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Acta Orthopaedica Et Traumatologica... 2012The purpose of this study was to retrospectively evaluate the clinical and functional results of nerve grafting and end-to-end peroneal nerve repair between sciatic...
OBJECTIVE
The purpose of this study was to retrospectively evaluate the clinical and functional results of nerve grafting and end-to-end peroneal nerve repair between sciatic bifurcation and distal branching.
METHODS
The study included 26 patients (22 men, 4 women; mean age: 19.9 years; range: 5 to 46 years) who underwent peroneal nerve repair between 1992 and 2009. Open nerve injuries were seen in 21 patients and closed injuries in 5. Surgical repair was performed with sural nerve grafting in 19 patients and end-to-end in 7. Mean nerve graft length was 5.42 (range: 2 to 15) cm with a mean 3.1 (range: 2 to 4) nerve cables used. Mean follow-up was 33 (range: 13 to 96) months. The British Medical Research Council (BMRC) scale was used for the evaluation of the tibialis anterior and peroneal muscles and Semmes-Weinstein monofilaments were used for protective sensation evaluation.
RESULTS
Adequate and full recovery was observed in 19 patients (73%). Mean follow-up time was 39.3 months in patients undergoing nerve grafting and 30.1 months in end-to-end nerve repair. Fifteen of 19 patients with nerve grafting and 4 of 7 patients with end-to-end nerve repair had an adequate or full recovery. Posterior tibial tendon transfer to dorsal foot was applied in 3 of 7 patients without recovery. Protective sensory recovery was determined in 16 of 22 patients.
CONCLUSION
Good results in both end-to-end repair and in repair with grafting is possible in peroneal nerve repair.
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Muscle Strength; Neurosurgical Procedures; Peroneal Nerve; Retrospective Studies; Tendon Transfer; Treatment Outcome; Young Adult
PubMed: 23428768
DOI: No ID Found -
Plastic and Reconstructive Surgery Aug 2014When is common peroneal nerve repair worthwhile? What is the effect of delayed repair? What is the maximum length of graft that can be used? This study aimed to address... (Review)
Review
BACKGROUND
When is common peroneal nerve repair worthwhile? What is the effect of delayed repair? What is the maximum length of graft that can be used? This study aimed to address these questions by assessing the current literature and ascertaining the predictors of outcome that would guide peripheral nerve surgeons in determining the correct treatment of common peroneal nerve injury.
METHODS
After an extensive literature review, 28 studies (1577 repairs) were assessed. The authors evaluated outcomes, using the British Medical Research Council grading for motor recovery, where M4 or above was considered a good outcome, and related them to delay, graft length, mechanism of injury, and age.
RESULTS
Good outcomes (M4 and M5) were obtained in 45 percent of cases; more specifically, 80 percent for neurolysis, 37 percent for direct suture, and 36 percent for nerve graft. Excluding neurolysis, good outcomes were obtained in 44 percent of repairs performed within 6 months but in only 12 percent of repairs performed after 12 months (p=0.0046), and in 64 percent of repairs using grafts shorter than 6 cm but in only 11 percent of repairs using grafts longer than 12 cm (p=0.0002). Age did not influence outcome (p=0.2750).
CONCLUSIONS
Common peroneal nerve repair was worthwhile in approximately half of all cases. The authors suggest that the results of common peroneal nerve repair will be suboptimal if surgery is performed more than 12 months after injury or if a graft of more than 12 cm is required.
Topics: Humans; Neurosurgical Procedures; Peripheral Nerve Injuries; Peroneal Nerve; Treatment Outcome
PubMed: 25068351
DOI: 10.1097/PRS.0000000000000318 -
BMJ Case Reports Feb 2021The ankle is a region crowded with multiple neurovascular and musculotendinous structures. We describe a case of a rare neurological complication following ankle surgery.
The ankle is a region crowded with multiple neurovascular and musculotendinous structures. We describe a case of a rare neurological complication following ankle surgery.
Topics: Ankle Joint; Humans; Male; Middle Aged; Neuroma; Peroneal Nerve; Peroneal Neuropathies
PubMed: 33542001
DOI: 10.1136/bcr-2020-235675 -
Clinical Orthopaedics and Related... Jun 1991Eleven patients had either repair (two) or nerve graft reconstruction (nine) of the common peroneal nerve or its superficial or deep divisions about the knee. The...
Eleven patients had either repair (two) or nerve graft reconstruction (nine) of the common peroneal nerve or its superficial or deep divisions about the knee. The average follow-up period was 29.1 months. A good or excellent result was achieved in six (54.5%) patients. The results appeared best when direct nerve repair was possible or when a defect of 6 cm or less required grafting. Peroneal nerve exploration and repair or reconstruction as required seem indicated for known nerve disruption or unknown nerve continuity if there is no suggestion of continuing recovery by three to six months after the injury.
