Does the piriformis compress the sciatic nerve during limb length equalization?

BACKGROUND

Correction of limb length inequality during reconstruction procedures at the hip has the inherent danger of sciatic nerve injury. Among others, we think that constriction by a tightened Piriformis tendon may be a significant cause during longitudinal traction at the time of surgery.

PATIENTS: A specific protocol involving the use of staged surgical release at the time of intraoperative traction/limb length equalization gave only partial nerve compromise in one out of 11 cases; three other patients treated without this protocol developed sciatic nerve problems.

CONCLUSION

The authors feel that prior to the application of longitudinal traction, routine sectioning of the contracted piriformis tendon is important to prevent this complication; it is suggested that further investigations like intra operative nerve conduction studies during traction may perhaps substantiate these findings.