Pattyn Ryan, Loder Randall, Mullis Brian H
Indiana University School of Medicine, Indianapolis, IN.
Department of Orthopaedic Surgery, Riley Children's Hospital, Indianapolis, IN; and.
J Orthop Trauma. 2020 Jul;34(7):359-362. doi: 10.1097/BOT.0000000000001748.
To report the rate of peroneal nerve palsy after routine use of intraoperative distraction during open reduction internal fixation (ORIF) for lateral unicondylar and bicondylar tibial plateau fracture (TPF) repairs.
Retrospective chart review.
Level I trauma center.
Patients with traumatic TPF treated with ORIF between 2007 and 2017.
ORIF for lateral unicondylar and bicondylar TPF.
Presence and resolution of neurovascular injury.
There were a total of 21 lateral unicondylar and 40 bicondylar TPFs repaired through ORIF in 60 patients identified during the study period with 1-year follow-up and complete records for review. Thirty-six patients had staged external fixation before ORIF while 24 were treated with ORIF initially. Of the staged patients, 9 of 36 (25%) developed nerve palsy while those undergoing initial ORIF (not staged) developed palsy in only one case (1 of 24, or 4%). Of the patients who developed nerve palsy, 9 of 10 (90%) were staged with an initial external fixator before ORIF. The incidence of iatrogenic peroneal nerve palsy secondary to intraoperative distraction was 16.4% (10 of 61). Only 60% (6 of 10) of peroneal nerve palsies recovered clinically with a mean recovery time of approximately 14 weeks. Comparison of demographics in patients with peroneal nerve palsy versus those without yielded no significant difference by sex (P = 0.08), age (P = 0.27), fracture type (P = 0.29), tobacco use (P = 0.44), or alcohol use (P = 0.78).
Peroneal nerve palsy is a common sequela of ORIF for TPFs involving the lateral compartment using an intraoperative distractor. Staged external fixation followed by definitive ORIF using intraoperative distraction was associated with significant risk for developing nerve palsy (9/10). Many patients (40%) who develop peroneal nerve palsies do not recover, leading to permanent loss of motor and/or sensory function for 7% of patients studied. None of the epidemiologic variables evaluated yielded predictive value for development of peroneal nerve palsy or subsequent resolution. Caution should be exercised in avoiding overdistraction when using intraoperative distraction, especially in those cases that had staged fixation, most notably bicondylar injuries.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
报告在外侧单髁和双髁胫骨平台骨折（TPF）切开复位内固定术（ORIF）中常规使用术中牵张后腓总神经麻痹的发生率。
回顾性图表审查。
一级创伤中心。
2007年至2017年间接受ORIF治疗的创伤性TPF患者。
外侧单髁和双髁TPF的ORIF。
神经血管损伤的存在及恢复情况。
在研究期间确定的60例患者中，共有21例外侧单髁和40例双髁TPF通过ORIF修复，随访1年且有完整记录可供审查。36例患者在ORIF前进行了分期外固定，24例最初接受ORIF治疗。在分期患者中，36例中有9例（25%）发生神经麻痹，而最初接受ORIF（未分期）治疗的患者仅1例（24例中的1例，即4%）发生麻痹。在发生神经麻痹的患者中，10例中有9例（90%）在ORIF前使用了初始外固定架进行分期。术中牵张继发的医源性腓总神经麻痹发生率为16.4%（61例中的10例）。腓总神经麻痹患者中只有60%（10例中的6例）临床恢复，平均恢复时间约为14周。腓总神经麻痹患者与未发生麻痹患者的人口统计学比较显示，性别（P = 0.08）、年龄（P = 0.27）、骨折类型（P = 0.29）、吸烟（P = 0.44）或饮酒（P = 0.78）方面无显著差异。
腓总神经麻痹是使用术中牵张器治疗累及外侧间室的TPF的ORIF常见后遗症。分期外固定后使用术中牵张进行确定性ORIF与发生神经麻痹的显著风险相关（9/10）。许多发生腓总神经麻痹的患者（40%）未恢复，导致7%的研究患者永久性运动和/或感觉功能丧失。所评估的流行病学变量均未显示对腓总神经麻痹的发生或随后的恢复具有预测价值。使用术中牵张时应注意避免过度牵张，尤其是在那些进行了分期固定的病例中，最明显的是双髁损伤。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
