Iatrogenic femoral nerve injuries: analysis of medico-legal issues through a scoping review approach. (December 2021)

• Record Type: Journal Article
• Authors: Gibelli, Filippo; Ricci, Giovanna; Sirignano, Ascanio; Bailo, Paolo; De Leo, Domenico
• Is Part Of: Annals of medicine and surgery. Volume 72(2021)
• Publication Date: 2021-12
• Subjects: Femoral nerve palsy -- Iatrogenic injury -- Complications -- Neuropathy; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2021.103055
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Purpose: Accidental femoral nerve injury is a well-known iatrogenic complication of orthopaedic, abdominal, and pelvic surgery. Because of the largely transitory nature of the symptoms associated with nerve damage, its true incidence is in all likelihood underestimated. This work aims to illustrate the surgical contexts within which this nerve injury is reported, based on the evidence obtained from a Scoping Review of the literature of the last 20 years, with specific reference to the underlying etiopathogenetic mechanisms and prognostic outcomes, to highlight the evaluation issues of medico-legal interest related to this pathology. Methods: We conducted a Scoping Review of iatrogenic femoral nerve injuries reported between 2000 and 2021 by searching the electronic databases Pubmed, Scopus, Ovid Medline, Ovid Emcare, and Web of Science. We conducted the review according to the five-step methodology outlined by Arksey and O'Malley. Results: The literature search identified 104 papers, including case reports, case series, and retrospective studies. Surgical contexts within which iatrogenic femoral nerve injuries were reported include orthopaedic, abdominal, gynaecological, urological, vascular, and plastic surgery, as well as locoregional anaesthesiological procedures. The long-term prognosis was generally favourable. Conclusions: Because of its frequent iatrogenic genesis, femoral nerve injury is a topic of intense medico-legal interest. From the perspective of estimating the patient's disability, the mostly favourable nature of the prognosis makes the medico-legal assessment, in some respects, complex, thus requiring a precise evaluation methodology. Highlights: Femoral nerve injuries have an iatrogenic aetiology in most cases. The surgical contexts in which the damage most frequently occurs are orthopaedic, abdominal and gynaecological surgery. The prognosis of nerve damage is in the vast majority of cases good, as it is almost always neuroapraxic. The favourable prognosis of the injury implies that its medico-legal assessment requires a very rigorous methodology.