Prolonged peroneal nerve dysfunction after high tibial osteotomy: pre- and postoperative electrophysiological study

Abstract

To evaluate electrophysiological incidence and the type of peroneal nerve lesions seen after high tibial osteotomy we conducted an electrophysiological study (electromyography and nerve conduction velocity studies) in 11 patients who were suffering from medial gonarthrosis and treated by Maquet barrel-vault type high tibial valgization osteotomy. All the patients were tested both pre- and postoperatively. Every patient was examined postoperatively for a minimum of a 6 months after surgery to eliminate spontaneously reversible lesions. Results obtained from nonoperated legs served as controls. Three patients (27%) with peroneal nerve lesions were detected electrophysiologically; one had only motor involvement, one only sensory involvement, and one both motor and sensory involvement. Clinically only one of these patients was symptomatic, and the other two were detected by electrophysiological means. Peroneal nerve lesions which may be overlooked by mild weakness and hypesthesia in the early postoperative period can be detected by electrophysiological means at a higher rate than expected. These lesions persist a relatively long time and even can be permanent despite the absence of clinical symptoms.

Investigation of Neurologic Complications in Closed Wedge High Tibial Valgization Osteotomy Technique by Using Electrophysiological Methods

“…At the end of the study, there was a positive correlation between the degree of deformity and neurologic involvement. However, there was no significant relationship between the degree of deformity and neurologic involvement in our study (1). Three patients showed motor and/or sensory involvement of the peroneal nerve.…”

“…In a study by Aydogdu et al (1), peroneal nerve dysfunction after HTO was examined by electrophysiological methods in 11 patients. Pre-and post-operative EMG and nerve conduction velocity studies were performed.…”

“…However, as in the other knee surgeries, HTO has complications. Complications related with peroneal nerve especially are among the important complications of the technique (1). In our study, we aimed to investigate the peroneal nerve complications by using electrophysiological methods in patients who underwent HTO with the closed wedge valgization technique.…”

Comparação clínica e anatômica do nervo fibular na zona de segurança de Gerdy

“…Observou-se nesta amostra que existe aumento significativo na distância entre o tubérculo de Gerdy e a região posterior da fíbula (cm), após dissecção, em mé-dia, de 0,26cm (p = 0,018), o que corresponde a 8,6% (p = 0,007), conforme ilustra a Figura 3. Observou-se nesta amostra que existe diminuição significativa do ângulo entre a região posterior da fíbula e a crista tibial após dissecção, em média, de 3° (p = 0,047), que corresponde a 2,1% (p = 0,06), conforme ilustra a Figura 4. dária a osteoartrite do joelho (6,8) , tratamento das fraturas com fixadores externos (4,(9)(10)(11)(12)(13) , fasciotomias após síndro-me compartimental da perna (14)(15)(16) , biópsias percutâneas ao nível da região proximal da fíbula (5) e osteotomia da fíbula (2) . Portanto, o conhecimento da anatomia é muito importante, pois dano sobre o nervo fibular poderia trazer graves consequências funcionais (4,17,18) .…”

“…As duas mais importantes funções são a dorsoflexão do tornozelo e extensão dos dedos, que são ambos os componentes principais da marcha normal. Na região proximal da tíbia, lesões do nervo fibular podem produzir graves complicações (6)(7)(8) . O objetivo deste estudo foi comparar clínica e anatomicamente os limites do nervo fibular na zona de segurança de Gerdy.…”