Topics: Adolescent; Adult; Child; Follow-Up Studies; Humans; Middle Aged; Paralysis; Peroneal Nerve; Retrospective Studies; Sural Nerve
PubMed: 2044280
DOI: No ID Found -
Knee Surgery, Sports Traumatology,... Apr 2021The aim of the study was to evaluate the anatomical details of the articular branch of the peroneal nerve to the proximal tibiofibular joint and to project the height of...
The articular branch of the peroneal nerve to the proximal tibiofibular joint descends at a mean height of approximately 18 mm distal to the postero-lateral tip of the fibular head.
PURPOSE
The aim of the study was to evaluate the anatomical details of the articular branch of the peroneal nerve to the proximal tibiofibular joint and to project the height of its descent in relation to the fibular length.
METHODS
Twenty-five lower extremities were included in the study. Following identification of the common peroneal nerve, its course was traced to its division into the deep and superficial peroneal nerve. The articular branch was identified. The postero-lateral tip of the fibular head was marked and the interval from this landmark to the diversion of the articular branch was measured. The length of the fibula, as the interval between the postero-lateral tip of the fibular head and the tip of the lateral malleolus, was evaluated. The quotient of descending point of the articular branch in relation to the individual fibular length was calculated.
RESULTS
The articular branch descended either from the common peroneal nerve or the deep peroneal nerve. The descending point was located at a mean height of 18.1 mm distal to the postero-lateral tip of the fibular head. Concerning the relation to the fibular length, this was at a mean of 5.1%, starting from the same reference point.
CONCLUSION
The articular branch of the common peroneal nerve was located at a mean height of 18.1 mm distal to the the postero-lateral tip of the fibular head, respectively, at a mean of 5.1% of the whole fibular length starting from the same reference point. These details represent a convenient orientation during surgical treatment of intraneural ganglia of the common peroneal nerve, which may result directly from knee trauma and indirectly from ankle sprain.
Topics: Aged; Aged, 80 and over; Cadaver; Dissection; Female; Fibula; Humans; Knee Joint; Male; Peroneal Nerve
PubMed: 32691096
DOI: 10.1007/s00167-020-06156-5 -
Semergen 2023
Topics: Humans; Aged, 80 and over; Peroneal Nerve; Peroneal Neuropathies; Nerve Compression Syndromes
PubMed: 36155264
DOI: 10.1016/j.semerg.2022.101837 -
Microsurgery 2006In the past, the attitude toward surgical repair of sciatic and peroneal nerve lesions was excessively pessimistic. Refinements of microsurgical technique, nerve... (Review)
Review
In the past, the attitude toward surgical repair of sciatic and peroneal nerve lesions was excessively pessimistic. Refinements of microsurgical technique, nerve conduction studies, and the establishment of indications and optimal timings for surgical interventions have led to significant improvements in outcomes, making repair worthwhile in most cases. Tendon transfers can augment functional outcomes, and are performed as secondary procedures or (in selected cases) in combination with the initial repair. Developments in the basic sciences, bioengineering, and medical imaging may further improve the results of management of these serious nerve injuries.
Topics: Algorithms; Humans; Peroneal Nerve; Sciatic Nerve; Treatment Outcome
PubMed: 16628741
DOI: 10.1002/micr.20241 -
Neurosurgical Focus Nov 2011This study analyzes 84 cases of peroneal nerve injuries associated with sports-related knee injuries and their surgical outcome and management.
OBJECT
This study analyzes 84 cases of peroneal nerve injuries associated with sports-related knee injuries and their surgical outcome and management.
METHODS
The authors retrospectively reviewed the cases of peroneal nerve injury associated with sports between the years 1970 and 2010. Each patient was evaluated for injury mechanism, preoperative neurological status, electrophysiological studies, lesion type, and operative technique (neurolysis and graft repair). Preoperative status of injury was evaluated by using a grading system published by the senior authors. All lesions in continuity had intraoperative nerve action potential recordings.
RESULTS
Eighty-four (approximately 18%) of 448 cases of peroneal nerve injury were found to be sports related, which included skiing (42 cases), football (23 cases), soccer (8 cases), basketball (6 cases), ice hockey (2 cases), track (2 cases) and volleyball (1 case). Of these 84 cases, 48 were identified as not having fracture/dislocation and 36 cases were identified with fracture/dislocation for surgical interventions. Good functional outcomes from graft repair of graft length < 6 cm (70%) and neurolysis (85%) in low-intensity peroneal nerve injuries associated with sports were obtained. Recovery from graft repair of graft length between 6 and 12 cm (43%) was good and measured between Grades 3 and 4. However, recovery from graft repair of graft length between 13 and 24 cm was obtained in only 25% of patients.
