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Peripheral Nerve Injury Following Tibial Osteotomy in Children. Is There a Role for Routine Prophylactic Common
Nisarg Mehta1, Stewart Morrison2, Chris Harris2
1Department of Orthopaedics, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, Merseyside, UK.
Insights
Peripheral nerve injury occurred in 6.3% of pediatric tibial osteotomies, with 81% recovery. Risk factors included multiple osteotomies and acute valgus correction, suggesting selective prophylactic decompression.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Neurology
Background:
- Tibial osteotomy is crucial for limb lengthening and deformity correction in children.
- Nerve injury is a potential complication, necessitating evaluation of risk factors and outcomes.
Purpose of the Study:
- To assess long-term clinical outcomes of tibial osteotomy in children.
- To identify risk factors for peripheral nerve injury, specifically common peroneal and tibial nerves.
- To evaluate recovery rates and secondary outcomes like return to theatre.
Main Methods:
- Retrospective analysis of 173 tibial osteotomies in 135 pediatric patients (excluding neuromuscular conditions) over 7 years.
- Primary outcome: peripheral nerve injury; Secondary outcomes: return to theatre, deformity correction.
- Statistical analysis to determine risk factors (e.g., multiple osteotomies, acute correction).
Main Results:
- Overall nerve injury rate was 6.3% (3.5% in tibial lengthening cases).
- 81% of injured patients achieved complete (45%) or partial (36%) recovery.
- Significant risk factors for nerve injury: multiple osteotomies (RR: 1.30) and acute valgus correction (RR: 1.35).
Conclusions:
- Nerve injury is a low-incidence complication of pediatric tibial osteotomy with a high recovery rate.
- Prophylactic common peroneal nerve decompression may be considered for double-level osteotomies and acute valgus correction.
- Informed consent regarding nerve injury risk is essential for shared decision-making.
Aims:
To evaluate the long-term clinical outcomes and risk factors for nerve injury in children undergoing tibial osteotomy for lengthening and/or deformity correction at a tertiary pediatric center, focusing on common peroneal and tibial nerve injuries.
Methods:
This retrospective study included all children under 18 years of age who underwent tibial osteotomy over a 7-year period, excluding those with neuromuscular conditions. The primary outcome was peripheral nerve injury, while secondary outcomes included early unplanned return to theatre and deformity parameters.
Results:
A total of 173 tibial osteotomies were performed on 135 children, 80 of which were for tibial lengthening. Peripheral nerve injuries occurred in 11 cases (6.3%), with 81% showing complete (45%) or partial recovery (36%). Among patients undergoing tibial lengthening, the prevalence of nerve injury was 3.5%. Significant risk factors for nerve injury included multiple osteotomies ( P =0.02, RR: 1.30) and acute correction of valgus deformities ( P =0.01, RR: 1.35).
Conclusion:
The overall prevalence of nerve injury was 6.3% for all osteotomies and 3.5% in those undergoing tibial lengthening, with an 81% recovery rate. The rate of early unplanned return to the theatre was low at 3.4%. Prophylactic decompression of the common peroneal nerve should be considered for double-level osteotomies and acute correction of valgus deformity but is not routinely required during standard tibial lengthening. The potential risk of nerve injury should be discussed with the families as part of shared decision-making.
Level Of Evidence:
Level IV.
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