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1
Dikici, Fatih, Özcan Gayretli, İlke Ali Gürses, et al. "Anatomic correlation of common fibular nerve palsy encountered after short leg casts." Anatomy 15, no. 2 (2021): 116–20. http://dx.doi.org/10.2399/ana.21.898254.
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Objectives: Short leg casts are routine applications in orthopaedic practice. The aim of the study was to investigate the course of the common fibular nerve and its branches (deep and superficial fibular nerves) around the fibular neck in order to describe a convenient method for applying the lower extremity casts with low risk of fibular nerve entrapment. Methods: Fifty lower extremities of 26 cadavers were examined. The point where common fibular nerve itself or its branches (deep and superficial fibular nerves) crossed over the fibular neck were dissected. The points where the nerve or its branches have risk of compression between the fibula and the cast were investigated in relation to fibular length. Results: The average fibular length was 356.9±26.4 mm. The common fibular nerve did not pass over the fibular neck in any specimen, instead, its branches crossed over it. The average distance from the tip of the fibular head to deep fibular nerve and superficial fibular nerve were 42.9±6.5 mm and 52±6.3 mm, respectively. The mean ratio of fibular length to these distances were 8.5±1.2 and 7.0±0.8, respectively. Conclusion: As short knee casts is a frequent application in clinical practice, it is important to determine a safe upper border for the casts to protect common fibular nerve or its branches. We recommend that the upper border of short leg casts should not exceed the upper 1/7th of the fibular length of the patient in order to avoid fibular nerve palsy.
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Flores, Leandro Pretto. "Proximal Motor Branches From the Tibial Nerve as Direct Donors to Restore Function of the Deep Fibular Nerve for Treatment of High Sciatic Nerve Injuries: A Cadaveric Feasibility Study." Operative Neurosurgery 65, suppl_6 (2009): ons218—ons225. http://dx.doi.org/10.1227/01.neu.0000346329.90517.79.
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Abstract Objective: The results of surgical repair of the fibular division of the sciatic nerve have been considered unsatisfactory, especially if grafts are necessary to reconstruct the nerve. To consider the clinical application of the concept of distal nerve transfer for the treatment of high sciatic nerve injuries, this study aimed to determine detailed anatomic data about the possible donor branches from the tibial nerve that are available for reinnervation of the deep fibular nerve at the level of the popliteal fossa. Methods: An anatomic study was performed that included the dissection of the popliteal fossa in 12 lower limbs of 6 formalin-fixed adult cadavers. It focused on the detailed anatomy of the tibial nerve and its branches at the level of the proximal leg as well as the anatomy of the common fibular nerve and its largest divisions at the level of the neck of the fibula, i.e., the deep and superficial fibular nerves. Results: The branches of the tibial nerve destined to the lateral and medial head of the gastrocnemius had a mean length of 43 mm and 35 mm, respectively. The branch to the posterior soleus muscle had a mean length of 65 mm. Intraneural dissection of the common fibular nerve, isolating its deep and superficial fibular divisions, was possible to a proximal mean distance of 71 mm. A tensionless direct suture to the deep fibular nerve was made possible by using the nerve to the lateral head of the gastrocnemius and the nerve to the posterior soleus muscle in all specimens. Direct suture of the nerve to the medial head of the gastrocnemius was possible in all cases except 1. Conclusion: The nerve to the lateral and medial heads of the gastrocnemius and the nerve to the posterior soleus muscle can be used as donors to restore function of the deep fibular nerve in cases of high sciatic nerve injury. However, proximal intraneural dissection of the deep fibular division of the common fibular nerve must also be performed. We recommend that the nerve to the posterior soleus muscle should be the first choice for a donor in the proposed transfer.
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Dylon, P. Collins BS, M. Chowdhury MS Nayeem, Sedani BS Anika, Henderson BS Claudia, McNally MS Nova Southeastern U. Debra, and Lutfi MD MS DPM Nicholas. "Factors Influencing Common Fibular Nerve Course Variability before Bifurcation into the Superficial Fibular Nerve and Deep Fibular Nerve: A Cadaveric Study." International Journal of Medical Science and Clinical Research Studies 2, no. 9 (2022): 991–97. https://doi.org/10.5281/zenodo.7100355.
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<strong><em>Background and Objectives</em></strong><em>: </em>The common fibular nerve (CFN) has anatomical variance between individuals as it transitions from the posterior thigh to the anterior leg. The nerve’s course around the fibular neck is of particular interest, where it becomes vulnerable to injury at the lateral knee. Therefore, we sought to compare factors that may predict distal CFN variability, such as height, age, sex, fibular length, and proximal sciatic variations, which individually or cumulatively play a role in predicting clinically significant locations where the CFN commonly transitions among certain populations. <strong><em>Methods:</em></strong><em> </em>In this cadaveric study, twenty anatomically-fixed specimens were analyzed, ten males and ten females. Data gathered included age, sex, height, CFN transition point measured from the proximal head of the fibular to the point 90 degrees off the midline of the fibula where the CFN courses around the fibular neck, fibular length, and proximal sciatic nerve variations characterized based on the Beaton and Anson classification system. Factors were compared and statistical values were generated. <strong><em>Results:</em></strong><em> </em>There was a statistically significant difference between CFN transition points compared to fibular lengths, heights, and between sexes. Sciatic nerve (SN) bifurcation levels and exits were bilaterally identical on all cadavers. All SN exits were Beaton and Anson type 1 (undivided nerve below and undivided piriformis), and bifurcation levels were 20% high, 25% middle, and 55% low. <strong><em>Conclusions:</em></strong> This study highlights the importance of considering a person’s height, fibular length, and sex when addressing injuries involving the CFN at the lateral leg.
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Singh, Jagdeep, Pranav Gupta, Sahil Kanwar, and Azhar Pookunju. "Common Peroneal Nerve Splitting in Proximal Fibular Osteochondroma: A Rare Presentation." Journal of Orthopaedic Case Reports 13, no. 9 (2023): 10–13. http://dx.doi.org/10.13107/jocr.2023.v13.i09.3856.
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Introduction: Osteochondroma is the most common benign tumor of bone. Tumors are metaphyseal in origin and commonly involve distal femur, proximal tibia, and proximal fibula in the lower extremity. Osteochondroma located at proximal fibula can change the normal path of nerves and it may lead to the compression of vessels or peroneal nerve, leading to paralysis. Case Report: We are reporting a case of an 18-year-old female with proximal fibular osteochondroma causing splitting of common peroneal nerve without any neuropathy. Conclusion: We strive to make the surgeons aware that, when removing osteochondroma located at proximal fibula, care should be taken to identify the entire nerve at the site of lesion before the removal as a procedure done in a hurry in such a case can cause irreversible damage to the patient. Keywords: Cartilage cap, peroneal nerve, osteochondroma.
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Cruz, V. S., J. C. Cardoso, L. B. M. Araújo, P. R. Souza, M. S. B. Silva, and E. G. Araújo. "Anatomical aspects of the nerves of the leg and foot of the giant anteater (Myrmecophaga tridactyla, Linnaeus, 1758)." Arquivo Brasileiro de Medicina Veterinária e Zootecnia 66, no. 5 (2014): 1419–26. http://dx.doi.org/10.1590/1678-6481.
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Although distal stifle joint nerve distribution has been well established in domestic animals, this approach is scarcely reported in wild animals. Therefore, the aim of this study was to describe the nerves of the leg and foot of Myrmecophaga tridactyla with emphasis on their ramification, distribution, topography and territory of innervation. For this purpose, six adult cadavers fixed and preserved in 10% formalin solution were used. The nerves of the leg and foot of the M. tridactylawere the saphenous nerve (femoral nerve branch), fibular and tibial nerves and lateral sural cutaneous nerve (branches of the sciatic nerve) and caudal sural cutaneous nerve (tibial nerve branch). The saphenous nerve branches to the skin, the craniomedial surface of the leg, the medial surface of the tarsal and metatarsal regions and the dorsomedial surface of the digits I and II (100% of cases), III (50% of cases) and IV (25% of cases). The lateral sural cutaneous nerve innervates the skin of the craniolateral region of the knee and leg. The fibular nerve innervates the flexor and extensor muscles of the tarsal region of the digits and skin of the craniolateral surface of the leg and dorsolateral surface of the foot. The tibial nerve innervates the extensor muscles of the tarsal joint and flexor, adductor and abductor muscles of the digits and the skin of the plantar surface. The caudal sural cutaneous nerve innervates the skin of the caudal surface of the leg. The nerves responsible for the leg and foot innervation were the same as reported in domestic and wild animals, but with some differences, such as the more distal division of the common fibular nerve, the absence of dorsal metatarsal branches of the deep fibular nerve and a greater involvement of the saphenous nerve in the digital innervation with branches to the digits III and IV, in addition to digits I and II.