CONCLUSIONS
Traumatic knee-level peroneal nerve injury due to sports is usually associated with stretch/contusion, which more often requires graft repair. Graft length is the factor to be considered for the prognosis of nerve repair.
Topics: Athletic Injuries; Comorbidity; Humans; Knee Injuries; Male; Neurosurgical Procedures; Peroneal Nerve; Peroneal Neuropathies; Retrospective Studies
PubMed: 22044100
DOI: 10.3171/2011.9.FOCUS11187 -
Skeletal Radiology Aug 2020To describe our technical and preliminary clinical experience with ultrasound-guided diagnostic deep peroneal nerve (DPN) blocks for patients considering deep peroneal...
OBJECTIVE
To describe our technical and preliminary clinical experience with ultrasound-guided diagnostic deep peroneal nerve (DPN) blocks for patients considering deep peroneal neurectomy.
MATERIALS AND METHODS
Retrospective analysis of ultrasound-guided diagnostic DPN blocks performed in the anterior lower leg in patients pursuing deep peroneal neurectomy for foot pain not directly attributable to the DPN. Patient age, sex, foot laterality, diagnosis, nerve block complications, location of the DPN with respect to vascular landmarks in the lower leg, pain relief from nerve block, and pain relief from neurectomy (if performed) were recorded.
RESULTS
Twenty-six DPN blocks were performed for 25 feet, of which a majority had pain attributable to midfoot osteoarthritis (22/25). Variable DPN locations with respect to vascular landmarks in the lower leg were observed, including lateral to the anterior tibial artery (12/25), anterior to the artery (5/25), medial to the artery (3/25), lateral to the lateral paired vein (4/25), and 1-cm lateral to the artery (1/25). After DPN blocks, patients reported pain relief in 22/25 feet. Of the eleven patients who proceeded to have a deep peroneal neurectomy, ten reported improved foot pain.
CONCLUSION
Diagnostic deep peroneal nerve blocks for patients considering deep peroneal neurectomy for denervation therapy should be performed in the anterior lower leg where the anterior tibial vessels serve as anatomic landmarks. Those who perform DPN blocks with ultrasound guidance should be aware of variable DPN position with respect to the vascular landmarks.
Topics: Aged; Denervation; Female; Humans; Male; Middle Aged; Nerve Block; Peroneal Nerve; Retrospective Studies; Ultrasonography, Interventional; Young Adult
PubMed: 32296877
DOI: 10.1007/s00256-020-03443-7 -
International Angiology : a Journal of... Dec 2009The aim of the presented work was to assess the causes of injury to great nerves during varicose vein surgery and comment on the consequences.
AIM
The aim of the presented work was to assess the causes of injury to great nerves during varicose vein surgery and comment on the consequences.
METHODS
This was a retrospective study of 2344 patients operated on for primary varicose veins between the years 1980 and 2005.
RESULTS
In three patients out of 2344 the peroneal nerve was injured. The three patients underwent neurosurgery. In the first patient transplantation of the sacral nerve was performed. In the second patient the nerve was released from ligatures, and in the third patient the nerve was first released from the cicatrice and the transposition of the tendon of the posterior tibial muscle followed. All three patients went through intensive rehabilitation. The first patient still wears peroneal splint, the limb is atrophic. In the second patient the function has been well restored and he is not disabled anymore. However, the restitution of the lower limb function is not sufficient for him to work as a teacher of physical education. The third patient still suffers from serious paresis of the peroneal nerve.
CONCLUSIONS
Even a frequent and relatively simple intervention such as varicose vein surgery may be accompanied by serious complications affecting patients for the rest of their lives. Serious motor nerve injuries are encountered only in operations in the popliteal fossa and the fibula head. Complications are more frequent when operations are performed by young general surgeons than when they are performed by an experienced surgeon or an expert in vascular surgery. The affected patients should be referred for neurosurgery; however, results are unpredictable. In spite of an intensive rehabilitation and possible plastic surgery the patients are permanently affected.
Topics: Adult; Clinical Competence; Czech Republic; Female; Humans; Male; Middle Aged; Neurosurgical Procedures; Peroneal Nerve; Peroneal Neuropathies; Recovery of Function; Retrospective Studies; Saphenous Vein; Time Factors; Treatment Outcome; Varicose Veins; Vascular Surgical Procedures; Young Adult
PubMed: 20087282
DOI: No ID Found