Injury, Int. J. Care Injured 31 (2000) 207±208
Case report
Implanted piece of allogeneic femoral bone and late sciatic nerve
compression
N de Roeck*, K Drabu
Orthopaedic Research Unit, East Surrey Hospital, Canada Avenue, Redhill RH1 5RH, UK
Accepted 9 November 1999
1. Introduction
He was subsequently admitted for exploration of his
right thigh and extraction of foreign bone. His right
posterior thigh was approached through a dorsal
longitudinal incision and the implanted bone was
identi®ed within the long head of biceps femoris in the
mid-thigh, overlying the sciatic nerve. The bone frag-
ment was carefully dissected free and sent for histo-
logical analysis.
His symptoms of pain and sciatica had resolved by
out-patient review at 2 weeks. Histological analysis of
the bone showed revealed a piece of dead cortical bone
which had proved extremely resistant to demineralisa-
tion. There was no evidence of any in¯ammatory re-
sponse in or around the bone.
We report a case of a 39 year old male who sus-
tained a right thigh wound in 1983 in a motorcycle
accident. The wound was caused by collision with
another motorcyclist who sustained an open segmental
femoral fracture. The protruding femur of the other
motorcyclist impacted with our patient's right thigh
causing extensive soft tissue damage and destruction of
quadriceps, particularly vastus lateralis. A piece of cor-
tical bone from the femur of the other motorcyclist
was implanted into his thigh.
The original injuries were treated at another hospital
from our own. He received debridement of the wound
and soft tissues which healed satisfactorily although
with loss of quadriceps mass. The implanted bone was
left in-situ. He went on to make an excellent functional
recovery.
2. Discussion
The case describes a highly unusual method of im-
plantation of a piece of allogeneic bone. The cellular
activity within the bone had been lost as no revascular-
isation as seen in successful cortical bone grafts had
occurred [1,2]. This prevented any remodelling or
resorption and hence its persistence as mineralised
dead cortical bone for 14 years. This persistent piece
of bone caused delayed symptoms of sciatica as it
started to impinge on the sciatic nerve in the thigh.
Sciatica is commonly caused by herniation of a lumbar
disc and also by other vertebral and intrapelvic pathol-
ogy [3,4]. There are also many extra-pelvic causes of
sciatica described. These are rare in isolation and
include pyriformis syndrome [5], compression by
methyl methacrylate cement post total hip replacement
[6], sciatic hernia [7] and avulsion fracture of the
ischial tuberosity [8]. This case demonstrates a pre-
He was referred to our care 14 years after the orig-
inal injury owing to increasing discomfort in his pos-
terior right thigh. He had become aware of the
implanted bone when sitting and had permanent dis-
comfort and paraesthesiae radiating into the dorsum
of his right calf. He did not have other sensory or
motor symptoms. Clinical examination revealed a
palpable bony lump deep to his hamstrings in the right
thigh. Neurological examination revealed no abnorm-
ality other than demonstration of the area in which
the paraesthesiae were distributed. X-rays showed a 8
 4 cm piece of cortical bone in his right thigh (Figs. 1
and 2).
* Corresponding author. Tel.: +44-1737-768-511 ext. 1333; fax:
+44-1737-768-978.
0020-1383/00/$ - see front matter # 2000 Elsevier Science Ltd. All rights reserved.
PII: S0020-1383(99)00281-8
Carmack et al.
