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Peroneal Nerve Decompression in Patients with Multiple Hereditary Exostoses: Indications, Complications, and
Aaron J Huser1, Hans K Nugraha, Arun R Hariharan
1Paley Orthopedic & Spine Institute, West Palm Beach, Florida.
The Journal of Bone and Joint Surgery. American Volume
|April 25, 2024
Summary
This study on multiple hereditary exostoses (MHE) found that peroneal nerve decompression and fibular osteochondroma excision can cause complications, especially in skeletally immature patients. Recurrence was exclusively observed in this group, highlighting the need for careful consideration in MHE management.
Area of Science:
- Orthopedic Surgery
- Genetics
- Neurology
Background:
- Multiple hereditary exostoses (MHE) is a genetic disorder characterized by multiple osteochondromas.
- Peroneal nerve compression can occur due to osteochondromas, leading to neurological deficits.
- No prior studies have exclusively examined peroneal nerve decompression and proximal fibular osteochondroma excision in MHE patients.
Purpose of the Study:
- To evaluate the indications for peroneal nerve decompression and proximal fibular osteochondroma excision in patients with MHE.
- To assess the complications associated with these procedures in MHE patients.
- To determine the recurrence rate of symptoms after surgical intervention in MHE patients.
Main Methods:
- Retrospective review of patients with MHE undergoing peroneal nerve decompression from 2009 to 2023.
- Analysis of indications, clinical status, surgical techniques, recurrence, and complications.
- Statistical analysis using Fisher exact test, logistic regression, and Kaplan-Meier method.
Main Results:
- 126 limbs in MHE patients were analyzed; common indications included pain, weakness, and neuropathic symptoms.
- Complications occurred in 7 cases, with foot drop being noted postoperatively.
- Logistic regression identified anterior osteochondroma excision, proximal fibular excision, and prior decompression as significant risk factors for complications.
- The recurrence rate was 13.8%, exclusively in skeletally immature patients, with lower long-term recurrence-free probabilities.
Conclusions:
- Neurologic symptoms and pain are primary indications for peroneal nerve decompression in MHE.
- Excision of anterior osteochondromas and previous decompression increase complication risk.
- Recurrence of symptoms is limited to skeletally immature patients, underscoring the importance of age in surgical outcomes.
