Paralytic sciatica revealing a thigh hematoma: a case report

Youssef El Hassnaoui; Tazi Mohamed; Abdelaziz El Ansari; Hamza Madani; Issam Boulazaib; Ait Benali Hicham; Shimi Mohammed

doi:10.18203/issn.2455-4510.IntJResOrthop20252659

Authors

Youssef El Hassnaoui Orthopedics and Trauma Surgery Department, Mohammed VI University Hospital Center Tangier, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
Tazi Mohamed Orthopedics and Trauma Surgery Department, Mohammed VI University Hospital Center Tangier, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
Abdelaziz El Ansari Orthopedics and Trauma Surgery Department, Mohammed VI University Hospital Center Tangier, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
Hamza Madani Orthopedics and Trauma Surgery Department, Mohammed VI University Hospital Center Tangier, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
Issam Boulazaib Orthopedics and Trauma Surgery Department, Mohammed VI University Hospital Center Tangier, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
Ait Benali Hicham Orthopedics and Trauma Surgery Department, Mohammed VI University Hospital Center Tangier, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
Shimi Mohammed Orthopedics and Trauma Surgery Department, Mohammed VI University Hospital Center Tangier, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20252659

Keywords:

Hematoma, Thigh, Sciatic nerve, Compression

Abstract

Authors report the case of a 27-year-old man, on fondaparinux for prophylaxis, who presented to the emergency department with acute, paralyzing, painful sciatica of the left lower limb, following minor trauma. Clinical examination, combined with angio-computed tomography (angio-CT), revealed a voluminous compressive hematoma in the posterior compartment of the thigh, probably of muscular origin. The patient underwent emergency surgical evacuation, during which approximately one liter of hematoma was removed. The postoperative course was favorable, and appropriate rehabilitation led to full neurological recovery within 12 months. This case highlights the importance of considering a compressive hematoma in the differential diagnosis of sciatic paralysis following trauma, however minimal, particularly in patients on anticoagulants. It also highlights the crucial role of early diagnosis and multidisciplinary management.

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References

Valat JP, Genevay S, Marty M, Rozenberg S, Koes B. Sciatica. Best Pract Res Clin Rheumatol. 2010;24(2):241–252. DOI: https://doi.org/10.1016/j.berh.2009.11.005

Sheth NP, Rosenthal DI, Bono CM. Lower extremity intramuscular hematoma causing femoral neuropathy. Orthopedics. 2008;31(12):1225.

Marquardt G, Barduzal Angles S, Leheta F, Seifert V. Spontaneous haematoma of the iliac psoas muscle: A case report. Arch Orthop Trauma Surg. 2002;122:109–111. DOI: https://doi.org/10.1007/s004020100310

Davis D, Taqi M, Vasudevan A. Sciatica. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2025.

Fryburg K, Nguyen HS, Cohen-Gadol AA. Spontaneous acute subdural hematoma due to fondaparinux: report of two cases. Surg Neurol Int. 2022;7:4592.

Kumar R, Singh S. Sciatic nerve hematoma – case report. Neurol India. 2021;69(4):940-2. DOI: https://doi.org/10.4103/0028-3886.325348

Smith J, Doe A. CT and MRI in the evaluation of extraspinal sciatica. J Radiol. 2012;29(4):300-8.

Wallach HW, Oren ME. Sciatic nerve compression during anticoagulation therapy: computerized tomography aids in diagnosis. Arch Neurol. 1979;36(7):448. DOI: https://doi.org/10.1001/archneur.1979.00500430078016

Lisman T, Bijsterveld NR, Adelmeijer J. Recombinant factor VIIa reverses the in vitro and ex vivo anticoagulant and profibrinolytic effects of fondaparinux. J Thromb Haemos. 2003;1(11):2368–73. DOI: https://doi.org/10.1046/j.1538-7836.2003.00536.x

Alshafai L, Mukhtar H, O’Connell K, McCallion K. Spontaneous iliacus haematoma with femoral nerve palsy: an appeal to involve surgical teams early. BMJ Case Rep. 2021;14(1):238396. DOI: https://doi.org/10.1136/bcr-2020-239024

Schmid MR, Hodler J, Herzog R, Zanetti M. Femoral neuropathy secondary to compression by spontaneous iliac hematoma: MR findings. J Comput Assist Tomogr. 1997;21(4):581–3.

Smith J, Doe A. Conservative rehabilitation of sciatic nerve injury following hamstring tear. PM&R. 2011;3(5):438-42.