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VOLUME 13 , ISSUE 2 ( August, 2018 ) > List of Articles

Original Article

Causes of peroneal neuropathy associated with orthopaedic leg lengthening in different canine models

Natalia A. Shchudlo, Tatyana N. Varsegova, Mikhail M. Shchudlo, Mikhail A. Stepanov, Andrey A. Yemanov

Keywords : Peroneal nerve, Neuropathy, Leg lengthening, Dog

Citation Information : Shchudlo NA, Varsegova TN, Shchudlo MM, Stepanov MA, Yemanov AA. Causes of peroneal neuropathy associated with orthopaedic leg lengthening in different canine models. 2018; 13 (2):95-102.

DOI: 10.1007/s11751-018-0313-2

License: CC BY-NC-SA 4.0

Published Online: 31-08-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Peroneal neuropathy is one of the complications of orthopaedic leg lengthening. Methods of treatment include slowing of distraction and decompression both of which may lead to additional complications. The purpose of this study was to analyse the changes in histologic peroneal nerve structure during experimental orthopaedic lengthening using various modes of manual or automatic distraction. The obtained data provide the basis for better understanding of peroneal neuropathy pathogenesis and refinement of prophylaxis and preventive treatment protocols. Four experimental models of canine leg lengthening using the Ilizarov fixator were studied: 1 (n = 10)—manual distraction—1 mm/day divided into four increments; 2 (n = 12)—automatic distraction—1 mm/day in 60 increments, 3 (n = 9) and 4 (n = 9)—increased rate of high frequency automatic distraction: 3 mm/day in 120 and 180 increments, respectively. In peroneal nerves semi-thin sections cross-sectional fascicular areas, content of adipocytes in epineurium, endoneurial vascularisation, morphometric parameters of nerve fibres were assessed by computerised analysis at the end of distraction and of consolidation periods and 30 days after fixator removal. In Groups 1–2 massive nerve fibre degeneration along with epineural vessels obliteration was revealed in two cases from 22, whereas in Groups 3–4 there were 10 from 18 (p < 0.01). Injuries of perineurium and endoneurial vessels were noted in Group 3, and long-lasting thinning of nerve fascicles in Group 4. The decrease in epineurial fat tissue was revealed in all groups, more drastic in 3. Modifications and injuries of nerve sheaths and blood vessels depending on distraction rate and frequency contribute to peroneal neuropathy. Its mechanical, circulatory and metabolic causes are discussed.