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Robinson, Lawrence R., and Linda Probyn. "How Much Sciatic Nerve Does Hip Flexion Require?" Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 46, no. 2 (2019): 248–50. http://dx.doi.org/10.1017/cjn.2018.378.
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ABSTRACT:Measured nerve conduction velocity in the fibular nerve increases across the knee during hip flexion. This is due to stretching of sciatic and fibular nerves. We modeled the additional nerve length required for the sciatic nerve to course around the flexed hip, based upon distance between the hip and the sciatic nerve on magnetic resonance imaging (MRI). The median distance from the femoral head to the sciatic nerve was 41 mm. The model predicted that 64 mm of sciatic nerve is required for hip flexion. This impacts our understanding of lower limb nerve conduction studies and clinical straight leg raising tests.
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Özbek, Serhat, and M. Ayberk Kurt. "Simultaneous end-to-side coaptations of two severed nerves to a single healthy nerve in rats." Journal of Neurosurgery: Spine 4, no. 1 (2006): 43–50. http://dx.doi.org/10.3171/spi.2006.4.1.43.
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Object This experimental study was designed to evaluate functional and sensory outcomes and morphological features observed after simultaneous end-to-side coaptations of distal stumps of two nerves to a single neighboring nerve. Studies were performed using both parallel and end-to-side coaptation (PEC) and serial end-to-side coaptation (SEC) methods in a rat model. Methods In the PEC group, distal stumps of the sural and common fibular nerves were coapted to the intact tibial nerve 1 cm apart from each other in an end-to-side fashion. In the SEC group, identical surgical procedures apart from the coaptation method were conducted. For the coaptation method in this group, the distal stump of the common fibular nerve was first coapted to the side of the intact tibial nerve, and then the distal stump of the sural nerve was coapted to the side of the common fibular nerve 1 cm apart from the first coaptation site. Nonoperated contralateral sides were used as controls. Nerve regeneration in both groups was evaluated functionally, electrophysiologically, and histomorphometrically. Conclusions When there is a need for two end-to-side coaptations of two severed nerves, PEC is the recommended method of choice to obtain better axonal regeneration into both nerves.
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Shields, Lisa B. E., Vasudeva G. Iyer, Christopher B. Shields, Yi Ping Zhang, and Abigail J. Rao. "Varied Presentation and Importance of MR Neurography of the Common Fibular Nerve in Slimmer’s Paralysis." Case Reports in Neurology 13, no. 2 (2021): 555–64. http://dx.doi.org/10.1159/000518377.
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Slimmer’s paralysis refers to a common fibular nerve palsy caused by significant and rapid weight loss. This condition usually results from entrapment of the common fibular nerve due to loss of the fat pad surrounding the fibular head. Several etiologies of common fibular nerve palsy have been proposed, including trauma, surgical complications, improperly fitted casts or braces, tumors and cysts, metabolic syndromes, and positional factors. We present 5 cases of slimmer’s paralysis in patients who had lost 32–57 kg in approximately 1 year. In 2 cases, MR neurogram of the knee demonstrated abnormalities of the common fibular nerve at the fibular head. Two patients underwent a common fibular nerve decompression at the fibular head and attained improved gait and sensorimotor function. Weight loss, diabetes mellitus, and immobilization may have contributed to slimmer’s paralysis in 1 case. Awareness of slimmer’s paralysis in patients who have lost a significant amount of weight in a short period of time is imperative to detect and treat a fibular nerve neuropathy that may ensue.
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Tognon-Miguel, Vânia, Adriana Helena do Nascimento-Elias, Maria Cristina Lopes Schiavoni, and Amilton Antunes Barreira. "A histomorphometric study of unmyelinated fibers of the fibular nerve in Wistar rats." Arquivos de Neuro-Psiquiatria 74, no. 5 (2016): 367–72. http://dx.doi.org/10.1590/0004-282x20160051.
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ABSTRACT There are few histomorphometric studies on the unmyelinated fibers of the fibular nerve in rats, and the number of experimental studies using this nerve has been increasing in the last years. Sixty-two percent of the endoneurial area from 10 fibular nerves of adult Wistar rats was scanned by electron microscopy, and digitized. The total number of unmyelinated axons (1.882 ± 271) was significantly lesser, and their axon diameters (0.2 µm to 2.8 µm) significantly higher than that determined in previous studies. The histogram peaked at 1 µm. The differences could be due to the nerve sampled area, the number and the age of the animals evaluated, and the laboratory techniques used. This study brings new and referential data to be used in experimental investigations involving histomorphometric evaluation of the rat fibular nerve.
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Stipp-Brambilla, Elisangela Jeronymo, Adriana Maria Romão, José Antonio Garbino, Manoel Henrique Salgado, and Fausto Viterboz. "The effect of surgical exposure of nerves and muscles in neurophysiologic tests on rats." Acta Fisiátrica 17, no. 3 (2010): 109–11. http://dx.doi.org/10.11606/issn.2317-0190.v17i3a103343.
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The neurophysiologic study in the modality of electroneuromyography (ENMG) determined and quantified the components in the motor ambit. The main data supplied by the examination was from the motor and sensory nerve conduction studies and by electromyography. However, many factors can interfere with the nervous response to electrostimulation, such as: age, gender, temperature, humidity, and other things. The aim of this work was to verify the effect of surgical exposure of the sciatic, common fibular, tibial, and cranial tibial muscle nerves in a neurophysiologic test on rats. Twenty (20) Wistar male rats were utilized, with approximately 80 days of age, divided into two groups. In the normal group the exam was made without the surgical exposure of the fibular nerve. In the surgical group the common fibular nerve was exposed. With the experimental model utilized, it was concluded that the neurophysiologic test done on animals with nerves and muscles surgically exposed is viable, since the alteration in animal temperature did not interfere significantly with the values of the electrophysiological parameters observed. In addition, the exposure of nerves and muscles allows stimulation of an exact point on the target nerve.
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Renno, Waleed M. "Ganglion Cyst at the Proximal Tibiofibular Joint in a Patient with Painless Foot Drop." Pain Physician 8;19, no. 8;11 (2016): E1147—E1160. http://dx.doi.org/10.36076/ppj/2016.19.e1147.
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Entrapment neuropathies of the fibular nerve and its branches are often underdiagnosed due to the lack of reliable diagnosis using clinical examination and electrophysiologic evaluation. Most fibular nerve compressions may be classified into 2 broad categories: (a) mechanical causes, which occur at fibrous or fibro-osseous tunnels, and (b) dynamic causes related to nerve injury during specific limb positioning. Foot drop resulting from weakness of the dorsiflexor muscles of the foot is a relatively uncommon presentation and closely related to L5 neuropathy caused by a disc herniation. However, we herein describe a rare case of usually painless foot drop triggered by a cyst at the proximal tibiofibular joint compressing the deep fibular nerve. The presence of multilevel disc diseases made the diagnosis more difficult. Foot drop is highly troubling, and health care providers need to broaden their search for the imperative and overlapping causes especially in patients with painless drop foot, and the treatment is variable and should be directed at the specific cause. The magnetic resonance imaging (MRI), including high-resolution and 3D MR neurography, allows detailed assessment of the course and anatomy of peripheral nerves, as well as accurate delineation of surrounding soft-tissue and osseous structures that may contribute to nerve entrapment. Knowledge of normal MRI anatomy of the nerves in the knee and leg is essential for the precise assessment of the presence of peripheral entrapment conditions that may produce painless or painful drop foot. In conclusion, we stress the importance of preoperative anatomic mapping of entrapment neuropathies to minimize neurological complications. Key words: Foot drop, fibular nerve, ganglion cyst, proximal tibiofibular joint
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Goss, David, Christopher Reb, and Terrence Philbin. "Anatomic Structures at Risk When Utilizing an Intramedullary Nail for Distal Fibular Fractures." Foot & Ankle Orthopaedics 2, no. 3 (2017): 2473011417S0001. http://dx.doi.org/10.1177/2473011417s000181.
