomatic patients, chronic ossified subperiosteal iliac hematomas were incidentally detected by CT. Progressive ossification of acute hematoma was demonstrated at follow-up in two patients. CONCLUSIONS Subperiosteal iliac hematoma is rare but has typical imaging findings that may present acutely in adolescents or chronically in asymptomatic adults.
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Affiliation(s)
- Raphaël Guillin
- Department of Musculoskeletal Imaging, Rennes University Hospital, 35203, Rennes Cedex 2, France.
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14
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Yi TI, Yoon TH, Kim JS, Lee GE, Kim BR. Femoral neuropathy and meralgia paresthetica secondary to an iliacus hematoma. Ann Rehabil Med 2012; 36:273-7. [PMID: 22639754 PMCID: PMC3358686 DOI: 10.5535/arm.2012.36.2.273] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 04/19/2011] [Indexed: 11/05/2022] Open
Abstract
Compressive femoral and lateral femoral cutaneous neuropathies from an iliacus hematoma are unusual presentation. We report a case of a 16-year-old boy who developed right femoral and lateral femoral cutaneous neuropathies as a complication of traumatic ipsilateral iliacus hematoma formation. The patient complained of numbness in the right thigh and calf as well as right leg weakness, and pain in the right inguinal area. Nerve conduction study and needle electromyography identified the neuropathies. After the electrodiagnostic studies, the pelvic bone MRI revealed a large, 9×5×4.5 cm right iliacus hematoma. As a result, diagnosis of a right iliacus hematoma compressing the femoral and lateral femoral cutaneous nerves was made, and the patient underwent an operation to remove the hematoma. Symptoms and neurological signs showed notable improvement after surgical decompression. Subsequent follow-up electrodiagnostic studies after 11 weeks demonstrated regeneration evidence.
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Affiliation(s)
- Tae Im Yi
- Department of Rehabilitation Medicine, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam 463-774, Korea
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15
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Conesa X, Ares O, Seijas R. Massive psoas haematoma causing lumbar plexus palsy: a case report. J Orthop Surg (Hong Kong) 2012; 20:94-7. [PMID: 22535820 DOI: 10.1177/230949901202000119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
An 84-year-old man who was receiving oral anticoagulation therapy presented with complete lumbar plexus palsy caused by a massive psoas haematoma. Conservative treatment rather than drainage of the haematoma was undertaken, because of the risk of bleeding complications and mortality. At the one-year follow-up, the patient had no clinical signs of neurological recovery. The patient died 2 months later due to his concurrent medical problems. A high degree of suspicion is needed for the diagnosis because of the insidiously developing neurological deficit.
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Affiliation(s)
- Xavier Conesa
- Department of Traumatology and Orthopaedic Surgery, Hospital Municipal de Badalona, Barcelona, Spain
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16
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Kong WK, Cho KT, Lee HJ, Choi JS. Femoral Neuropathy due to Iliacus Muscle Hematoma in a Patient on Warfarin Therapy. J Korean Neurosurg Soc 2012; 51:51-3. [PMID: 22396845 PMCID: PMC3291708 DOI: 10.3340/jkns.2012.51.1.51] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 06/28/2011] [Accepted: 01/11/2012] [Indexed: 11/27/2022] Open
Abstract
Spontaneous hematomas of the iliacus muscle are rare lesions and these are seen in individuals receiving anticoagulation therapy or patients with blood dyscrasias such as hemophilia. It can cause femoral neuropathy and resultant pain and paralysis. Although there is no clear consensus for the treatment of femoral neuropathy from iliacus muscle hematomas, delays in the surgical evacuation of hematoma for decompression of the femoral nerve can lead to a prolonged or permanent disability. We report here on a rare case of a spontaneous iliacus muscle hematoma that caused femoral neuropathy in a patient who was taking warfarin for occlusive vascular disease and we discuss the treatment.
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Affiliation(s)
- Woo Keun Kong
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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17
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Abrams BM. Femoral and Saphenous Neuropathies. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00109-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Burke NG, Walsh M, O'Brien T, Synnott K. Diagnostic gait pattern of a patient with longstanding left femoral nerve palsy: a case report. J Orthop Surg (Hong Kong) 2010; 18:382-4. [PMID: 21187558 DOI: 10.1177/230949901001800327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The gait pattern of a 35-year-old man with longstanding, left femoral nerve palsy was assessed using 3-dimensional kinematic and kinetic analysis. Stability of his left knee in stance was achieved by manipulating the external moments of the limb so that the ground reaction force passes in front of the knee joint. This compensatory mechanism of locking the knee in extension is reliant on the posterior capsular structures. The patient was managed conservatively and continued to walk without aids.
