483 Complete Sciatic Nerve Transection from A Closed Femoral Fracture: A Case Report

Abstract Introduction Complete transection of the sciatic nerve following a closed femoral fracture is exceedingly uncommon. Delayed diagnosis may result due to this unrecognised injury pattern. Case Description: An 18-year-old male motorcyclist was referred following a significantly displaced closed, femoral fracture. The patient was sedated at the scene and transferred to theatre for definitive fixation, where an open reduction was performed via an anterior approach. Symptoms of paresthesia and weakness were reported immediately postoperatively, and formal neurological examination prompted an emergency MRI. On this basis, the patient was transferred to plastics and underwent surgical exploration, where complete transection of the sciatic nerve was identified just proximal to the bifurcation into the common peroneal and tibial nerve. A nerve gap of five centimetres was identified requiring reconstruction with grouped fascicular sural nerve grafts. Discussion: Complete transection of the sciatic nerve is a devastating injury that compromises the function of the posterior compartment of the thigh and all motor function below the knee. To our knowledge, reports of complete sciatic nerve transection secondary to a closed fracture of the femoral shaft are extremely rare in the pertinent literature, with only two other cases reported to date.

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Tissue Engineered Axon Tracts Serve as Living Scaffolds to Accelerate Axonal Regeneration and Functional Recovery Following Peripheral Nerve Injury in Rats

10.1101/654723 ◽

2019 ◽

Cited By ~ 2

Author(s):

Kritika S. Katiyar ◽

Laura A. Struzyna ◽

Joseph P. Morand ◽

Justin C. Burrell ◽

Basak Clements ◽

...

Keyword(s):

Sciatic Nerve ◽

Functional Recovery ◽

Peripheral Nerves ◽

Axonal Regeneration ◽

Axon Regeneration ◽

Nerve Transection ◽

Sciatic Nerve Transection ◽

Nerve Grafts ◽

Axonal Regrowth ◽

Peripheral Axon

AbstractAlthough regeneration of damaged axons in peripheral nerves has long been observed, the mechanisms facilitating this growth are not well characterized. Recently, we demonstrated that host axon regeneration could be greatly enhanced by transplanting engineered living axon tracts to guide outgrowth. Here, we used a model of rat sciatic nerve transection to explore potential mechanisms of this facilitated regeneration and its efficacy in comparison with nerve guidance tubes (NGTs) and autografts. Tissue engineered nerve grafts (TENGs) were developed via “stretch-growth” in mechanobioreactors and consisted of centimeter-scale aligned axonal tracts. Either TENGs, NGTs or autografts (reversed nerve) were then transplanted to bridge a 1 cm segmental gap in the sciatic nerve with the mechanisms of axonal regrowth assessed at 2 weeks and the extent of functional recovery assessed at 16 weeks. We observed numerous host axons growing directly along and intertwining with pre-formed axonal tracts in TENGs. This behavior appears to mimic the action of “pioneer” axons in developmental pathfinding by providing living cues for directed and accelerated outgrowth. Indeed, we found that the rates of axon regeneration were 3-4 fold faster than NGTs and equivalent to autografts. It was also observed that infiltration of host Schwann cells – traditional drivers of peripheral axon regeneration – was both accelerated and progressed directly along TENG axonal tracts. These TENG repairs resulted in levels of functional recovery equivalent to autografts, with each being several fold superior to NGT repairs. This new mechanism – which we term “axon-facilitated axon-regeneration” – may be further exploited to enhance axonal regeneration and functional recovery following neurotrauma.

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Complete Sciatic Nerve Transection Associated with a Closed Femoral Shaft Fracture

Journal of Trauma & Treatment ◽

10.4172/2167-1222.1000298 ◽

2016 ◽

Vol 5 (2) ◽

Cited By ~ 1

Author(s):

Boris A Zelle ◽

Antonio J Webb

Keyword(s):

Sciatic Nerve ◽

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Nerve Transection ◽

Sciatic Nerve Transection

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Faculty Opinions recommendation of Sciatic nerve transection triggers release and intercellular transfer of a genetically expressed macromolecular tracer in dorsal root ganglia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13396998.14765124 ◽

2011 ◽

Author(s):

Michael Andresen ◽

Tally Largent-Milnes

Keyword(s):

Sciatic Nerve ◽

Dorsal Root Ganglia ◽

Dorsal Root ◽

Nerve Transection ◽

Sciatic Nerve Transection ◽

Intercellular Transfer

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Effects of Taxol on Regeneration in a Rat Sciatic Nerve Transection Model

Scientific Reports ◽

10.1038/srep42280 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 8

Author(s):

Shih-Tien Hsu ◽

Chun-Hsu Yao ◽

Yuan-Man Hsu ◽

Jia-Horng Lin ◽

Yung-Hsiang Chen ◽

...

Keyword(s):

Growth Factors ◽

Sciatic Nerve ◽

Peripheral Nerve ◽

Nerve Regeneration ◽

Nerve Transection ◽

Cremophor El ◽

Neuronal Connectivity ◽

Sciatic Nerve Transection ◽

Expression Levels ◽

Nerve Growth Factors

Abstract Recent studies describe taxol as a candidate treatment for promoting central nerve regeneration. However, taxol has serious side effects including peripheral neurotoxicity, and little information is known about the effect of taxol on peripheral nerve regeneration. We investigated the effects of taxol on regeneration in a rat sciatic nerve transection model. Rats were divided into four groups (n = 10): normal saline (i.p.) as the control, Cremophor EL vehicle, and 2 or 6 mg/kg of taxol in the Cremophor EL solution (four times in day-2, 4, 6, and 8), respectively. We evaluated neuronal electrophysiology, animal behaviour, neuronal connectivity, macrophage infiltration, location and expression levels of calcitonin gene-related peptide (CGRP), and expression levels of both nerve growth factors and immunoregulatory factors. In the high-dose taxol group (6 mg/kg), neuronal electrophysiological function was significantly impaired. Licking latencies were significantly changed while motor coordination was unaffected. Neuronal connectivity, macrophage density, and expression levels of CGRP was dramatically reduced. Expression levels of nerve growth factors and immunoregulatory factors was also reduced, while it was increased in the low-dose taxol group (2 mg/kg). These results indicate that taxol can modulate local inflammatory conditions, impair nerve regeneration, and impede recovery of a severe peripheral nerve injury.

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