From the Research
Lumbar plexopathy from hip fractures should be managed with prompt diagnosis, pain control using pregabalin (75-150mg twice daily) as it has shown to be more effective in reducing pain compared to gabapentin in the short-term follow-up 1, and surgical repair of the hip fracture to relieve ongoing nerve compression.
Causes and Risk Factors
Lumbar plexopathy can occur as a complication of hip fractures due to direct trauma, compression, or stretching of the lumbar plexus nerves. The condition occurs because the lumbar plexus (L1-L4 nerve roots) lies in close proximity to the hip joint and can be damaged during fracture displacement or subsequent hematoma formation.
- Traumatic lesions occur mostly in conjunction with severe bony injuries, especially fractures of the acetabulum and of the pelvic ring 2.
- Postoperative lesions can occur after operations on the hip joint, with the lumbar plexus portion most frequently involved 2.
Clinical Presentation
Patients may experience:
- Weakness in hip flexion and knee extension
- Sensory loss in the anterior and medial thigh
- Diminished patellar reflex
- Pain and paresthesia in the lower limbs
Diagnosis and Management
Management includes:
- Prompt diagnosis through clinical examination and electrodiagnostic studies
- Appropriate pain control using medications like pregabalin (75-150mg twice daily) for neuropathic pain
- NSAIDs such as ibuprofen (400-600mg three times daily) or acetaminophen (1000mg four times daily) may help with inflammatory pain
- Physical therapy should be initiated early to prevent muscle atrophy and maintain joint mobility
- Surgical repair of the hip fracture is essential to relieve any ongoing nerve compression Recovery from lumbar plexopathy varies widely, from weeks to months, depending on the severity of nerve damage. Early recognition and treatment are crucial to improve outcomes and prevent permanent neurological deficits. Electrodiagnostic assessments (EDX) can provide prognostic information for recovery, with most severe nerve injuries being a combination of neurapraxia and variable degrees of axonotmesis 3.