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Pelvic fractures in which integrate the acetabulum fractures represent a risk of traumatic injury to the sciatic nerve trunk by stretching or section (1): Judet and Letournel reported a complication rate of around 6% (1). Fractures of the acetabulum strictly speaking are also providers of neurological complications with rates, significant, have recently been precisely detailed by a cohort study published by Lehmann et al. (2): In a series of 2073 patients, the authors reported an overall complication rate of neurological related to the initial trauma of the order of 4%. In this series, 1395 patients were operated with a rate of iatrogenic neurological complications of 2 to 3%. Regarding the first routes (and therefore the types of fractures), the Kocher-Langenbeck path is the path that leads to the greatest number of neurological complications: 3 to 4% in this series (2). However, this cohort study does not specify what truncal achievement it is. Obviously violations posterior acetabular are preferentially providers of sciatic injury while violations prior acetabular are more providers of obturator or femoral lesions. But this is not always the case. Moreover, this study does not specify the type or severity of neurological involvement.
Methodology Design: This is an interventional study in routine care, prospective, single-center.
Main objective / secondary:
Primary objective :
To evaluate the sensitivity of the neurophysiological monitoring combining two specific new procedures to detect intraoperative complications on the sciatic trunk (by measuring potential with somatosensory storied collection of P15 and electromyographic recording with the potential of sciatic nerve in the popliteal fossa).
secondary objectives
Frequency of neurophysiological changes on the interventions of the acetabulum.
An anomaly being retained as:
Interval prolongation N8-P15> 10%
And / or decrease in the amplitude ratio P15 / N22> 50%
And / or elongation of the latency of nerve potential> 10% of the value-operative Opré
And / or reducing the amplitude of the nerve potential> 50% Correlation between the impact of changes neurophysiological intraoperative and
The occurrence of postoperative neurological deficit:
Correlation between the incidence of intraoperative neurophysiological modifications and:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Neurophysiological monitoring | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Neurophysiological MONITORING | Device | The neurophysiology team perform:
A PES stimulation every 10 minutes consistently. Meanwhile, important surgical time and known to be at risk for neurological injury will be noted and their exact schedule specified:
For the ways of Kocher-Langenbeck, a collection of potential nerve sciatic trunk upstream of the critical region:
|
| Measure | Description | Time Frame |
|---|---|---|
| Assessment of the score of electrophysiological intraoperative event | The Score will be assessed between 1 to 3 (1= negative. 2= average, 3= good):
| Day -1 before surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Assessment of change of sensitivity: according to the quotation of the ASIA score | Day 2, Month 3, Month 6 et Month 12 | |
| Assessment of change of Pain (VAS) Visual Assessment Scale | Day 2, Month 3, Month 6 et Month 12 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Guillaume P RIOUALLLON, MD | Fondation Hôpital Saint-Joseph | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Groupe Hospitalier Paris Saint Joseph | Paris | Île-de-France Region | 75014 | France |
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| ID | Term |
|---|---|
| D064926 | Neurophysiological Monitoring |
| ID | Term |
|---|---|
| D008991 | Monitoring, Physiologic |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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