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.