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  1. Ilizarov GA (1989) The tension-stress effect on the genesis and growth of tissues: part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res 239:263-285
  2. Paley D (1990) Problems, obstacles and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 250:81-104
  3. Aquerreta JD, Forriol F, Cañadell J (1994) Complications of bone lengthening. Int Orthop 18(5):299-303
  4. Maffulli N, Lombari C, Matarazzo L, Nele U, Pagnotta G, Fixsen JA (1996) A review of 240 patients undergoing distraction osteogenesis for congenital post-traumatic or postinfective lower limb length discrepancy. J Am Coll Surg 182(5):394-402
  5. Kawoosa AA, Majid S, Mir MR, Mir GR (2003) Results of tibial lengthening by Ilizarov technique. Indian J Orthop 37:7
  6. Aranovich AM, Dindiberia EV, Klimov OV, Novikov KI (2005) Oshibki i oslozhneniia pri udlinenii goleni u bol'nykh akhondroplaziei [Errors and complications for leg lengthening in patients with achondroplasia]. Travmatologiia i ortopediia Rossii 1:36-37
  7. Kim H, Lee SK, Kim KJ, Ahn JH, Choy WS, Kim YI, Koo JY (2009) Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator. Int Orthop 33(3):835-841
  8. Galardi G, Comi G, Lozza L, Marchettini P, Novarina M, Facchini R et al (1990) Peripheral nerve damage during limb lengthening. Neurophysiology in five cases of bilateral tibial lengthening. J Bone Jt Surg (Br) 72(1):121-124
  9. Nogueira MP, Paley D, Bhave A, Herbert A, Nocente C, Herzenberg JE (2003) Nerve lesions associated with limb-lengthening. J Bone Jt Surg (Am) 85(8):1502-1510
  10. Nogueira MP, Paley D (2011) Prophylactic and therapeutic peroneal nerve decompression for deformity correction and lengthening. J Oper Tech Orthop 21:180-183
  11. Simpson AHRW, Halliday J, Hamilton DF, Smith M, Mills K (2013) Limb lengthening and peripheral nerve function-factors associated with deterioration of conduction. J Acta Orthop 84(6):579-584
  12. Huang SC, Chang CW (1997) Electrophysiologic evaluation of neuromuscular functions during limb lengthening by callus distraction. J Formos Med Assoc 96(3):172-178
  13. Van den Bergh FRA, Vanhoenacker FM, De Smet E, Huysse W, Verstraete KL (2013) Peroneal nerve: normal anatomy and pathologic findings on routine MRI of the knee. Insights Imaging 4(3):287-299
  14. Kadiyala RK, Ramirez A, Taylor AE, Saltzman CL, Cassell MD (2005) The blood supply of the common peroneal nerve in the popliteal fossa. J Bone Jt Surg (Br) 87(3):337-342
  15. Ugrenoviæ S, Topaloviæ M, Jovanoviæ I, Antoviæ A, Miliæ M, Ignjatoviæ A (2014) Morphological and morphometric analysis of fascicular structure of tibial and common peroneal nerves. Facta Univ Ser Med Biol 16(1):18-22
  16. Eleftheriou KI, Beri S, Alavi A, Tennant S (2014) Deep peroneal nerve palsy during growth spurt: a case report. Eur J Pediatr 173(12):1603-1605
  17. Compton J, Fragomen A, Rozbruch SR (2015) Skeletal repair in distraction osteogenesis: mechanisms and enhancements. JBJS Rev 3(8):e2. https://doi.org/10.2106/JBJS.RVW.N.00107
  18. Pap K, Berta A, Szoke G, Dunay M, Nemeth T, Hornok K, Marosfoi L, Rethelyi M, Kozsurek M, Puskar Z (2015) Nerve stretch injury induced pain pattern and changes in sensory ganglia in a clinically relevant model of limb-lengthening in rabbits. Physiol Res 64:571-581
  19. Gorbach YN, Stepanov MA (2015) Osobennosti morfogeneza kostnoi tkani pri udlinenii goleni metodom chreskostnogo osteosinteza pri povishennom sutochnom tempe [Peculiarities of bone tissue morphogenesis during shin lengthening using the method of transosseous distraction osteosynthesis with the increased daily rate]. Morfologiia 147(2):69-74
  20. Lundborg G, Rydevik B (1973) Effects of stretching the tibial nerve of the rabbit. A preliminary study of the intraneural circulation and the barrier function of the perineurium. J Bone Jt Surg Br 55(2):390-401
  21. Kihara M, McManis PG, Schmelzer JD, Kihara Y, Low PA (1995) Experimental ischemic neuropathy: salvage with hyperbaric oxygenation. Ann Neurol 37(1):89-94
  22. Perentes E, Nakagawa Y, Ross GW, Stanton C, Rubinstein LJ (1987) Expression of epithelial membrane antigen in perineurial cells and their derivatives: an immunohistochemical study with multiple markers. Acta Neuropathol (Bert) 75:160-165
  23. Shanthaveerappa T, Bourne G (1962) The “perineural epithelium”, a metabolically active, continuous, protoplasmic cell barrier surrounding peripheral nerve fasciculi. J Anat 96:527-537
  24. Marciniak C (2013) Fibular (peroneal) neuropathy: electrodiagnostic features and clinical correlates. Phys Med Rehabil Clin N Am 24(1):121-137
  25. Verheijen MHG, Chrast R, Burrola P, Lemke G (2003) Local regulation of fat metabolism in peripheral nerves. Genes Dev 17(19):2450-2464
  26. Varsegova TN (2011) Reaktivno-destruktivnyye izmeneniya bol'shebertsovogo nerva pri udlinenii goleni drobnoy i vysokodrobnoy distraktsiyey v eksperimente [Reactive-and-destructive changes in tibial nerve at the lengthening of shin with use of fractional and high-fractional distraction in experiment]. Byulleten' Vostochno-Sibirskogo nauchnogo tsentra Sibirskogo otdeleniya SORAN [Bulletin of the East Siberian Scientific Center SBRAMS] 4(80):234-238
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