Injection‑induced sciatic nerve injuries in Turkey: a public health and patient safety analysis of Supreme Court decisions.

Abstract

Background: Intramuscular injections are routine interventions worldwide, yet when executed incorrectly they can cause sciatic nerve injury (SNI) that leaves patients with lifelong motor-sensory disability. Although international guidelines recommend the ventrogluteal site, the dorsogluteal region remains dominant in Turkey, potentially elevating risk. This study analysed Turkish Supreme Court decisions on injection-induced SNI from public-health, ethical and legal perspectives.

Methods: We conducted a retrospective cross-sectional content analysis of all publicly available Supreme Court criminal and civil decisions issued between January 2006 and April 2025 that contained SNI-related keywords. After deduplication and relevance screening, 92 unique cases were eligible. Two investigators independently coded each judgment; disagreements were resolved by consensus. Variables recorded were legal category, injection site, clinical indication, drug class, injector profession, defendant identity, symptom latency, electrophysiological pattern, first-instance verdict and Supreme Court outcome. Frequencies and percentages were calculated with SPSS v.29.

Results: Negligent bodily injury was the leading charge (50/92, 54%); 32% of files also sought monetary compensation. Gluteal injections accounted for 79% of cases, most administered for postoperative analgesia (33%) or antibiotic therapy (27%). Nurses performed 60% of injections, physicians 9%. Individual health professionals (physicians ± nurses) were defendants in 65% of lawsuits, while hospitals (alone or jointly) appeared in 23%. Symptoms emerged immediately or within 1 h in 76% of plaintiffs, and electromyography typically revealed severe axonal damage-predominantly of the peroneal division. The Supreme Court overturned 100% of firstinstance convictions and 32% of acquittals, most often citing inadequate expert evaluation (35%), contradictory reports (20%), uncertainty over negligence versus complication (18%) or missing informedconsent documentation (10%).

Conclusions: Injection-related sciatic nerve injuries in Turkey remain potentially preventable. The entrenched use of the dorsogluteal site, limited anatomical awareness, inadequate informed consent practices, and inconsistencies in medico-legal evaluations continue to contribute to both patient harm and an increased burden of litigation. Transitioning to the ventrogluteal technique, mandating annual refresher training, standardising consent forms, and accrediting neurophysiology expert panels could help reduce both injury incidence and courtroom burden-advancing the WHO's "zero harm" patient safety goal.