Sciatic transection: nerve extraordinaire with an unforeseen injury

Objective: Closed femur fractures leading to complete transection of the sciatic nerve are rare injuries. Early clinical suspicion and an magnetic resonance imaging (MRI) of the thigh are necessary to confirm the diagnosis. Surgical intervention at the earliest is the only definitive treatment, followed by prolonged and intense rehabilitation. Case report: A 38-year-old lady, a police constable, met with a road traffic accident. She was run over by a vehicle, inflicting a closed femur fracture in the right thigh with a complete sciatic nerve transection. She presented to the emergency department with severe thigh pain, bruising, and swelling over the thigh. On clinical examination, distal pulsations were intact, but there was a complete loss of movement below the knee. Following resuscitation, splinting, and stabilization, she was evaluated with an X-ray. A comminuted, displaced lower half of the femur shaft fracture was noticed. For motor and sensory loss below the knee, she underwent emergency MRI and sciatic neurography confirming sciatic transection at the fracture level with a gap of 4 cm between the two ends of the nerve with a large hematoma. She underwent open reduction and internal fixation (ORIF) emergently, followed by sciatic nerve repair with a sural nerve graft from the ipsilateral leg after 4 weeks. Conclusion: Closed femur shaft fracture with sciatic nerve transection is a rare occurrence. Very few case reports are available in the literature. Early diagnosis, surgical reconstruction, and intense rehabilitation are essential for a satisfactory neurological outcome.