Frequent Sural Nerve Injury with Posterior Approach for Ankle Fracture Fixation.
J Am Acad Orthop Surg
; 32(16): 747-753, 2024 Aug 15.
Article
en En
| MEDLINE
| ID: mdl-38723261
ABSTRACT
INTRODUCTION:
The purpose of this study was to report the incidence of iatrogenic sural nerve injury in a large, consecutive sample of surgically managed ankle fractures and to identify factors associated with sural nerve injury and subsequent recovery. We hypothesize that a direct posterior approach may be associated with higher risk of iatrogenic sural nerve injury.METHODS:
A retrospective cohort study of 265 skeletally mature patients who sustained ankle fractures over a 2-year period was done. All were treated with open reduction and internal fixation of fractured malleoli. Patient, injury, and treatment features were documented. The presence (n = 26, 9.8%) of sural nerve injury and recovery of sural nerve function were noted.RESULTS:
All 26 sural nerve injuries were iatrogenic, occurring postoperatively after open reduction and internal fixation. Patients who sustained sural nerve injuries had more ankle fractures secondary to motor vehicle collisions (23.1% versus 9.2%), more associated trimalleolar fractures (69.2% versus 33.9%), and more Orthopaedic Trauma Association/AO 44B3 fractures (57.7% versus 25.1%), all P < 0.05. A posterior approach to the posterior malleolus through the prone position was used in 20.4% of patients. All 26 of the sural nerve injuries (100%) occurred when the patient was placed prone for a posterior approach, P < 0.001. Therefore, 26 of the 54 patients (48%) treated with a posterior approach sustained an iatrogenic sural nerve injury. 62% of patients had full recovery of sural nerve function with no residual numbness, and patients with nerve recovery had fewer associated fracture-dislocations (23.1% versus 100%, P = 0.003).CONCLUSIONS:
A posterior approach for posterior malleolus fixation was associated with a 48% iatrogenic sural nerve injury rate, with 62% recovering full function within 6 months of injury. Morbidity of this approach should be considered, and surgeons should be cautious with nerve handling. LEVEL OF EVIDENCE Level III, Therapeutic.
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Base de datos:
MEDLINE
Asunto principal:
Nervio Sural
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Fracturas de Tobillo
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Fijación Interna de Fracturas
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Enfermedad Iatrogénica
Idioma:
En
Revista:
J Am Acad Orthop Surg
/
J. Am. Acad. Orthop. Surg
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Journal of the American Academy of Orthopaedic Surgeons
Asunto de la revista:
ORTOPEDIA
Año:
2024
Tipo del documento:
Article