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Category: Ankle Introduction/Purpose: Distal fibula fractures are most commonly fixated with plate and screw constructs. Conversely, modern generation fibular intramedullary nails are load-sharing devices that offer rigid internal fixation via percutaneous technique with only transaxial screws residing subcuticularly. The relative risk of damage to nearby structures is well characterized for plate and screws constructs; however, no such data is available for fibular nails. As a result, the purpose of this anatomic study was to assess the relative risk to nearby anatomic structures when implanting a current generation retrograde locked intramedullary fibular nail. Methods: This was an IRB-exempt study. Ten human cadaveric lower extremities were instrumented with a contemporary retrograde locked intramedullary fibular nail with three distal locking and two syndesmotic fixation options. The cadavers were then dissected by a single experienced orthopedic foot and ankle surgeon in a standardized fashion. The shortest distance, in millimeters (mm), between the site of procedural steps and nearby named structures of interest (i.e. sural nerve, superficial peroneal nerve and the peroneal tendons) was measured and recorded. Levels of risk were then assigned based on observed distances as high (0 to 5 mm), moderate (5.1 to 10 mm) and low (greater than 10 mm). Results: The peroneus brevis tendon was at high risk when making the distal skin incision in all specimens (Table). When reaming and inserting the nail through the distal fibula aperture, the peroneus brevis was at high risk in 7 specimens. The peroneus longus tendon was at moderate to high risk when inserting both the proximal and distal syndesmotic screws in 9 specimens. The superficial peroneal nerve was at high risk when inserting an anterior to posterior distal locking screw in 7 specimens. The sural nerve was at low risk for all procedural steps. Of note, no structures were observed to have been directly damaged. Conclusion: The current findings indicate that strict adherence to sound percutaneous technique is needed in order to minimize iatrogenic damage to neighboring structures when performing retrograde locked intramedullary fibular nail insertion. This includes making skin-only incisions, thorough blunt spreading down to bone, and maintaining close approximation between tissue protection sleeves and bone at all times. The current findings indicate that the peroneal tendons and superficial peroneal nerve are at the highest risk, and should be considered when performing relevant clinical outcomes studies.
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Yarikov, A., O. Makeeva, А. Baitinger, et al. "Fibular canal syndrome: modern principles of diagnosis and treatment." Vrach 34, no. 9 (2023): 5–9. http://dx.doi.org/10.29296/25877305-2023-11-01.
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Fibular tunnel syndrome is the most common tunnel syndrome of the lower extremity. Compression of the fibular nerve most often occurs at the level of the fibular head. The article describes in detail the etiology and pathogenesis of this tunnel neuropathy. Clinical manifestations of fibular tunnel syndrome are considered, methods of diagnosis and treatment are described. The prognosis of peroneal nerve neuropathy is favorable, and in most patients there is a complete or almost complete restoration of nerve function. If conservative treatment is ineffective, surgical techniques are recommended.
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Anderson, James C. "Common Fibular Nerve Compression." Clinics in Podiatric Medicine and Surgery 33, no. 2 (2016): 283–91. http://dx.doi.org/10.1016/j.cpm.2015.12.005.
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Chitra, R. "The relationship between the deep fibular nerve and the dorsalis pedis artery and its surgical importance." Indian Journal of Plastic Surgery 42, no. 01 (2009): 018–21. http://dx.doi.org/10.1055/s-0039-1699306.
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ABSTRACTThe aim of this study was to demonstrate the relationship between the deep fibular nerve and the dorsalis pedis artery to provide useful anatomical knowledge for safe surgical approaches in plastic surgery. The dissection of 30 cadaver lower limbs was undertaken to describe the relationship of the deep fibular nerve to the dorsalis pedis artery in the anterior tarsal tunnel and on the dorsum of the foot. The anterior tarsal tunnel is a flattened space between the inferior extensor retinaculum and the fascia overlying the talus and navicular. The deep fibular nerve and its branches pass longitudinally through this fibro-osseous tunnel, deep to the tendons of the extensor hallucis longus and extensor digitorum longus. Four distinct relationships of the deep fibular nerve to the dorsalis pedis artery were determined. The dorsalis pedis neurovascular island flap contains both the dorsalis pedis artery and the deep fibular nerve. Because the design of a neurovascular free flap requires detailed knowledge of the nerve and vascular supply, the data presented here are intended to help surgeons during surgical approaches to the foot and ankle.
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Frommer, Adrien, Maike Niemann, Georg Gosheger, et al. "Temporary Proximal Tibial Epiphysiodesis for Correction of Leg Length Discrepancy in Children—Should Proximal Fibular Epiphysiodesis Be Performed Concomitantly?" Journal of Clinical Medicine 10, no. 6 (2021): 1245. http://dx.doi.org/10.3390/jcm10061245.
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The need for concomitant proximal fibular epiphysiodesis (PFE) when correcting leg length discrepancy (LLD) with temporary proximal tibial epiphysiodesis (PTE) in children is controversially discussed. This single center, retrospective cohort study analyzes proximal fibular growth in patients treated by PTE with and without concomitant PFE. Radiographic measurements were conducted before implantation and at implant removal. The position of the fibular head in relation to the tibia was assessed with recently established radiographic reference values. All patients (n = 58, 19 females) received PTE to treat LLD at a mean age of 12.2 years (range 7 to 15). In 27/58 (47%) concomitant PFE was performed. Mean follow-up was 36.2 months (range 14.2 to 78.0). The position of the proximal fibula at implant removal was within physiological range in 21/26 patients (81%) with PFE and in 21/30 patients (70%) without PFE. Proximal fibular overgrowth newly developed in 2/26 patients (8%) treated with PFE and in 5/30 patients (17%) treated without PFE (p = 0.431). Peroneal nerve injury or discomfort due to proximal fibular overlength was not reported. The position of the proximal fibula should be critically assessed preoperatively under consideration of reference values before PTE. In consequence of this study, the authors do not routinely perform PFE concomitantly with PTE for correction of moderate LLD in children if the proximal fibula is localized within physiological radiographic margins determined by the established reference values.
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Xue, Yangyang, and Shuangjian He. "A case report of old injury of lateral collateral ligament of knee joint combined with injury of common peroneal nerve." SAGE Open Medical Case Reports 10 (January 2022): 2050313X2211232. http://dx.doi.org/10.1177/2050313x221123298.
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Since common peroneal nerve is easy be injured because of superficial position of caput fibulae, less surrounding soft tissue and poor mobility, injury of common peroneal nerve is a problem worth discussing in the field of trauma orthopedics. Common peroneal nerve injury often causes foot prolapse, inability in dorsiflexion and eversion, sensory disturbance of anterolateral side of the lower leg and dorsum of foot. In this article, a case of old injury of lateral collateral ligament of knee joint combined with an avulsion fracture of fibular head resulting in injury of common peroneal nerve was reported and repaired by surgery with good effects.
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Nayak, Devendra, Jai Singh Baghel, Shiksha Nayak, Anuj Rawat, Manisha Baghel, and Tushar Baisla. "ASSESSMENT AND CATEGORIZATION OF BONE TUMOURS OF THE FIBULA AND ITS FUNCTIONAL OUTCOME AFTER TREATMENT USING THE KNEE SOCIETY SCORE." International Journal of Advanced Research 13, no. 02 (2025): 1473–77. https://doi.org/10.21474/ijar01/20517.
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Introduction:Bone tumors of the fibula are rare, accounting for only 2.5% of all bone tumors. The complexity of their diagnosis and management arises from their proximity to neurovascular structures, particularly the common peroneal nerve. Aim and Objectives:This study aims to assess and categorize fibular bone tumors in a series of patients and evaluate functional outcomes after treatment using the Knee Society Score (KSS). Materials & Methods: A total of 20 patients with primary or secondary fibular bone tumors were prospectively recruited. Treatment options varied from curettage for benign lesions to wide resection or amputation for aggressive malignancies. Results:Functional outcomes were measured using KSS at various intervals post-surgery. The results highlight the diverse nature of fibular bone tumors and the effectiveness of different surgical approaches in maintaining functional outcomes.
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Holmes, Scott A., Steven J. Staffa, Anastasia Karapanagou, et al. "Biological laterality and peripheral nerve DTI metrics." PLOS ONE 16, no. 12 (2021): e0260256. http://dx.doi.org/10.1371/journal.pone.0260256.
