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Anterior transposition of the superficial peroneal nerve branch during the internal fixation of the lateral malleolus.
J Trauma. 2010 Feb; 68(2):421-4.JT

Abstract

BACKGROUND

Because of the anatomic variations of the superficial peroneal nerve (SPN), it has long been stressed that caution should be exercised at the time of open reduction and internal fixation (ORIF) of the lateral malleolus.

METHODS

Blair and Botte described type B intermediate dorsal cutaneous nerve (IDCN) in which the SPN penetrates crural fascia posterior to the fibula about 5 cm proximal to the joint and crosses the lateral border of the fibulae. We hypothesized that the type B IDCN is especially vulnerable to direct surgical injury if present and the anterior transposition of this nerve may decrease the incidence of symptoms related to the SPN injury. Fifty-three ankle fractures in 53 adult patients treated by the ORIF of lateral malleolus using the lateral approach between the periods from May 2001 to December 2006 were included. Intraoperative documentation about the presence of the type B IDCN variant at the surgical field was performed, and preoperative and postoperative sensory changes were carefully evaluated.

RESULTS

We encountered Blair type B variant in 7 cases (12%). The IDCN was carefully dissected and transposed anteriorly before the plating. One of these seven patients had sensory deficit preoperatively, and it was recovered spontaneously 5 months after operation. There was one patient whose IDCN was inadvertently severed, and it was repaired. At the time of last follow-up, only partial recovery of the sensory deficit was noted. Five of seven patients did not show any neurologic deficit with anterior transposition.

CONCLUSION

Recognition and anterior transposition of the type B IDCN could reduce the incidence of the SPN nerve injuries during the ORIF of the lateral malleolar fractures.

Authors+Show Affiliations

Department of Orthopedic Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20154553

Citation

Kim, Hak Jun, et al. "Anterior Transposition of the Superficial Peroneal Nerve Branch During the Internal Fixation of the Lateral Malleolus." The Journal of Trauma, vol. 68, no. 2, 2010, pp. 421-4.
Kim HJ, Oh JK, Oh CW, et al. Anterior transposition of the superficial peroneal nerve branch during the internal fixation of the lateral malleolus. J Trauma. 2010;68(2):421-4.
Kim, H. J., Oh, J. K., Oh, C. W., Hwang, J. H., & Biswal, S. (2010). Anterior transposition of the superficial peroneal nerve branch during the internal fixation of the lateral malleolus. The Journal of Trauma, 68(2), 421-4. https://doi.org/10.1097/TA.0b013e3181a70847
Kim HJ, et al. Anterior Transposition of the Superficial Peroneal Nerve Branch During the Internal Fixation of the Lateral Malleolus. J Trauma. 2010;68(2):421-4. PubMed PMID: 20154553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anterior transposition of the superficial peroneal nerve branch during the internal fixation of the lateral malleolus. AU - Kim,Hak Jun, AU - Oh,Jong-Keon, AU - Oh,Chang-Wug, AU - Hwang,Jin-Ho, AU - Biswal,Sandeep, PY - 2010/2/16/entrez PY - 2010/2/16/pubmed PY - 2010/4/2/medline SP - 421 EP - 4 JF - The Journal of trauma JO - J Trauma VL - 68 IS - 2 N2 - BACKGROUND: Because of the anatomic variations of the superficial peroneal nerve (SPN), it has long been stressed that caution should be exercised at the time of open reduction and internal fixation (ORIF) of the lateral malleolus. METHODS: Blair and Botte described type B intermediate dorsal cutaneous nerve (IDCN) in which the SPN penetrates crural fascia posterior to the fibula about 5 cm proximal to the joint and crosses the lateral border of the fibulae. We hypothesized that the type B IDCN is especially vulnerable to direct surgical injury if present and the anterior transposition of this nerve may decrease the incidence of symptoms related to the SPN injury. Fifty-three ankle fractures in 53 adult patients treated by the ORIF of lateral malleolus using the lateral approach between the periods from May 2001 to December 2006 were included. Intraoperative documentation about the presence of the type B IDCN variant at the surgical field was performed, and preoperative and postoperative sensory changes were carefully evaluated. RESULTS: We encountered Blair type B variant in 7 cases (12%). The IDCN was carefully dissected and transposed anteriorly before the plating. One of these seven patients had sensory deficit preoperatively, and it was recovered spontaneously 5 months after operation. There was one patient whose IDCN was inadvertently severed, and it was repaired. At the time of last follow-up, only partial recovery of the sensory deficit was noted. Five of seven patients did not show any neurologic deficit with anterior transposition. CONCLUSION: Recognition and anterior transposition of the type B IDCN could reduce the incidence of the SPN nerve injuries during the ORIF of the lateral malleolar fractures. SN - 1529-8809 UR - https://www.unboundmedicine.com/medline/citation/20154553/Anterior_transposition_of_the_superficial_peroneal_nerve_branch_during_the_internal_fixation_of_the_lateral_malleolus_ L2 - http://dx.doi.org/10.1097/TA.0b013e3181a70847 DB - PRIME DP - Unbound Medicine ER -