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Affiliation(s)
- Neil G Burke
- Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland.
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Patel A, Calfee R, Thakur N, Eberson C. Non-operative management of femoral neuropathy secondary to a traumatic iliacus haematoma in an adolescent. ACTA ACUST UNITED AC 2008; 90:1380-1. [PMID: 18827251 DOI: 10.1302/0301-620x.90b10.21040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Iliacus haematoma is a relatively rare condition, which may cause a local compressive neuropathy. It is usually diagnosed in adults with haemophilia or those on anticoagulation treatment and may occur after trauma. We present the case of a healthy 15-year-old boy with a femoral neuropathy due to an iliacus haematoma which resolved following conservative treatment.
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Affiliation(s)
- A Patel
- Department of Orthopaedic Surgery, The Alpert School of Medicine, Brown University, 2 Dudley Street, Providence, Rhode Island 02905, USA.
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Gogus A, Ozturk C, Sirvanci M, Aydogan M, Hamzaoglu A. Femoral nerve palsy due to iliacus hematoma occurred after primary total hip arthroplasty. Arch Orthop Trauma Surg 2008; 128:657-60. [PMID: 18026742 DOI: 10.1007/s00402-007-0489-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Indexed: 11/26/2022]
Abstract
The perforation of the medial acetabular wall during total hip arthroplasty due to drilling is not uncommon. But, it has rarely been associated with serious adverse events. Here, we present a case report describing an iliacus hematoma with subsequent femoral nerve palsy after primary total hip arthroplasty in a 67-year-old woman who underwent primary total hip arthroplasty due to painful hip osteoarthritis. The diagnosis was made by pelvic magnetic resonance imaging. Conservative treatment was employed and the symptoms were resolved within 3 months. It should be borne in mind that femoral nerve palsy may occur after total hip arthroplasty. It may be due to a treatable cause, such as iliacus hematoma. So, pelvic MRI is recommended in such a condition, rather than just observation.
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Affiliation(s)
- Abdullah Gogus
- Faculty of Medicine, Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul Science University, Abide-i Hürriyet Caddesi, Sişli, Istanbul, Turkey
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Holzheimer RG. Pathophysiology of Groin Pain in Sporting Patients May Be More Complex than the Standard Definition of Groin Hernia. J Am Coll Surg 2008; 207:142-3; author reply 143. [DOI: 10.1016/j.jamcollsurg.2008.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2008] [Accepted: 03/04/2008] [Indexed: 10/21/2022]
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Rommelmann P. Kompression des Nervus femoralis durch ein sekundär disloziertes Trochanter-minor-Fragment bei pertrochantärer Femurfraktur. Unfallchirurg 2007; 110:645-7. [PMID: 17581729 DOI: 10.1007/s00113-007-1290-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pertrochanteric fractures of the femur are often associated with avulsion of the lesser trochanter. The most commonly applied techniques of osteosynthesis (proximal femur nailing; PFN/dynamic hip screw; DHS/gliding nail) do not involve repositioning or fixation of this fragment, which is dislocated as the result of traction from the iliopsoas muscle so that it is resting in the soft tissue. We report the case of a 70-year-old male patient with a pertrochanteric femur fracture with an initially undisplaced lesser trochanter fragment after a fall (AO classification 31-A2). PFN was performed on the day of the accident after closed reduction. Following an uneventful course, with increasing mobilisation the patient developed a compression syndrome of the femoral nerve with unbearable pain in the thigh. The cause was compression of the femoral nerve by a secondarily dislocated fragment of the lesser trochanter. After revision from a ventral approach with removal of the fragment the patient experienced total relief of the pain. No similar cases have so far been reported in the literature.
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Affiliation(s)
- P Rommelmann
- Klinik für Unfallchirurgie und Orthopädie, St. Elisabeth-Krankenhaus, Josefstrasse 3, 46045 Oberhausen, Germany.
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Abrams BM. Femoral and Saphenous Neuropathies. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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