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Background and purpose Clinical comparisons do not usually take laterality into account and thus may report erroneous or misleading data. The concept of laterality, well evaluated in brain and motor systems, may also apply at the level of peripheral nerves. Therefore, we sought to evaluate the extent to which we could observe an effect of laterality in MRI-collected white matter indices of the sciatic nerve and its two branches (tibial and fibular). Materials and methods We enrolled 17 healthy persons and performed peripheral nerve diffusion weighted imaging (DWI) and magnetization transfer imaging (MTI) of the sciatic, tibial and fibular nerve. Participants were scanned bilaterally, and findings were divided into ipsilateral and contralateral nerve fibers relative to self-reporting of hand dominance. Generalized estimating equation modeling was used to evaluate nerve fiber differences between ipsilateral and contralateral legs while controlling for confounding variables. All findings controlled for age, sex and number of scans performed. Results A main effect of laterality was found in radial, axial, and mean diffusivity for the tibial nerve. Axial diffusivity was found to be lateralized in the sciatic nerve. When evaluating mean MTR, a main effect of laterality was found for each nerve division. A main effect of sex was found in the tibial and fibular nerve fiber bundles. Conclusion For the evaluation of nerve measures using DWI and MTI, in either healthy or disease states, consideration of underlying biological metrics of laterality in peripheral nerve fiber characteristics need to considered for data analysis. Integrating knowledge regarding biological laterality of peripheral nerve microstructure may be applied to improve how we diagnosis pain disorders, how we track patients’ recovery and how we forecast pain chronification.
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Enomoto, Masataka, B. Duncan X. Lascelles, and Mathew P. Gerard. "Defining local nerve blocks for feline distal pelvic limb surgery: a cadaveric study." Journal of Feline Medicine and Surgery 19, no. 12 (2017): 1215–23. http://dx.doi.org/10.1177/1098612x17690652.
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Objectives Anatomical and methodological detail is lacking regarding local anesthetic peripheral nerve block techniques for distal pelvic limb surgery in cats. The aim of this study was to develop, describe and test nerve block methods based on cadaveric dissections and dye injections. Methods Ten pairs of feline pelvic limbs (n = 20) were dissected and the tibial nerve (T n.), common fibular (peroneal) nerve (CF n., and its two branches, the superficial fibular [peroneal] nerve [SpF n.] and the deep fibular [peroneal] nerve [DpF n.]) and the saphenous nerve (Sa n.) were identified. Based on these dissections, a ‘distal crus block’ (selective blockade of the CF n., T n. and Sa n.) and a ‘distal pes block’ (selective blockade of the SpF n., DpF n., T n. and Sa n.) were developed for surgical procedures in two different regions of the distal pelvic limb. Techniques were tested using new methylene blue (NMB) dye injections in feline pelvic limbs (n = 12). Using a 25 G × 5/8 inch needle and 1 ml syringe, 0.1 ml/kg of NMB dye solution was injected at the site of the CF n., and 0.05 ml/kg was injected at the sites of the SpF n., DpF n., Sa n. and T n. The length and circumference (fully or partially stained) of each stained nerve were measured. Results Positive staining of nerves was observed in 12/12 limbs. The lengths stained for the CF n., DpF n., SpF n., Sa n. and T n. were 27.19 ± 7.13, 20.39 ± 5.57, 22.82 ± 7.13, 30.89 ± 6.99 and 25.16 ± 8.09 mm, respectively. The nerves were fully stained in 12, 12, 10, 11 and 11 out of 12 limbs, respectively. Conclusions and relevance These two, three-point injection methods may be an effective perioperative analgesia technique for feline distal pelvic limb procedures.
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Bashlachev, M. G., G. Yu Evzikov, V. A. Parfenov, N. B. Vuitsyk, and F. V. Grebenev. "Dynamic neuropathy of the common peroneal nerve at the level of the fibular head (literature review and case report)." Russian journal of neurosurgery 21, no. 1 (2019): 54–59. http://dx.doi.org/10.17650/1683-3295-2019-21-1-54-59.
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The study objective is to report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head and to discuss diagnostic methods and neurosurgical treatment. Materials and methods. We report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head in a female patient. The patient was treated in the Neurology Clinic of I.M. Sechenov First Moscow State Medical University. We analyzed clinical manifestations and compared them with the data described in research literature. Results. Upon admission, the patient complained of pain in the anterolateral surface of the right shin and in the dorsum of the foot during walking. At rest, the patient experienced no pain. We observed no motor or sensory disorders typical of nerve root disorders at the level of L5. Lasegue’s test was negative. The patient had a positive Tinel’s sign in the area of the right fibular head. In order to clarify the diagnosis, we performed a repeated extension test in the right ankle joint and it was positive. The patient underwent surgery that included peroneal nerve decompression and neurolysis at the level of the fibular head. In the postoperative period, the patient had complete pain relief. Conclusion. Due to the difficulties in the diagnostics of dynamic neuropathy of the common peroneal nerve, this disease is often mistaken for radiculopathy at the level of L5. Thorough clinical examination, testing for Tinel’s sign in the area of the fibular head, and repeated extension test in the ankle joint ensure the correct diagnosis and reduce the frequency of ineffective surgeries on the lumbar spine. Surgical decompression of the common peroneal nerve at the level of the fibular head with obligatory opening of the entrance to the nerve canal is an effective method of treatment in such patients.
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Corriveau, Mark, Jacob D. Lescher, and Amgad S. Hanna. "Peroneal nerve decompression." Neurosurgical Focus 44, videosuppl1 (2018): V6. http://dx.doi.org/10.3171/2018.1.focusvid.17575.
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Peroneal neuropathy is a common pathology encountered by neurosurgeons. Symptoms include pain, numbness, and foot drop. When secondary to compression of the nerve at the fibular head, peroneal (fibular) nerve release is a low-risk procedure that can provide excellent results with pain relief and return of function. In this video, the authors highlight key operative techniques to ensure adequate decompression of the nerve while protecting the 3 major branches, including the superficial peroneal nerve, deep peroneal nerve, and recurrent genicular (articular) branches. Key steps include positioning, circumferential nerve dissection, fascial opening, isolation of the major branches, and closure.The video can be found here: https://youtu.be/0y9oE8w1FIU.
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Montella, Bruce J., Dermot A. O'Farrell, Wm Stephen Furr, and John M. Harrelson. "Fibular Osteochondroma Presenting as Chronic Ankle Sprain." Foot & Ankle International 16, no. 4 (1995): 207–9. http://dx.doi.org/10.1177/107110079501600407.
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A 19-year-old baseball player was referred for assessment of recurrent sprains of the right ankle. This was found to be secondary to a palsy of the common peroneal nerve that was compressed by an osteochondroma of the fibular neck. The lesion was resected from the fibula and the patient made a complete recovery. We present this case as an example of a rare underlying problem in a patient who was initially diagnosed as having a sports-related ankle injury.
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Guy, Sylvain, Fernando Cury Rezende, Alexandre Ferreira, et al. "Easy Surgical Approach of the Posterolateral Corner of the Knee." Video Journal of Sports Medicine 1, no. 2 (2021): 263502542199742. http://dx.doi.org/10.1177/2635025421997429.
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Background: The anatomy of the posterolateral corner (PLC) of the knee is complex. The approach of the PLC can be a challenging and stressful surgical time. Indications: The indications are posterolateral meniscal repair, open lateral meniscus allograft transplantation, posterolateral tibial plateau fracture, and PLC reconstruction for grade III sprains. Technique Description: The skin incision is straight, realized with the knee positioned at 90° of flexion, passing slightly posterior to the lateral epicondyle, anterior to the fibular head (FH), and ending on Gerdy’s tubercle. The subcutaneous tissues are dissected posteriorly so as to expose the FH and the biceps femoris (BF) tendon. The aponeurosis of the peroneus muscles is incised vertically opposite to the anterior side of the FH. The common fibular nerve is exposed at the neck of the fibula. Metzenbaum scissors are then inserted subaponeurotically, posteriorly, and parallel to the BF tendon, superficially to the nerve. An incision is made opposite the scissor’s blades, freeing the common fibular nerve. The BF tendon is spread forward and the lateral gastrocnemius is pulled posteriorly. Metzenbaum scissors are inserted in a closed position between the lateral gastrocnemius and the posterolateral joint capsule, and then spread to create a triangular door with a proximal base. The base consists of the BF tendon, the posterior side of the lateral gastrocnemius, and the anterior side of the posterolateral joint capsule. A counter-angled Hohmann retractor can now be applied against the posterior tibial plateau to retract the lateral gastrocnemius posteriorly and medially, exposing the PLC of the knee. Results: Noble structures are easily exposed and protected. The common fibular nerve is dissected and reclined posteriorly, and the popliteus vessels are reclined posteriorly and medially, protected by the lateral gastrocnemius. Passing under the BF tendon allows a better vision of the PLC along with less constraint than passing above, as the working window is further away from the femoral insertion of the lateral gastrocnemius. Discussion/Conclusion: The present surgical approach allows a simple, safe, and reproducible exposure of the PLC of the knee.
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Aydin, A. "The dissemination of pelvic limb nerves originating from the lumbosacral plexus in the porcupine (Hystrix cristata)." Veterinární Medicína 54, No. 7 (2009): 333–39. http://dx.doi.org/10.17221/95/2009-vetmed.
