Muhammed Ziya KIR, Sadık ŞAHİNGÖZ, Yüksel ANCI, Ahmet Nezih KÖK, Mustafa Talip ŞENER

Siyatik Sinir Yaralanmasi: Adli Olgular

Amaç: Siyatik sinir (SN) yaralanması travmatik olay sonucu olarak ya da enjeksiyon esnasındatıbbi müdahale sonucu olabilir. Bu çalışmada adli incelemeye konu olan siyatik siniryaralanmaları ve nedenlerini belirlemek amacıyla yapıldı.Yöntemler: 2002-2011 yılları arasında Atatürk Üniversitesi Adli Tıp Anabilim Dalındadüzenlenen 16.827 olguya ait raporlar retrospektif olarak incelendi. Toplam 21 SN yaralanmasıbelirlenerek olgular değerlendirildi. Bulgular: SN yaralanması 10 (%47.6) olguda intramüsküler (IM) enjeksiyona bağlıydı.EMG’de 10 (%47.6) olguda tibial-peroneal sinir hasarı saptandı. Fiziksel muayenede 7 (%33.3)olguda düşük ayak, 8 (%38.1) olguda dorsifleksiyon veya plantar fleksiyon kaybı saptandı. Sonuç: SN hasarı olan olguların yaklaşık yarısı IM enjeksiyona bağlı gelişmiştir. Bu sebepleSN yaralanması gelişmemesi için IM enjeksiyonlar yetkili sağlık personelince yapılmalı vesağlık personeli bu konuda eğitilmelidir

Anahtar Kelimeler:

Siyatik sinir hasarı, intramuskuler enjeksiyon, düşük ayak, adli vaka

SCIATIC NERVE INJURY: LEGAL CASES

Objective: Sciatic nerve (SN) injuries may occur as a result of traumatic events or in result ofmedical interventions during the injections. This study was carried out to determine the causesof sciatic nerve injury which was subject to judicial scrutiny.Method: 16,827 cases were analyzed between the years 2002 and 2011 which were sent toDepartment of Forensic Medicine of Atatürk University were evaluated retrospectively. A totalof 21 SN injury cases were evaluated Results: The reason of SN injury were in 10 cases (47.6%) intramusculer (IM) injection. InEMG of these 10 cases (47.6%) were identified as tibial-peroneal nerve injury. Physicalexaminations showed foot drop in 7 cases (33.3%) and dorsiflexion or plantar flexion weaknessin 8 cases (38.1%).Conclusion: More than half of the cases of SN injury were due to IM injection. For that reason,IM injection should be made by authorized medical staff and these staff should be well educated

Keywords:

Sciatic nerve injury, intramuscular injection, foot drop, legal case,

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Weil YA, Pearle AD, Palladas L, Liebergall M, Mosheiff R. Long-term functional outcome of penetrating sciatic nerve injury. The Journal of Trauma. 2008;64:790-5.
Kim DH, Murovic JA, Tiel R, Kline DG. Management and outcomes in 353 surgically treated sciatic nerve lesions. Journal of Neurosurgery. 2004;101:8-17.
Kline DG, Kim D, Midha R, Harsh C, Tiel R. Management and results of sciatic nerve injuries: a 24-year experience. Journal of Neurosurgery. 1998;89:13-23.
Vayvada H, Demirdöver C, Menderes A, Yılmaz M, Karaca C. The functional results of acute nerve grafting in traumatic sciatic nerve injuries. Ulus Travma Acil Cerrahi Derg. 2013;19:109-14.
Hanson DJ. Acute and chronic lesions from intramuscular injections. Hospital Formulary Management. 1966;1:31-4.
Ling CM, Loong SC. Injection injury of the radial nerve. Injury: The British journal of Accident Surgery. 1976;8:60-2.
Muller-Vahl H. Adverse reactions after intramuscular injections. Lancet. 1983;321:1050.
Small SP. Preventing sciatic nerve injury from intramuscular injections: literature review. Journal of Advanced Nursing. 2004;47:287-96.
Roosen NK, Kline DG. Peripheral nerve injury. In Prognosis of Neurological Disorders. Evans RB, Baskin DS, Yatsu FM, editor. New York: Oxford University Press; pp. 394-426, 2000.
Mishra P, Stringer MD. Sciatic nerve injury from intramuscular injection: a persistent and global problem. International Journal of Clinical Practice. 2010;64:1573-9.
Bramhall RJ, Deveraj VS. Traumatic sciatic nerve palsy after gluteal injection. Eur J Plast Surg. 2011;34:137-8.
Gentili F, Hudson A, Kline DG, Hunter D. Peripheral nerve injection injury: an experimental study. Neurosurgery. 1979;4:244-53.
Gentili F, Hudson AR, Hunter D. Clinical and experimental aspects of injection injuries of peripheral nerves. The Canadian Journal of Neurological Sciences Le journal Canadien des Sciences Neurologiques. 1980;7:143-51.
Ong MJ, Lim GH, Kei PL. Clinics in diagnostic imaging (140). Iatrogenic sciatic nerve injury secondary to intramuscular injection. Singapore Med J. 2012;53:551-4.
Senes FM, Campus R, Becchetti F, Catena N. Sciatic nerve injection palsy in the child: early microsurgical treatment and long-term results. Microsurgery. 2009;29:443-8.
Bağış S, Adam M, Leblebici ÜB, Güven AZ, Çeliker AR. Sciatic nerve injury due to intramuscular injection: electrophysiological findings and one-year follow-up. Turk J Med Sci. 2012; 42: 913-7.
Preston D, Logigian E. Iatrogenic needle-induced peroneal neuropathy in the foot. Annals of Internal Medicine. 1988;109:921-2.
Horowitz SH. Iatrogenic causalgia. Classification, clinical findings, and legal ramifications. Archives of Neurology. 1984;41:821-4.
Pickett JB. Localizing peroneal nerve lesions. American Family Physician. 1985;31:189-96.
Pandian JD, Bose S, Daniel V, Singh Y, Abraham AP. Nerve injuries following intramuscular injections: a clinical and neurophysiological study from Northwest India. JPNS. 2006;11:165-71.
Tak SD, Dar GN. Halwai MA, Mir MR. Post-injection nerve injuries in Kashmir: a menace overlooked. Eur J Res Med Sci. 2008;13:244-7.
Streib EW, Sun SF. Injection injury of the sciatic nerve: unusual anatomic distribution of nerve damage. European Neurology. 1981;20:481-4.
Sunderland S. The relative susceptibility to injury of the medial and lateral popliteal divisions of the sciatic nerve. The British Journal of Surgery. 1953;41:300-2.
Clark K, Williams PE, Jr., Willis W, McGavran WL, 3rd. Injection injury of the sciatic nerve. Clinical Neurosurgery. 1970;17:111-25.
Nisbet AC. Intramuscular gluteal injections in the increasingly obese population: retrospective study. BMJ. 2006;332:637-8.
Chan VO, Colville J, Persaud T, Buckley O, Hamilton S, Torreggiani WC. Intramuscular injections into the buttocks: are they truly intramuscular? European Journal of Radiology. 2006;58:480-4.
Muller-Vahl H. Isolated complete paralysis of the tensor fasciae latae muscle. European Neurology. 1985;24:289-91.
Cook IF, Murtagh J. Ventrogluteal area – a suitable site for intramuscular vaccination of infants and toddlers. Vaccine. 2006; 24:2403-8.