Manny Porat1, Fabio Orozco2, Nitin Goyal3, Zachary Post2, Alvin Ong2. 1. Reconstructive Orthopedics, 737 Main Street, Suite 6, Lumberton, NJ 08048 USA ; 200 Bowman Drive, Suite E-100, Voorhees, NJ 08043 USA. 2. Rothman Institute, 2500 English Creek Avenue, Building 1300, Egg Harbor Township, NJ 08234 USA. 3. Anderson Orthopaedic Clinic, 2445 Army Navy Drive, Arlington, VA 22206 USA.
Abstract
BACKGROUND: Nerve injury during acetabular and pelvic fracture fixation can have devastating consequences for trauma patients already in a compromised situation. QUESTIONS/PURPOSES: This study aims to evaluate the efficacy of multimodality intraoperative neurophysiologic monitoring during acetabular and pelvic fracture fixation in identifying emerging iatrogenic nerve injury. METHODS: Sixty patients were retrospectively identified after surgical fixation following acetabular or pelvic fracture. Neuromonitoring during surgery was performed using three different modalities, transcranial electric motor evoked potential (tceMEP), somatosensory evoked potential (SSEP), and electromyographic (EMG) monitoring. Each modality was evaluated for sensitivity and specificity of detecting an intraoperative nerve injury. RESULTS: tceMEP monitoring was found to be 100% sensitive and 86% specific at detecting an impending nerve injury. The sensitivity and specificity of SSEP were 75% and 94%, while EMG sensitivity was unacceptably low at 20% although specificity was 93%. CONCLUSIONS: Multimodality neuromonitoring of transcranial electric motor and peroneal nerve somatosensory evoked potentials with or without spontaneous EMG monitoring is a safe and effective method for detecting impending nerve injury during acetabular and pelvic surgery.
BACKGROUND:Nerve injury during acetabular and pelvic fracture fixation can have devastating consequences for traumapatients already in a compromised situation. QUESTIONS/PURPOSES: This study aims to evaluate the efficacy of multimodality intraoperative neurophysiologic monitoring during acetabular and pelvic fracture fixation in identifying emerging iatrogenic nerve injury. METHODS: Sixty patients were retrospectively identified after surgical fixation following acetabular or pelvic fracture. Neuromonitoring during surgery was performed using three different modalities, transcranial electric motor evoked potential (tceMEP), somatosensory evoked potential (SSEP), and electromyographic (EMG) monitoring. Each modality was evaluated for sensitivity and specificity of detecting an intraoperative nerve injury. RESULTS: tceMEP monitoring was found to be 100% sensitive and 86% specific at detecting an impending nerve injury. The sensitivity and specificity of SSEP were 75% and 94%, while EMG sensitivity was unacceptably low at 20% although specificity was 93%. CONCLUSIONS: Multimodality neuromonitoring of transcranial electric motor and peroneal nerve somatosensory evoked potentials with or without spontaneous EMG monitoring is a safe and effective method for detecting impending nerve injury during acetabular and pelvic surgery.
Authors: George John Haidukewych; Julia Scaduto; Dolfi Herscovici; Roy W Sanders; Thomas DiPasquale Journal: J Orthop Trauma Date: 2002-05 Impact factor: 2.512
Authors: Alan S Hilibrand; Daniel M Schwartz; Venkat Sethuraman; Alexander R Vaccaro; Todd J Albert Journal: J Bone Joint Surg Am Date: 2004-06 Impact factor: 5.284
Authors: Daniel M Schwartz; Joshua D Auerbach; John P Dormans; John Flynn; Denis S Drummond; J Andrew Bowe; Samuel Laufer; Suken A Shah; J Richard Bowen; Peter D Pizzutillo; Kristofer J Jones; Denis S Drummond Journal: J Bone Joint Surg Am Date: 2007-11 Impact factor: 5.284