Femoral nerve palsy as a complication of anterior iliac crest bone harvest: Report of two cases and review of the literature

There are many documented neurological complications of anterior iliac crest bone harvest. Until now, these have included injuries to the iliohypogastric, subcostal and lateral femoral cutaneous nerves. Femoral nerve palsy as a direct surgical complication of anterior iliac crest bone harvest has never been cited in any surgical literature, although it has been reported in deep pelvic and abdominal surgeries in which improper retraction and/or prolonged hyperextension of the hip may have caused a nerve compression syndrome. In addition, surgical patients on antithrombolytic therapy have experienced hemorrhage within the iliacus and iliopsoas muscles, resulting in hematoma and secondary femoral nerve compression. The classic motor and sensory deficits reported in femoral nerve palsies are reduced or absent patellar reflex, weak hip flexion, quadriceps muscle weakness, and anesthesia of the anterior thigh and medial aspect of the leg. Two cases of femoral nerve palsy with different etiologies are presented.