Advertisement

Short- and long-term results of common peroneal nerve injuries treated by neurolysis, direct suture or nerve graft

  • C. Horteur
  • A. Forli
  • D. Corcella
  • R. Pailhé
  • G. Lateur
  • D. Saragaglia
Original Article • KNEE - TRAUMA
  • 4 Downloads

Abstract

Introduction

Damage to the common peroneal nerve is the most frequent nerve injury in lower limb traumas. Our objective was to assess the motor and sensory recovery levels and the functional outcomes after remedial surgery for common peroneal nerve trauma, through either neurolysis, direct suture or nerve graft.

Methods

This is a transversal, observational study of a monocentric cohort of 20 patients who underwent surgery between January 2004 and June 2016, which included 16 men and 4 women whose median age was 35 ± 11 years. We assessed the level of sensory and motor nerve recovery and the Kitaoka score. Nine patients benefited from neurolysis, 5 had direct sutures, and 6 received a nerve graft.

Results

With 48 months’ average follow-up, 7 out of 9 patients underwent neurolysis and 4 out of 5 with direct sutures had good motor recovery (≥ M4), but none for the grafts. Sensory recovery (≥ S3) was satisfactory in 7 out of 9 cases in the neurolysis group, 3 out of 5 in the direct suture group, and 3 out of 6 in the nerve graft group. The average Kitaoka score was 83.7 ± 11.5 for the neurolysis group, 86.8 ± 16 for the direct suture group, and 73 ± 14 for the graft group.

Conclusion

Surgical treatment by neurolysis and direct suture yields good results with a motor recovery ratio nearing 80%. When a nerve graft becomes necessary, recovery is poor and resorting to palliative techniques in the shorter run is a strategy which should be evaluated.

Keywords

Common peroneal nerve Suture Nerve graft Neurolysis 

Notes

Compliance with ethical standards

Conflict of interest

The authors hereby declare no conflict of interest.

