Indirect sciatic nerve transection from gunshot induced comminuted femoral fracture

Sciatic nerve transection is a severe peripheral nerve injury associated with profound motor and sensory deficits, often resulting in long-term disability if not promptly addressed. We report a case of persistent motor loss after a ballistic injury in a 31-year-old female, initially attributed to the concussive effect of the ballistic and later found to be the consequence of a bony fragment transection. One year after the initial trauma, radiographs at our institution demonstrated a displaced, posteriorly directed sharp bony fragment at the level of the distal femoral diaphysis. MRI revealed features consistent with a traumatic neuroma in discontinuity with fusiform enlargement of the terminal stump proximal to the bone fragment and an intraneural cyst of the stump distal to the fragment. This case underscores the importance of dedicated nerve imaging in temporal proximity to injury as early identification and surgical intervention is critical to maximize functional outcomes in complex ballistic nerve injuries.