Neuromuscular injury during limb lengthening: a longitudinal follow-up by rabbit tibial model

Limb lengthening has been used for many years to correct congenital anomalies and unequal leg length. Some surgeons focus on bone genesis and anatomical alignment, and pay less attention to potential damage to muscles, nerves, and vessels during the gradual stretching. In an attempt to identify the presence and extent of neuromuscular abnormalities during leg elongation, a rabbit tibial osteotomy model was used for 17 male rabbits, and fixation-distraction apparatuses were applied at a rate of 1 mm lengthening per day. Electrophysiological test was used to investigate both hindlegs every 2 weeks for 8 weeks after surgery. Needle electromyography (EMG) showed denervation in the elongated legs with 14 limbs having peroneal nerve damage and 12 limbs having damage to the posterior tibial nerve. Nerve regeneration signs were found in ankle extensors and flexors beginning 2 weeks postoperatively. The results of nerve conduction studies revealed significant differences (P < .05) in CMAP amplitude (mV) and area (mV.mS) in ankle extensors and flexors between elongated and nonelongated legs. There was no significant side-to-side difference with respect to distal latency. The incidence of neuromuscular injury was common in these rabbits. These findings suggest that early detection of neuromuscular involvement by electrophysiological test is a practical way to assess neuromuscular function during limb lengthening.