References

  1. 1.
    Wood MB (1991) Peroneal nerve repair. Surgical results. Clin Orthop Relat Res 267:206–210Google Scholar
  2. 2.
    Seidel JA, Koenig R, Antoniadis G, Richter HP, Kretschmer T (2008) Surgical treatment of traumatic peroneal nerve lesions. Neurosurgery 62:664–673CrossRefGoogle Scholar
  3. 3.
    Kim DH, Midha R, Murovic JA, Spinner R, Teil R (2008) Nerve injuries, 2nd edn. Saunders, PhiladelphiaGoogle Scholar
  4. 4.
    Wilkinson MC, Birch R (1995) Repair of the common peroneal nerve. J Bone Jt Surg Br 77:501–503CrossRefGoogle Scholar
  5. 5.
    Roganovic Z (2005) Missile-caused complete lesions of the peroneal nerve and peroneal division of the sciatic nerve: results of 157 repairs. Neurosurgery 57:1201–1212CrossRefGoogle Scholar
  6. 6.
    Sedel L (1985) The surgical management of nerve lesions in the lower limbs. Clinical evaluation, surgical technique and results. Int Orthop 9:159–170CrossRefGoogle Scholar
  7. 7.
    Clawson DK, Seddon HJ (1960) The late consequences of sciatic nerve injury. J Bone Jt Surg Br 42:213–225CrossRefGoogle Scholar
  8. 8.
    George SC, Boyce DE (2014) An evidence-based structured review to assess the results of common peroneal nerve repair. Plast Reconstr Surg 134:302–311CrossRefGoogle Scholar
  9. 9.
    Gosk J, Rutowski R, Rabczyński J (2005) The lower extremity nerve injuries—own experience in surgical treatment. Folia Neuropathol 43:148–152Google Scholar
  10. 10.
    Masquelet AC, McCullough CJ, Tubiana R (1994) Voies d’abord chirurgicales du membre inférieur. Masson, ParisGoogle Scholar
  11. 11.
    Kitaoka HB, Patzer GL (1997) Analysis of clinical grading scales for the foot and ankle. Foot Ankle Int 18:443–446CrossRefGoogle Scholar
  12. 12.
    Kim DH, Murovic JA, Tiel RL, Kline DG (2004) Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center. Neurosurgery 54:1421–1428CrossRefGoogle Scholar
  13. 13.
    Matejcik V, Steno J, Benetin J, Kuchar M (2001) Surgical treatment of injuries of nervus fibularis. Bratisl Lekárske Listy 102:361–364Google Scholar
  14. 14.
    White J (1968) The results of traction injuries to the common peroneal nerve. J Bone Jt Surg Br 50:346–350CrossRefGoogle Scholar
  15. 15.
    Stancić MF, Eskinja N, Bellinzona M, Mićović V, Stosić A, Tomljanović Z (1996) The role of interfascicular nerve grafting after gunshot wounds. A report of 44 cases. Int Orthop 20:87–91CrossRefGoogle Scholar
  16. 16.
    Millesi H (2006) Factors affecting the outcome of peripheral nerve surgery. Microsurgery 26:295–302CrossRefGoogle Scholar
  17. 17.
    Giuffre JL, Bishop AT, Spinner RJ, Shin AY (2010) Surgical technique of a partial tibial nerve transfer to the tibialis anterior motor branch for the treatment of peroneal nerve injury. Ann Plast Surg 69:48–53CrossRefGoogle Scholar
  18. 18.
    Giuffre JL, Bishop AT, Spinner RJ, Levy BA, Shin AY (2012) Partial tibial nerve transfer to the tibialis anterior motor branch to treat peroneal nerve injury after knee trauma. Clin Orthop Relat Res 470:779–790CrossRefGoogle Scholar
  19. 19.
    Nath RK, Lyons AB, Paizi M (2008) Successful management of foot drop by nerve transfers to the deep peroneal nerve. J Reconstr Microsurg 24:419–427CrossRefGoogle Scholar
  20. 20.
    Ferraresi S, Garozzo D, Buffatti P (2003) Common peroneal nerve injuries: results with one-stage nerve repair and tendon transfer. Neurosurg Rev 26:175–179CrossRefGoogle Scholar
  21. 21.
    Garozzo D, Ferraresi S, Buffatti P (2002) Common peroneal nerve injuries in knee dislocations: results with one-stage nerve repair and tibialis posterior tendon transfer. J Orthop Traumatol 2:135–137CrossRefGoogle Scholar
  22. 22.
    Giuseffi SA, Bishop AT, Shin AY, Dahm DL, Stuart MJ, Levy BA (2010) Surgical treatment of peroneal nerve palsy after knee dislocation. Knee Surg Sports Traumatol Arthrosc 18:1583–1586CrossRefGoogle Scholar
  23. 23.
    Sedel L, Nizard RS (1993) Nerve grafting for traction injuries of the common peroneal nerve. A report of 17 cases. J Bone Jt Surg Br 75:772–774CrossRefGoogle Scholar
  24. 24.
    Werner BC, Norte GE, Hadeed MM, Park JS, Miller MD, Hart JM (2017) Peroneal nerve dysfunction due to multiligament knee injury: patient characteristics and comparative outcomes after posterior tibial tendon transfer. Clin J Sport Med 27:10–19CrossRefGoogle Scholar
  25. 25.
    Kutubidze A (2009) Upper and lower extremities nerve injuries: own experience in surgical treatment. Georgian Med News 166:7–9Google Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • C. Horteur
    • 2
  • A. Forli
    • 1
  • D. Corcella
    • 1
  • R. Pailhé
    • 2
  • G. Lateur
    • 2
  • D. Saragaglia
    • 2
  1. 1.Department of Hand and Reconstructive SurgeryGrenoble North University HospitalLa TroncheFrance
  2. 2.Department of Orthopaedic Surgery and Sports TraumatologyGrenoble South University HospitalEchirollesFrance

Personalised recommendations