Clinical Results Following Surgery for Traumatic Peroneal Nerve Injury: A Review of Risk Factors Following Various Surgical Techniques

Kadiyala Rosberg^*
*Correspondence: Kadiyala Rosberg, Department of Neurosurgery, University of Ulm, BKH Günzburg, Lindenallee 2, 89312 Günzburg, Germany, Email:

Introduction

Traumatic peroneal nerve injury is a common peripheral nerve injury resulting from trauma, particularly fractures, dislocations, or compression. The peroneal nerve, a branch of the sciatic nerve, is responsible for controlling the muscles of the lower leg and foot, making it critical for motor functions such as dorsiflexion and eversion. Injury to the peroneal nerve can lead to significant disability, including foot drop, sensory loss and impaired gait, which may greatly impact a patient's quality of life. Surgical intervention is often required for severe cases, particularly when conservative treatments fail to restore function. This review aims to evaluate the clinical results following surgery for traumatic peroneal nerve injury, with a particular focus on the risk factors associated with various surgical techniques [1].

Description

The clinical outcomes following surgical treatment of traumatic peroneal nerve injury depend on a variety of factors, including the timing of intervention, the severity of the nerve damage, the type of surgical procedure performed and patient-specific characteristics such as age, comorbidities and the mechanism of injury. Early diagnosis and prompt surgical intervention are key factors in improving the prognosis for patients with peroneal nerve injuries. However, the success of surgery is not always guaranteed and many patients experience varying degrees of recovery, with some remaining permanently disabled despite surgical intervention. The peroneal nerve is particularly vulnerable to trauma due to its superficial anatomical location near the fibular head. Direct compression or injury to the nerve can occur in the context of fractures, knee dislocations, or as a result of prolonged external pressure during surgical procedures. In such cases, nerve injury may range from a simple contusion to more severe forms, such as axonotmesis or neurotmesis, where the nerve is completely severed. The degree of injury to the peroneal nerve has a direct impact on the surgical approach and subsequent outcomes. Electrophysiological studies, such as Nerve Conduction Velocity (NCV) Testing and Electromyography (EMG), are often used to assess the extent of damage and guide treatment decisions [2].

Non-operative treatment, including physical therapy, orthotic devices and observation, is usually sufficient for patients with mild injuries where there is no significant nerve damage. However, when there is persistent weakness, foot drop, or sensory deficits, surgical options may be considered. The most common surgical procedures for peroneal nerve injury include nerve decompression, nerve grafting and nerve transfer techniques. The choice of surgical technique depends on the extent of the nerve damage and the timing of the surgery, with early intervention generally providing better outcomes. Nerve decompression is the most straightforward surgical approach, typically employed when the injury is caused by external pressure on the nerve, such as in cases of compression from a fracture or prolonged immobilization. The goal of decompression is to relieve the pressure on the nerve and restore normal blood flow, allowing for recovery of nerve function. The success of nerve decompression is largely dependent on the duration of compression before surgery. If the nerve is compressed for a prolonged period, irreversible damage can occur, making decompression alone less effective. Clinical studies have shown that nerve decompression performed within six months of injury offers the best chance for recovery, with many patients experiencing significant improvement in both motor function and sensory perception. However, when the nerve has been compressed for longer periods, nerve degeneration can be severe and decompression may not result in complete recovery [3].

In more complex cases, nerve transfer techniques may be employed to restore function. Nerve transfer involves redirecting a healthy nerve, often from a nearby muscle, to the injured nerve to restore motor function. This technique is particularly useful when nerve grafting is not feasible due to the severity of the injury or the distance between the nerve ends. Nerve transfers are typically performed for more proximal injuries where nerve grafting would be difficult or where the available donor nerves are not suitable for grafting. The results of nerve transfer procedures are generally positive, with many patients experiencing a restoration of motor function, although the recovery process can be lengthy. Nerve transfers are associated with high patient satisfaction rates, but they require careful selection of donor nerves and precise surgical technique to achieve optimal results [4,5].

Conclusion

Overall, the clinical results following surgery for traumatic peroneal nerve injury are highly variable, with numerous factors influencing outcomes. Early diagnosis and prompt surgical intervention are key to optimizing recovery, as delayed treatment can lead to irreversible nerve degeneration and poor outcomes. The choice of surgical technique, whether it be nerve decompression, nerve grafting, or nerve transfer, depends on the severity and nature of the injury. While many patients experience significant improvements in motor function and sensation following surgery, the recovery process can be slow and some patients may continue to experience residual weakness or sensory deficits. A comprehensive approach to treatment, including early surgical intervention, personalized rehabilitation and close monitoring of the patient's progress, is essential for achieving the best possible outcomes in the management of traumatic peroneal nerve injury.

Acknowledgment

None.

Conflict of Interest

None.

References

1. Huckhagel, Torge, Jakob Nüchtern, Jan Regelsberger and Mathias Gelderblom, et al. "Nerve trauma of the lower extremity: Evaluation of 60,422 leg injured patients from the TraumaRegister DGU® between 2002 and 2015." Scand J Trauma Resusc Emerg Med 26 (2018): 1-8.

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2. Kadiyala, R. K., A. Ramirez, A. E. Taylor and C. L. Saltzman, et al. "The blood supply of the common peroneal nerve in the popliteal fossa." J Bone Joint Surg 87 (2005): 337-342.

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