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In this study the nerves originating from the plexus lumbosacrales of porcupines (<I>Hystrix cristata</I>) were investigated. Four porcupines (two males and two females) were used. The plexus lumbosacrales of animals were appropriately dissected and dissemination of pelvic limb nerves originating from the plexus lumbosacrales was examined. The nerves originated from the plexus lumbosacrales of porcupines (<I>Hystrix cristata</I>): iliohypogastric nerve from T15, ilioinguinal nerve (on the left side of only one animal) genitofemoral and lateral femoral cutaneous nerves from T15 and L1, the femoral and obturator nerves from T15, L1, L2 and L3. The femoral nerve divided into two as the common dorsal digital nerve I and II after it branched into motor and skin nerves. The cranial gluteal nerve originated from L3 and L4 in males and from only L3 in females. The caudal gluteal nerve and the caudal femoral cutaneous and sciatic nerves originated from the common root which was formed by the union of L3, L4 and S1 in one animal, and by the union of L3, L4, S1 and S2 in the three other animals. The sciatic nerve divided into the tibial and fibular nerve. The fibular nerve divided into two as the common dorsal digital nerve III and IV, and extended after branching in one direction to extensor muscles. The tibial nerve divided into the common palmares digital nerve I, II, III and IV, and extended after branching into the cutaneous surae caudales nerve and rami muscle distales. The cutaneous surae caudales nerve divided into the common palmar and dorsal digital nerve V. The pudendal and caudal rectal nerves originated from S2 in three animals and from S1 in the remaining animal. In the point of origin from the branches of spinal nerves originating from the plexus lumbosacrales, and also in the absence of the ilioinguinal nerve (on left side abroad of only one animal), originating from T15 and L1 of the genitofemoral and lateral femoral cutaneous nerves, from T15 of the iliohypogastric nerve, the studied porcupines differed from rodentia and other mammals
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Cherrad, T., M. Bennani, H. Zejjari, J. Louaste, and L. Amhajji. "Peroneal Nerve Palsy due to Bulky Osteochondroma from the Fibular Head: A Rare Case and Literature Review." Case Reports in Orthopedics 2020 (November 12, 2020): 1–5. http://dx.doi.org/10.1155/2020/8825708.
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Common peroneal neuropathy is the most common compressive neuropathy in the lower extremities. The anatomical relationship of the fibular head with the peroneal nerve explains entrapment in this location. We report the case of a 14-year-old boy admitted with a left foot drop. The diagnosis was an osteochondroma of the proximal fibula compressing the common peroneal nerve. The patient underwent surgical decompression of the nerve and resection of the exostosis. Three months postoperatively, there was a complete recovery of the deficits. The association of osteochondroma and peroneal nerve palsy is rare. Early diagnosis is required in order to adjust the management and improve the results. It is worth to underscore that surgical resection is proven to be the appropriate treatment method ensuring high success rates.
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Le, Elliot L. H., Taylor H. Allenby, Marlie Fisher, et al. "Intraneural Topography and Branching Patterns of the Common Peroneal Nerve: Studying the Feasibility of Distal Nerve Transfers." Plastic and Reconstructive Surgery - Global Open 12, no. 10 (2024): e6258. http://dx.doi.org/10.1097/gox.0000000000006258.
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Background: Common peroneal nerve (CPN) disruption is the most common lower extremity nerve injury and results in gait disturbances and sensory paresthesias. The goal of this study is to describe branching patterns and the intraneural topography of the CPN to facilitate operative planning in CPN reconstruction. Methods: The CPN and its distal motor and sensory branches were dissected in 6 lower leg cadavers. Branching patterns and distances were recorded with the fibular head as the landmark. Histological review of the nerve cross sections helped characterize the intraneural topography within the fibular tunnel. Results: The CPN distal branching patterns were highly variable. The tibialis anterior motor branch was found on average 9.6 cm distal to the fibular head. Despite the variable branching patterns, the fascicular topography of the CPN within the fibular tunnel was consistent. Proximal to the tunnel, the nerve has 3 major fascicles, which include the superficial peroneal motor, common sensory, and deep peroneal motor (DPN) fascicles from lateral to medial. Within the tunnel, the topography consolidates into the superficial peroneal motor and DPN major divisions—motor axons anteriorly and sensory axons posteriorly. Conclusions: The data presented provide clinically relevant information for the peripheral nerve surgeon where fascicular reconstruction of the nerve and neurolysis should focus on the anterior half of the nerve to restore ankle dorsiflexion. The nerve proximally is divided into 3 major fascicles compared with 2 distally. Surgeons may consider distal nerve transfers from the tibial nerve motor branches to the DPN or tibialis anterior motor branch.
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Kozu, Takashi, Masayoshi Machida, Katsuaki Taira, Noboru Oikawa, Naho Nemoto, and Kazuyoshi Nakanishi. "Peroneal Nerve Palsy Caused by Proximal Fibular Solitary Osteochondroma: Case Report and Literature Review." Case Reports in Orthopedics 2022 (September 13, 2022): 1–3. http://dx.doi.org/10.1155/2022/5865040.
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Osteochondroma is a relatively common benign tumor of the bone, and compressive neuropathies due to osteochondroma are comparatively rare. Here, we present a rare case of osteochondroma of the fibular head that caused peroneal nerve palsy in an 8-year-old girl. Physical examination revealed 0/5 tibialis anterior, 1/5 extensor hallucis longus, and 1/5 peroneal brevis muscle power—according to the manual muscle testing grading system, as well as numbness on the lateral side of the right leg and the back of the foot. Radiological examination and ultrasound revealed a bone tumor in the head of the right fibula. Magnetic resonance imaging ruled out spinal nerve root compression. It was discovered that the bone tumor in the fibular head had compressed and displaced the common peroneal nerve. The patient underwent surgical decompression of the right peroneal nerve. A bone region measuring 22 × 14 × 8 mm was removed. Three months postoperatively, the preoperative neurological deficits were found to be nearly resolved. The patient presented with a foot drop for 1 year, but symptoms resolved 3 months after surgery. Conventional wisdom states that surgery should be performed within 3 months, but we recommend that surgery be performed as soon as diagnosis is made even in cases with a long history, as it may improve patient symptoms and outcomes.
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Guo, Changzhi, Xiaoran Zhang, Feng Gao, Lingxiang Wang, and Tao Sun. "Surgical management of proximal fibular tumors: risk factors for recurrence and complications." Journal of International Medical Research 46, no. 5 (2018): 1884–92. http://dx.doi.org/10.1177/0300060518762677.
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Objectives The aim of this study was to identify patient- and treatment-specific independent risk factors for the recurrence of proximal fibular tumors and complications of their surgical management. Methods Patients who underwent surgical treatment of proximal fibular tumors at our institution from 2004 to 2015 were retrospectively reviewed. All patients had a pathologically confirmed diagnosis and were followed up for at least 12 months for recurrence and complications. All patients were evaluated with respect to seven patient-, disease-, and treatment-specific variables. Results In the univariate analysis, peroneal nerve palsy at presentation and malignancy were associated with an increased risk of recurrence, iatrogenic peroneal nerve injury, and wound healing problems. The multivariate analysis showed that peroneal nerve palsy at presentation was an independent risk factor for recurrence and iatrogenic peroneal nerve injury and that malignancy was an independent risk factor for wound healing problems. Conclusions Peroneal nerve palsy and malignant potential are independent risk factors for complications of surgical treatment of proximal fibular tumors. The recognition of these factors may contribute to proper management and help to prevent recurrence and postoperative complications.
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Mosa, Adam J., Zachary D. Randall, Brendan J. Navarro, Daniel A. Hunter, David M. Brogan, and Christopher J. Dy. "Superficial Peroneal Nerve Motor Branch Transfer to the Deep Peroneal Nerve: Cadaveric Study and Case Report." Plastic and Reconstructive Surgery - Global Open 13, no. 5 (2025): e6781. https://doi.org/10.1097/gox.0000000000006781.
