Surgical Treatment of Traumatic Peroneal Nerve Lesions

Seidel, Julia A; Koenig, Ralph Werner; Antoniadis, Gregor; Richter, Hans-Peter; Kretschmer, Thomas

doi:10.1227/01.neu.0000317315.48612.b1

Cited by 59 publications

(56 citation statements)

References 27 publications

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“…The overall good outcomes (M4 or greater) across the 1577 repairs in 28 studies [1][2][3][4][5][6][7]10,[12][13][14][15][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] amounted to slightly more than 45 percent. If studies from only the twenty-first century are taken into account, this percentage rises to slightly more than 50.2 percent (n = 1111); this is a significant improvement when compared with studies performed in the twentieth century, which was 38.7 percent (n = 466).…”

Section: Resultsmentioning

confidence: 99%

“…1,2,[4][5][6][7]10,[12][13][14][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Table 3 shows the 25 studies 1,2,4-7,10,12-14,17-31 included in this section with 1254 surgical repairs. Studies showed 80 percent of patients (n = 359) achieving M4 or above with neurolysis, while end-to-end suture yielded a good outcome in 37 percent of patients (n = 464) and interfascicular nerve grafting followed closely behind with 36 percent (n = 431).…”

Section: Repair Typementioning

confidence: 99%

“…Only 11 studies [4][5][6][7]12,14,18,20,23,24,29 had sufficient data to correlate graft lengths to outcomes, totaling 368 repairs, which were all performed using autologous sural nerve grafts. We looked at outcomes by subdividing the graft lengths used into three groups: less than 6 cm, 6 to 12 cm, and greater than 12 cm (Table 4).…”

Section: Length Of Graftmentioning

confidence: 99%

“…6,33 Mechanisms with the worst prognosis were gunshot wounds and shrapnel injuries (49 percent), traction (42 percent), and complex wounds made up of two or more injured adjacent structures (25 percent).…”

Section: Mechanism Of Injurymentioning

confidence: 99%

See 3 more Smart Citations

An Evidence-Based Structured Review to Assess the Results of Common Peroneal Nerve Repair

George

Boyce

2014

Plastic and Reconstructive Surgery

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Section: Resultsmentioning

confidence: 99%

Section: Repair Typementioning

confidence: 99%

Section: Length Of Graftmentioning

confidence: 99%

Section: Mechanism Of Injurymentioning

confidence: 99%

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An Evidence-Based Structured Review to Assess the Results of Common Peroneal Nerve Repair

George

Boyce

2014

Plastic and Reconstructive Surgery

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“…One study suggests operative exploration is indicated in a recognized nerve laceration or any open or closed injury that fails to show recovery by clinical or electromyographic examination 3 months or more after injury [22]. Nerve grafting is rarely successful when grafts are greater than 6 cm in length [7,17,18,22]; therefore, in traumatic longitudinal nerve traction injuries, in which the nerve injury is lengthy, nerve grafting may not be the optimal treatment. Posterior tibial tendon transfers and their variants (Bridle procedure, Riordan transfer) are a commonly used treatment for foot drop [6].…”

Section: Introductionmentioning

confidence: 99%

Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma

Giuffre

Bishop

Spinner

et al. 2012

Clinical Orthopaedics &Amp; Related Research

106

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Background Injuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle dorsiflexion. Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and anklefoot orthotics have been the standard treatment for foot drop. Questions/purposes We (1) describe an alternative surgical technique to obtain ankle dorsiflexion by partial tibial nerve transfer to the motor branch of the tibialis anterior muscle; (2) evaluate ankle dorsiflexion strength using British Medical Research Council grading after nerve transfer; and (3) qualitatively determine factors that influence functional success of surgery. Methods We retrospectively reviewed 11 patients treated with partial tibial nerve transfers after peroneal nerve injury. Pre-and postoperative motor strength was measured. Patients completed questionnaires regarding preand postoperative gait and disability.

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Sequential MR imaging demonstrates evolution of a fibular intraneural ganglion cyst after knee dislocation

et al. 2014

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The basis for the articular (unified) theory for the formation of intraneural ganglion cysts is a capsular disruption through which joint (cyst) fluid egresses into the articular branch and then a parent nerve (Spinner et al., 2003). Trauma has been associated with intraneural ganglion cysts. A recent meta-analysis revealed trauma being associated with intraneural ganglion cysts in 12% of cases (Desy and Spinner, 2014). Our group has described the pathoanatomy by which direct and indirect trauma may give rise to the most common form, fibular (peroneal), and its rarer corollary, tibial intraneural ganglion cysts, both derived from the superior tibiofibular joint (STFJ) (Lalezari et al., 2012; Spinner et al., 2012a,b;Cesmebasi et al., 2014). In direct trauma, there would be a force generated near the proximal leg/knee region that would affect the STFJ (Ogden, 1972(Ogden, , 1974Sekiya and Kuhn, 2003); in indirect trauma, forces would be translated from the ankle region (such as in ankle sprains or fracture) via the interosseous membrane to the proximal leg (Cesmebasi et al., 2014). A direct causeeffect relationship between traumatic injury and intraneural ganglion cyst formation has yet to be definitively established.A 20-year-old man tripped off a curb and fell on his left knee. He sustained a multi-ligamentous knee injury as a result from a knee dislocation. He presented to an emergency room with exquisite pain and foot drop from a common fibular nerve (CFN) palsy and was discharged after negative plain radiographs were obtained. Several days later, he noted increasing pain and was found to have elevated leg compartment pressures for which he underwent four compartment fasciotomies. MRI performed 7 days after the initial injury revealed a posterolateral corner injury involving disruption of the fibular collateral and posterior cruciate ligaments, posterolateral capsule, and the musculotendinous junction of the popliteus, lateral meniscus, and medial patellofemoral ligament. There was edema and thickening of the CFN extending from the fibular neck to a point just distal to the sciatic nerve bifurcation (Figs. 1A-1C). He was referred to colleagues at our institution for definitive care of the multi-ligament injury and the CFN injury. Repeat MRI 3 months after the injury confirmed the previous findings referable to the ligamentous injury. The CFN was markedly enlarged in the popliteal fossa. There was anterior and lateral compartment musculature atrophy consistent with denervation. Electromyography (EMG) confirmed a complete common fibular neuropathy. He underwent staged reconstruction over the course of 9 months: (1) exploration and nerve grafting of the left CFN with 2 cable grafts (9 cm in length) using the superficial fibular nerve; (2) high tibial wedge osteotomy with allograft bone graft; and (3) multi-ligament knee reconstruction. At last follow-up, 15 months post nerve grafting, he had no return of neurologic function but had regained a stable knee. It was recommended he undergo tendon transfer for persisten...

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Surgical Treatment of Traumatic Peroneal Nerve Lesions

Cited by 59 publications

References 27 publications

An Evidence-Based Structured Review to Assess the Results of Common Peroneal Nerve Repair

An Evidence-Based Structured Review to Assess the Results of Common Peroneal Nerve Repair

Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma

Sequential MR imaging demonstrates evolution of a fibular intraneural ganglion cyst after knee dislocation

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