Electromyographic and nerve conduction changes after tibial lengthening by the Ilizarov method

Clinical observation of several hundred Ilizarov patients has demonstrated prolonged muscle weakness in the involved limb after treatment. The etiology may be either neuropathic or myopathic. Direct intraoperative neural injury is unusual but generally is detected immediately postoperatively. We wished to determine the etiology of this clinical problem. Six consecutive patients completing tibial lengthening by the Ilizarov method were examined by electrodiagnostic methods. All patients were clinically normal. Electrodiagnostic testing showed abnormalities in six of six deep peroneal nerves. Five of six demonstrated abnormalities in the superficial peroneal sensory responses. In addition, two of six patients demonstrated abnormalities related to the posterior tibial nerve. Concomitantly, sequential perioperative limb compartment pressure studies were performed in nine patients undergoing 12 tibial applications of the Ilizarov technique. Increases in mean compartment pressures to between 20 and 30 mm Hg were demonstrated after tibial osteotomy and in the first 18 hours postoperatively.