Introduction and Aims: Prospective review of the patients who underwent stabilisation of displaced acetabular fractures in our unit in order to evaluate the presence of neurological lesions and functional outcome.

Method: Out of 136 patients operated over six years we identified 27 patients with neurological lesions. A standard protocol was followed for the clinical and neurophysiological evaluation of nerve injuries. Electromyography (EMG) was used to determine the anatomical location of the neurological lesions and the type of lesion, which act as a valuable tool in the diagnosis of double crush lesion in the sciatic nerve. Neurological recovery was evaluated with EMG studies and clinically rated as described by Clawson et al. Functional outcome was graded by the system proposed by Fassler and Swiontkowski.

Results: EMG studies revealed sciatic nerve lesions in all the cases. Additionally, in nine patients with a dropped foot there was evidence of a proximal (sciatic notch) and distal (neck of fibula) lesion – ‘double crush syndrome’. At final follow-up, clinical examination and associated EMG studies revealed full recovery in five cases with initial muscle weakness, and complete resolution of sensory symptoms (burning pain, hyposthesia) in four cases. There was improvement of functional capacity (motor and sensory) in two cases with initial complete drop foot and in four cases with muscle foot weakness. In 11 of the cases with dropped foot (all nine with double crush) at presentation, there was no improvement in function. Functional outcome was unsatisfactory in all patients with double crush injury.

Conclusion: In cases where there is evidence of ‘double crush lesions’ the prospect of functional recovery is low as seen in this group of patients. The patients with double crush syndrome are not expected to recover and could be considered as a sign of unfavourable outcome following neurological impairment after acetabular fractures. Single lesions appear to be associated with a more favourable prognosis.