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

Area of Science:

• Orthopedics
• Neurology
• Biomedical Engineering

Background:

• Prolonged muscle weakness is observed in patients after Ilizarov treatment.
• The cause of this weakness is often unclear, potentially neuropathic or myopathic.
• Intraoperative nerve injury is rare and usually detected early.

Purpose of the Study:

• To investigate the etiology of prolonged muscle weakness following Ilizarov tibial lengthening.
• To correlate electrodiagnostic findings with clinical observations.
• To assess perioperative limb compartment pressures during Ilizarov procedures.

Main Methods:

• Electrodiagnostic testing (nerve conduction studies, electromyography) was performed on six patients post-tibial lengthening.
• Sequential limb compartment pressure studies were conducted on nine patients undergoing Ilizarov tibial applications.
• Clinical examination confirmed all patients were asymptomatic prior to electrodiagnostic testing.

Main Results:

• All six patients showed abnormalities in deep peroneal nerve electrodiagnostics.
• Five of six patients had abnormal superficial peroneal sensory responses.
• Elevated mean compartment pressures (20-30 mm Hg) were noted after osteotomy and in the initial 18 hours postoperatively.
• Two patients exhibited posterior tibial nerve abnormalities.

Conclusions:

• Electrodiagnostic abnormalities in peroneal nerves are common after Ilizarov tibial lengthening.
• Elevated compartment pressures may contribute to or indicate nerve compromise.
• These findings suggest a neuropathic etiology for post-Ilizarov muscle weakness.