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Background: Foot drop carries substantial morbidity and is often due to deep peroneal (DPN) or common peroneal nerve (CPN) injury. Treatment options are limited. This study explored a new surgical approach by transferring a superficial peroneal nerve (SPN) branch to DPN. Cadaveric analysis, manual histomorphometry, and a case report are presented. Methods: Twenty-one limbs were analyzed. A reproducible surgical approach was used to identify CPN and trace it to the bifurcation into SPN and DPN, and then to the insertions into the peroneus longus (PL) and tibialis anterior (TA) muscles, respectively. Measurements were made from the superior most aspect of the fibular head to the bifurcation of the CPN, the insertion of the first and second SPN motor branches to the PL, and to the insertion of the DPN into the TA. The first SPN motor branch to the PL and DPN into the TA nerves were harvested, and histomorphological measurements of axonal densities were obtained. Results: Histomorphological analysis showed similar axonal densities between the transferred and target nerves, indicating a comparable potential for effective reinnervation. The mean distances from fibular head to various nerve branches were recorded to ensure tension-free transfer. No significant differences were found between nerve groups regarding axon density, total fascicle area, or total axon counts. Conclusions: This study supported feasibility of this nerve transfer technique, with initial results suggesting it represents a viable treatment option for foot drop secondary to DPN injury. Further research is needed to confirm these findings.
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Derr, Jeffrey J., Paula J. Micklesen, and Lawrence R. Robinson. "Predicting Recovery After Fibular Nerve Injury." American Journal of Physical Medicine & Rehabilitation 88, no. 7 (2009): 547–53. http://dx.doi.org/10.1097/phm.0b013e3181a9f519.
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Verma, Sumit, and Saahith Pochiraju. "Superficial fibular nerve sensory nerve conduction study in children." Muscle & Nerve 54, no. 4 (2016): 808–9. http://dx.doi.org/10.1002/mus.25181.
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Tran, John, Philip W. H. Peng, Michael Gofeld, Vincent Chan, and Anne M. R. Agur. "Anatomical study of the innervation of posterior knee joint capsule: implication for image-guided intervention." Regional Anesthesia & Pain Medicine 44, no. 2 (2019): 234–38. http://dx.doi.org/10.1136/rapm-2018-000015.
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Background and objectivesPeripheral nerve block is an important component of the multimodal analgesia for total knee arthroplasty. Novel interventional techniques of ultrasound-guided nerve block supplying the posterior knee joint capsule require knowledge of the innervation of the posterior capsule. The objectives of this cadaveric study were to determine the course, frequency, and distribution of the articular branches innervating the posterior knee joint capsule and their relationships to anatomical landmarks.MethodsFifteen lightly embalmed specimens were meticulously dissected. The origin of articular branches was identified, their frequency recorded, and the course documented in relation to anatomical landmarks. The capsular distribution of articular branches was documented and a frequency map generated.ResultsIn all specimens, articular branches from the posterior division of the obturator and tibial nerves were found to supply the posterior capsule. Additionally, articular branches from common fibular nerve and sciatic nerve were found in eight (53%) and three (20%) specimens, respectively. The capsular distribution of tibial nerve spanned the entire posterior capsule. The posterior division of obturator nerve supplied the superomedial aspect of the posterior capsule overlapping with the tibial nerve. The superolateral aspect of the posterior capsule was innervated by the tibial nerve and, when present, the common fibular/sciatic nerves.ConclusionsFrequency map of the course and distribution of the articular branches and their relationship to anatomical landmarks form an anatomical basis for peripheral nerve block approaches that provide analgesia to the posterior knee joint capsule.
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Maiyuran, Harinee, and Thomas Harris. "The Common Peroneal (High Fibular) Nerve Block." Foot & Ankle Orthopaedics 3, no. 3 (2018): 2473011418S0033. http://dx.doi.org/10.1177/2473011418s00330.
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Category: Ankle Introduction/Purpose: The bifurcation of the sciatic nerve results in the common peroneal nerve, along with the tibial nerve. A commonly block used before foot and ankle surgery is the sciatic block. This block requires an ultrasound or neurostimulation for accurate placement and can take time to administer effectively. We believe that the common peroneal, or high fibular nerve block, may be equivalent in some clinical circumstances to the sciatic block and does not require additional imaging for accurate placement. Methods: In this study, a mixture comprised of 5 mL 0.5% bupivacaine and 5 mL 1% lidocaine was used for each patient. Certain surface anatomic landmarks were used to place the block without ultrasound or neurostimulation. The time spent administering the block was recorded. Patients were not given pain medicines in the recovery unit unless the block did not work. A follow-up questionnaire was completed within 24 hours following surgery, and this was used to assess aspects of the patient’s post-operative experience. These include the number of hours following surgery that the patient: 1) first felt pain, 2) first took pain medication, 3) first felt tingling, 4) fully regained feeling in his/her leg, and 5) could wiggle his/her toes. Also, any complications were recorded. Results: This study involved 21 patients with an average age of 51. The most common procedures used with the block were hardware removal of the fibula and open reduction internal fixation of the fibula. The block took on average less than 3 minutes to administer and ultrasound was not used in any cases. No patients were given pain medicines in the recovery unit. None of the patients reported any complications, specifically, there were no cases of foot drop or any persistent paresthesias. The average time it took for patients to first feel pain after the block was approximately 8 hours. On average, patients first took pain medication approximately 11 hours after surgery, and regained sensation in their leg 15 hours after surgery. Conclusion: The benefits of the common peroneal block are multifold, as their clinical outcomes were positive and patients did not experience any complications. Also, from a surgeon perspective, the block is quick to administer and does not require ultrasound or neurostimulation.
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Ostrovskij, Vladimir V., Galina A. Korshunova, Sergey P. Bazhanov, Andrey A. Chekhonatskij, and Vladimir S. Tolkachev. "Electrophysiological patterns of sciatic nerve in patients with arthrosis deformans of the hip." N.N. Priorov Journal of Traumatology and Orthopedics 28, no. 2 (2021): 47–54. http://dx.doi.org/10.17816/vto71476.
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BACKGROUND: Neurological complications in sciatic nerve (SN) after a total hip replacement (THR) are observed in 0.93.2% of cases in patients with arthrosis deformans and age-related morphologic changes in SN. These cause the need for SN evaluation before THR. This research was aimed at the evaluation of the initial SN capacity with electrophysiological findings in patients with arthrosis deformans of the hip.
 MATERIALS AND METHODS: Electroneuromyography (ENMG) was used to evaluate fibular and tibial nerves M-responses as well as F-waves in 66 patients with dysplastic coxarthrosis and 12 patients with posttraumatic coxarthrosis. The findings were compared to those of the controls.
 RESULTS: Changes in ENMG findings for fibular nerve in 49 patients with dysplastic coxarthrosis were bilateral and showed significant difference only from the norm. In 19 of 66 cases (27.9%) low M-responses (р 0.02) were found in the side subject to THR. In 87.3% of cases, the signs of a decrease in the conductivity of proximal segments of the tibial nerve were revealed. In patients with posttraumatic coxarthrosis, the significant decrease in ENMG findings from both fibular and tibial nerves was observed in the affected side, they made up just 42-50% of those in the opposite side. Asymptomatic progress of denervation damage in hip and tibia muscles sometimes required needle EMG to fund the signs of motor innervation disorder. A-waves revealed in 65% of patients suggested local damage to one or both portions of SN.
 CONCLUSION: ENMG findings in patients with dysplastic arthrosis of the hip enabled revealing of the signs of neuropathy before surgeries and decreasing the risk of neurologic post-surgery complications.
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Baxla, Monica, Hare Krishna, Rati Tandon, Arthi Ganapathy, and Saroj Kaler. "Sciatic nerve: Non-union of its components and clinical implication." International Journal of Research in Medical Sciences 7, no. 2 (2019): 438. http://dx.doi.org/10.18203/2320-6012.ijrms20190349.
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Background: Having prior anatomical knowledge of the anatomical variations is a must for the accurate and effective diagnosis of clinical conditions associated with the sciatic nerve. Sciatic nerve, the longest nerve in the human body has been of great interest for the clinicians and anatomists; though many studies have been conducted in the past to study its anatomical aspect. Till now high division or low formation of the sciatic nerve has been reported but this article highlights the non-union of the components of the sciatic nerve and its clinical outcomes. It had been observed that the common fibular and tibial nerve which arise separately from the sacral plexus remain separated throughout their course. They do not join to form the sciatic nerve. Non-union of the components can result in incomplete blockade of the nerve but selective blockade of one of the components can be done when needed. Aim of the study was to determine the level of formation and the level of division of the sciatic nerve.Methods: Sixty-two lower limbs were taken from the Department of Anatomy, AIIMS, New Delhi and gluteal region was observed for common fibular and tibial nerve and their joining to form the sciatic nerve.Results: Out of 62 lower limbs; 52 specimens showed formation within the pelvis but in 10 specimens the sciatic nerve did not form at any point. Division of the nerve in 52 specimens were at various levels on the posterior aspect of thigh.Conclusions: While giving anaesthesia it’s important to know the formation as well as division of the nerve for an effective lower limb block for various surgical interventions and in case of non union of tibial and common fibular nerve to form the sciatic nerve individual nerve block can be given.
