[Surgical treatment of fibular nerve injury]

In the submitted retrospective study the authors present the results of 40 operations in 40 patients who were treated in the course of 15 years (from 1985-1999) on account of 40 injuries of the fibular nerve, historically known as an injury difficult to treat. The paper gives a basic outline of the surgical treatment.

From a total number of 40 in 20 patients external neurolysis was performed. In the remaining 20 patients reconstruction operations of the injured nerves were made whereby 8 operations involved suture of the peripheral nerve, and 12 operations were made using a nerve graft in case of complete and persisting neurological deficiency and absence of action potentials on EMG. The mechanism of injury comprised nerve injury caused by elongation with or without fracture, "sharp" or "blunt" injuries, shotgun injuries, compressions and iatrogenic injuries. If spontaneous repair did not occur within 2-6 months after injury the patients were operated and in 27 of 40 improvement was achieved preventing instability of the foot and in 25 of 40 protective sensitivity developed. Analysis of the effectiveness of surgery was focused on the following indicators: time of operation after injury, patient's age, character of injury, level of injury, type of surgical operation.

After neurolysis in 18 of 20 patients (90%) a useful grade of improvement was achieved despite severe preoperative motor deficiency. In 8 patients an "end to end" suture was made and in 6 (75%) the restoration was grade 3 or more. 12 patients needed a reconstruction operation by means of nerve grafts, the length of the graft varied from 4 to 20 cm. The grafts were shorter than 5 cm and in 2 patients, with a cut in 1 and with a iatrogenic injury in 1 patient. In both these patients the function was restored to grade M4. In 1 of 4 patients (20%) with a graft of 6 to 12 cm and in none of 6 with grafts from 13 to 20 cm restoration grade 3 or more was achieved. In those instances the authors observed however partial restoration of the trophics and tonus but without motor restoration.

Similarly as in other nerve injuries thorough preoperative examination and early surgery are necessary to achieve optimal results. It worth mentioning that excellent results were attained in proximal injuries of the fibular nerve as compared with injuries in the more distal area of the knee.