The Journal of Bone and Joint Surgery, Vol 74, Issue 10 1450-1455, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Pudendal nerve palsy complicating intramedullary nailing of the femur
RJ Brumback, TS Ellison, H Molligan, DJ Molligan, S Mahaffey and C Schmidhauser
Shock Trauma Center, Maryland Institute for Emergency Medical Services System, Baltimore 21201-1595.
A prospective study of 106 patients who had static interlocking nailing of
the shaft of the femur was performed to determine the relationship between
the duration and magnitude of intraoperative traction and the development
of a pudendal nerve palsy. A strain-gauge, mounted in the countertraction
post, measured the magnitude of the perineal pressure over time. All
nailings were performed with the patient in the supine position.
Postoperatively, the patients were interviewed by one of us, who had been
blinded from the results of the recordings of intraoperative pressure, for
a history of erectile dysfunction and changes in labial, scrotal, or penile
sensation. A light-touch sensory examination of the genitalia was performed
on all patients. Ten patients (six men and four women) had a pudendal nerve
palsy: nine had sensory changes only, and one complained of erectile
dysfunction. The symptoms had resolved at the three-month follow-up
evaluation in all patients except one man who complained of dysesthesia six
months postoperatively. The patients in whom a palsy did not develop had
been positioned on the fracture-table and the perineal post for an average
of 2.6 hours (range, 1.4 to 5.2 hours) compared with an average of 2.8
hours (range, 2.0 to 4.3 hours) for those in whom a palsy did not develop
(p = 0.15). The magnitude of the total traction forces averaged 34.9
kilogram-hours for the patients who did not have a palsy compared with 73.3
kilogram-hours for those who did (p < 0.03). Adduction of the hip, as
well as manipulations for reduction of the fracture, significantly
increased the traction forces.(ABSTRACT TRUNCATED AT 250 WORDS)
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