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Farias Molina, Wellington, Lourenço Galizia, Guilherme Bottino Martins, and Luiz Sérgio Martins Pimenta. "PO 18128 - Exposure area of the posterolateral approach to the distal region of the tibia." Scientific Journal of the Foot & Ankle 13, Supl 1 (2019): S26. http://dx.doi.org/10.30795/scijfootankle.2019.v13.1015.
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Introduction: The posterolateral approach was first described by Gatellier and Chastang in 1924 for assessing fragments of the posterior malleolar bone in ankle fractures. The correct posterior exposure of the distal tibia also makes it possible to treat osteochondritis dissecans of the talus, to excise benign tumors and to perform arthrodesis of the posterior facet of the subtalar joint. The objective of our study was to assess the exposure area of the posterior region of the distal tibia in the posterolateral approach and to determine its safety. Methods: The study was conducted on the fresh cadaver of a 54-year-old man without scars at the site. With the body positioned in dorsal decubitus, we marked the reference points. A 12-cm longitudinal incision was made halfway between the lateral malleolus and the Achilles tendon, extending distally along the posterior border of the fibula toward the fifth metatarsal. The sural nerve follows its course at a constant distance, on average 2.5 cm, posterior to the fibula. After the incision of the peroneal retinaculum sheath was made, the tendons were exposed and moved to the anterior. In the medial region, we moved the Achilles tendon and exposed the flexor hallucis longus tendon, moving it medially and exposing the posterior region of the tibia and syndesmosis. Using a digital caliper (Mitutoyu Kawasaki, Japan), we measured the exposed area. We respected a 40-mm safety area where the fibular artery arises from the bifurcation of the tibial-fibular trunk. We chose not to perform fibular osteotomy or a longitudinal section of the flexor hallucis longus tendon. Results: A 30.44-mm segment was exposed in the transverse plane of the distal tibial region that begins at the posterior distal tibiofibular syndesmosis. Conclusion: The posterolateral approach provides excellent exposure of the distal region of the tibia with great safety. The tibial nerve and the posterior tibial artery are safe after the flexor hallucis longus tendon is moved, and the sural nerve is contained in the region proximal to the approach. The exposed area stretches to the region near the medial malleolus, and the flexor retinaculum prevents a more medial approach. We conclude that the posterolateral approach is safe even for more medial lesions restricted to the flexor retinaculum.
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Mustaqim, Warih Anggoro, Satria Pandu Persada Isma, and Istan Irmansyah Irsan. "Peroneal Nerve Function and Knee Stability after Resection Giant Cell Tumour of Proximal Fibula, A Serial Case." Berkala Kedokteran 14, no. 1 (2018): 83. http://dx.doi.org/10.20527/jbk.v14i1.4588.
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Abstract: Giant-cell Tumour (GCT ) is a benign Tumour, locally aggressive neoplasm which is composed of sheets of neoplastic oviod mononuclear cells uniformly distributed large, osteoclast like giant cell. Incidence GCT of proximal fibula is rare. Peroneal nerve function and stability of knee joint must be considered at the proximal fibula GCT. In 2017 we found three cases of GCT of the proximal fibula in the outpatient clinic Saiful Anwar General Hospital. All three of these patients had a confirmed GCT of proximal fibula which planned for Tumour resection, peroneal nerve presevation and LCL ligament reconstruction. This is study of three patients with GCT of proximal fibula was confirm with Clinical Pathological Confrence (CPC). All of patient had presented of lump, slowly growing pain in lateral side of knee, limping when they walk and numbness in dorsal side of foot. One patient cannot dorsoflexion of ankle. We evaluated a peroneal nerve function and stability of knee after operation and one year after resection of tumour. All patient had occurred peroneal nerve lesion with no instability of knee post operatively. Two patient had complaint with numbness in dorsal side of foot and weakness ankle dorsoflexion and after one year both of patient had improved ankle dorsoflexion but still numbness in dorsal side of foot. One patient still complaining numbness in dorsal side of foot and weakness ankle dorsoflexion post operation and one year after operation. There is no LCL ligament instability in all of patient post operation and one year after operation. The peroneal nerve function and LCL ligament stability must consider when facing benign tumours in proximal fibula such as giant cell tumour proximal fibula. These resections result in an unavoidable loss of knee stability because of resecting the lateral collateral ligament (LCL) insertion site on the fibular head. Based on the literature, the incidence rate of postoperative peroneal nerve palsy ranges from 3% to 57%. Giant cell tumour in proximal fibula is rare and require wide excision with intraarticular resection of the proximal tibiofibular join. We must consider about peroneal nerve function and LCL ligament stability during resection of GCT proximal fibula. Keywords: Giant Cell Tumour Proximal Fibula, Peroneal Nerve function, LCL Ligament stability
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Freychet, Benjamin, Bertrand Sonnery-Cottet, Thomas L. Sanders, et al. "Arthroscopic Anatomy of the posterolateral structures of the knee." Orthopaedic Journal of Sports Medicine 7, no. 5_suppl3 (2019): 2325967119S0020. http://dx.doi.org/10.1177/2325967119s00208.
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Objectives The purpose of this study was to describe an arthroscopic surgical approach to identify and expose the popliteus tendon (PT), posterior fibular head, Fibular collateral ligament (FCL), popliteal fibular ligament (PFL), biceps femoris tendon, and the peroneal nerve. Methods 10 fresh human cadaveric knees were examined arthroscopically using standard anterior and posterior portals. The use of a transeptal approach with both posteromedial and posterolateral portals was required using a standard 30 degrees arthroscope. Optimal portal placement and specific technique and sequence for appropriate visualization of the PLC structures were tested and documented. Results In all specimens, all the PLC structures that we attempted to identify were successfully visualized. These included the PT, posterior fibular head, the FCL, the PFL, biceps femoris tendon, peroneal nerve, PT and FCL femoral attachments. Conclusion This study demonstrated that the identification and exposure of the PLC structures using an all arthroscopic approach can be successfully performed with precise portal placement. This technique may serve as a basis for arthroscopic treatment of PLC injuries.
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Barbosa, Ana Beatriz Marques, Priscele Viana dos Santos, Vanessa Apolonio Targino, et al. "Sciatic nerve and its variations: is it possible to associate them with piriformis syndrome?" Arquivos de Neuro-Psiquiatria 77, no. 9 (2019): 646–53. http://dx.doi.org/10.1590/0004-282x20190093.
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ABSTRACT The sciatic nerve forms from the roots of the lumbosacral plexus and emerges from the pelvis passing inferiorly to the piriformis muscle, towards the lower limb where it divides into common tibial and fibular nerves. Anatomical variations related to the area where the nerve divides, as well as its path, seem to be factors related to piriformis syndrome. Objective: To analyze the anatomical variations of the sciatic nerve and its clinical implications. Methods: This was a systematic review of articles indexed in the PubMed, LILACS, SciELO, SpringerLink, ScienceDirect and Latindex databases from August to September 2018. Original articles covering variations of the sciatic nerve were included. The level of the sciatic nerve division and its path in relation to the piriformis muscle was considered for this study. The collection was performed by two independent reviewers. Results: At the end of the search, 12 articles were selected, characterized according to the sample, method of evaluation of the anatomical structure and the main results. The most prevalent anatomical variation was that the common fibular nerve passed through the piriformis muscle fibers (33.3%). Three studies (25%) also observed anatomical variations not classified in the literature and, in three (25%) the presence of a double piriformis muscle was found. Conclusion: The results of this review showed the most prevalent variations of the sciatic nerve and point to a possible association of this condition with piriformis syndrome. Therefore, these variations should be considered during the semiology of disorders involving parts of the lower limbs.
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Coraci, Daniele, Andrea Faiola, Ilaria Paolasso, Alberto Battaglia, Valter Santilli, and Luca Padua. "Ultrasonographic assessment of superficial fibular nerve branches." Clinical Neurophysiology 127, no. 10 (2016): 3298–300. http://dx.doi.org/10.1016/j.clinph.2016.08.009.
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Ellanti, P., K. M. S. Mohamed, and K. O’Shea. "Superficial Peroneal Nerve Incarceration in the Fibular Fracture Site of a Pronation External Rotation Type Ankle Fracture." Open Orthopaedics Journal 9, no. 1 (2015): 214–17. http://dx.doi.org/10.2174/1874325001509010214.
