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Effects of external fixation and limb lengthening on peripheral nerve function
M R Makarov1, J G Birch, M R Delgado
1Department of Neurology & Neurophysiology, Texas Scottish Rite Hospital for Children, Dallas, USA.
Clinical Orthopaedics and Related Research
|August 1, 1996
Summary
Peripheral nerve function during limb lengthening is primarily affected by transfixion wires impinging on nerves. Minimizing wire-nerve contact is crucial for preserving nerve conduction during distraction osteogenesis.
Area of Science:
- Orthopedics
- Neurophysiology
Background:
- Limb lengthening procedures can impact peripheral nerve function.
- Understanding factors affecting nerve function is vital for patient outcomes.
Purpose of the Study:
- To identify factors influencing peripheral nerve function during limb lengthening.
- To correlate somatosensory evoked potentials (SEPs) with necropsy findings.
Main Methods:
- Serial somatosensory evoked potentials (SEPs) studies in 18 goats.
- Tibial lengthening using the Ilizarov apparatus (20% or 30% at 0.75 mm/day).
- Correlation of SEP data with gross soft tissue and nerve appearance at necropsy.
Main Results:
- Transfixion wires disrupting nerves were identified in 6 of 8 goats with peroneal nerve conduction changes.
- No wires were found in 2 goats with nerve changes, but diffuse soft tissue fibrosis was present.
- The rhythm of distraction did not significantly influence SEP changes; wire-nerve proximity was a key factor.
Conclusions:
- Anatomic relationship between transfixion wires and nerves is a critical factor in peripheral nerve dysfunction during limb lengthening.
- While the amount of lengthening correlates with nerve deterioration, direct mechanical disruption by wires is more significant.
- Preventing wire impingement on nerves is essential for maintaining nerve function during distraction osteogenesis.