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Sciatic nerve injury after closed reduction of a dislocated total hip arthroplasty (THA) is an exceedingly rare but tremendously devastating complication. Closed reduction is the standard of care and is typically associated with a low complication rate. There have only been seven sciatic nerve injuries after closed reduction of a dislocated THA reported in the literature, and none were secondary to nerve laceration. We report a case of sciatic nerve laceration after attempted closed reduction of a dislocated THA. This resulted in complete loss of sensory and motor sciatic nerve function. This case highlights the importance of a detailed neurologic examination before and after closed reduction of a dislocated total hip, the importance of using careful reduction maneuvers, and transitioning to open reduction when necessary., (© 2023 The Authors.)

Purpose: The ideal method of central slip reconstruction is difficult to determine due to the multitude of techniques, nonstandardized outcome reporting, and small patient series in the literature. Although most boutonniere deformities may be treated with nonsurgical measures, chronic, subacute, or open injuries may require operative intervention. To aid surgeons in the choice of the ideal central slip reconstruction method, this biomechanical study compared the 3 most common methods performed at our institution: direct repair, lateral band centralization, and distally-based flexor digitorum superficialis (FDS) slip repair., Methods: A boutonniere deformity was induced in 35 fresh-frozen cadaver digits. The central slip was repaired in 9 digits using a primary suture repair, in 9 digits using a lateral band centralization technique, and in 9 digits using a distally-based FDS slip reconstruction. A control group without injury was tested in 8 digits. Following repair or reconstruction, each digit was tested for load to failure, strain, and stiffness at the repair., Results: The average load to failure after central slip reconstruction was significantly greater for a distally based FDS slip method at 82.1 ± 14.6 N (95% CI, 62.2-101.9 N) than all other repair types. Although the FDS slip reconstruction was not as strong as the intact state (82.1 N vs 156.2 N, respectively), it was 2.6 times stronger than the lateral band centralization (82.1 N vs 31.6 N, respectively) and 3 times stronger than a primary repair (82.1 N vs 27.6 N, respectively)., Conclusions: Reconstruction of the central slip using a distally-based FDS slip provided the greatest biomechanical strength compared with the direct repair or lateral band centralization., Clinical Relevance: The use of a distally based reconstruction using FDS may allow for safer early motion., (Copyright © 2022 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)