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Ankle fractures are common representing up to 10% of all fractures with an incidence that is rising. Both conservative treatment and operative management of ankle fractures can lead to excellent outcomes. Neurovascular injuries are uncommon but can be a source of significant morbidity and associated poor outcome. The superficial peroneal nerve (SPN) in the lateral approach and the sural nerve in the posterolateral approach are at risk of injury. We report an unexpected finding of a superficial peroneal nerve incarcerated in the fibular fracture site of pronation external rotation type/ Weber-C ankle fracture. To the best of our knowledge we believe this to be the first English language report of an incarcerated SPN at a fibular ankle fracture site.
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Telleman, Johan A., Ingrid J. T. Herraets, H. Stephan Goedee, et al. "Nerve ultrasound." Neurology 92, no. 5 (2018): e443-e450. http://dx.doi.org/10.1212/wnl.0000000000006856.
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ObjectiveTo determine interobserver variability of nerve ultrasound in peripheral neuropathy in a prospective, systematic, multicenter study.MethodsWe enrolled 20 patients with an acquired chronic demyelinating or axonal polyneuropathy and 10 healthy controls in 3 different centers. All participants underwent an extensive nerve ultrasound protocol, including cross-sectional area measurements of median, ulnar, fibular, tibial, and sural nerves, and brachial plexus. Real-time image acquisition was performed blind by a local and a visiting investigator (reference). Five patients were investigated using different types of sonographic devices. Intraclass correlation coefficients were calculated, and a random-effects model was fitted to identify factors with significant effect on interobserver variability.ResultsSystematic differences between measurements made by different investigators were small (mean difference 0.11 mm2 [95% confidence interval 0.00–0.23 mm2]). Intraclass correlation coefficients were generally higher in arm nerves (0.48–0.96) than leg nerves (0.46–0.61). The hospital site and sonographic device did not contribute significantly to interobserver variability in the random-effects model.ConclusionsInterobserver variability of nerve ultrasound in peripheral neuropathy is generally limited, especially in arm nerves. Different devices and a multicenter setting have no effect on interobserver variability. Therefore, nerve ultrasound is a reproducible tool for diagnostics in routine clinical practice and (multicenter) research.
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AT, Wirtu, and Geneti SA. "Communicating Neuroanatomical Fibers in Health and Diseases." Journal of Human Anatomy 8, no. 1 (2024): 1–7. http://dx.doi.org/10.23880/jhua-16000205.
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Background: Combining neuroanatomical fiber information with other types of neuroimaging and genetic data can lead to a more comprehensive understanding of brain function and pathology. Variations in the branching patterns of the brachial plexus and the division of the sciatic nerve into the tibial and common fibular nerves has been documented in numerous studies, although not extensively in Ethiopia. The brachial plexus is formed by the ventral roots of spinal nerves from C5 to T1. Meanwhile, the sciatic nerve, which originates from the sacral plexus divides into the tibial and common fibular nerves at various points along its pathway. Given the significant implications of neural variations for enhancing medico legal practices, understanding these variations is crucial for making accurate diagnosis. Consequently, study examined different neuroantomical variants in Ethiopia. Objectives: To examine variations in the neural system connection and their clinical implications in the Ethiopian population and provide mechanistic insights into how different brain regions communicate and disruptions in these communications can lead to cognitive and behavioral symptoms. Methods and Materials: This research was carried out in a randomly selected medical institutions between January 2015 and February 2016. Preserved and carefully maintained human bodies were dissected by medical students, adhering to the protocols outlined in Grant’s Dissection Principles and Cunningham’s Manual of Practical Anatomy. The dissections took place in anatomy laboratory, with a specific focus on detecting any anatomical variations, particularly in the neural system of the human body. Results: In this study, we observed communication between the musculocutaneous nerve and the median nerve occurred in 6.3% of the sampled cases. Moreover, communication between the radial nerve and the ulnar nerve was found in 2.1% of the cases. Furthermore, variations in the pelvic division of the sciatic nerve were noted in 6.3% of the sampled cases from Ethiopia. Conclusion: We discovered a nerve responsible for communication within a specific part of the human body. Recognizing such communicating nerve fibers and their pathways is essential for clinicians to effectively diagnose sensorimotor symptoms. This understanding is also vital for neurologists, surgeons, and orthopedists in handling cases of nerve entrapment syndromes, carrying out post-traumatic assessments and undertaking exploratory procedures.
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De Martino Luppi, Andrea, Guilherme Emílio Ferreira, Isabella Sabião Borges, et al. "Role of multisegmental nerve ultrasound in the diagnosis of leprosy neuropathy." PLOS ONE 19, no. 7 (2024): e0305808. http://dx.doi.org/10.1371/journal.pone.0305808.
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Introduction/Aims Leprosy is the most common treatable peripheral neuropathy worldwide. The detection of peripheral nerve impairment is essential for its diagnosis and treatment, in order to prevent stigmatizing deformities and disabilities. This study was performed to identify neural thickening through multisegmental ultrasound (US). Methods We assessed US measurements of cross-sectional areas (CSAs) of ulnar, median and tibial nerves at two points (in the osteofibrous tunnel and proximal to the tunnel), and also of the common fibular nerve at the fibular head level in 53 leprosy patients (LP), and compared with those of 53 healthy volunteers (HV), as well as among different clinical forms of leprosy. Results US evaluation detected neural thickening in 71.1% (38/53) of LP and a mean number of 3.6 enlarged nerves per patient. The ulnar and tibial were the most frequently affected nerves. All nerves showed significantly higher measurements in LP compared with HV, and also greater asymmetry, with significantly higher values for ulnar and tibial nerves. We found significant CSAs differences between tunnel and pre-tunnel points for ulnar and tibial nerves, with maximum values proximal to the tunnel. All clinical forms of leprosy evaluated showed neural enlargement through US. Discussion Our findings support the role of multisegmental US as a useful method for diagnosing leprosy neuropathy, revealing that asymmetry, regional and non-uniform thickening are characteristics of the disease. Furthermore, we observed that neural involvement is common in different clinical forms of leprosy, reinforcing the importance of including US evaluation of peripheral nerves in the investigation of all leprosy patients.
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Tsukamoto, Hiroshi, Giuseppe Granata, Daniele Coraci, Ilaria Paolasso, and Luca Padua. "Ultrasound and neurophysiological correlation in common fibular nerve conduction block at fibular head." Clinical Neurophysiology 125, no. 7 (2014): 1491–95. http://dx.doi.org/10.1016/j.clinph.2013.11.041.
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dos Santos, Diogo Fernandes, Douglas Eulálio Antunes, Bruno Carvalho Dornelas, et al. "Peripheral nerve biopsy: a tool still needed in the early diagnosis of neural leprosy?" Transactions of The Royal Society of Tropical Medicine and Hygiene 114, no. 11 (2020): 792–97. http://dx.doi.org/10.1093/trstmh/traa053.
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Abstract Background The early recognition of neural impairment in leprosy, especially in primary neural forms, represents a challenge in clinical practice and a peripheral nerve biopsy may be required for diagnostic confirmation. This study aims to characterize the epidemiological, clinical, electroneuromyographic, laboratory and histopathological aspects of patients undergoing peripheral nerve biopsy during investigation of primary neural cases in leprosy. Methods A total of 104 patients with peripheral neuropathy who were referred to a national reference centre for leprosy were biopsied from 2014 to 2018. All cases underwent clinical, laboratory, histopathological and electroneuromyographic evaluations. Results Of 104 biopsied patients, leprosy was confirmed in 89.4% (93/104). The biopsied nerves were the ulnar (67.8% [63/93]), superficial fibular (21.5% [20/93]), sural (8.6% [8/93]), radial (1.1% [1/93]) and deep fibular (1.1% [1/93]). Twenty-nine percent (27/93) presented histopathological abnormalities and 4.4% (4/93) presented acid-fast bacilli. Nerve and superjacent skin quantitative polymerase chain reaction were positive in 49.5% (46/93) and 24.8% (23/93) of cases, respectively. Patients with multiple mononeuropathy had a higher frequency of histopathological abnormalities (p=0.0077). Conclusions This study reinforces peripheral nerve biopsy's role as an important tool in the investigation of primary neural cases, contributing to the early diagnosis and also reducing diagnostic errors and the need for empirical treatment.
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Nunes e Silva, Daniel, Andréia Conceição Milan Brochado Antoniolli da Silva, Ricardo Dutra Aydos, et al. "Nerve growth factor with fibrin glue in end-to-side nerve repair in rats." Acta Cirurgica Brasileira 27, no. 4 (2012): 325–32. http://dx.doi.org/10.1590/s0102-86502012000400008.
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PURPOSE: To determine the effects of end-to-side nerve repair performed only with fibrin glue containing nerve growth in rats. METHODS: Seventy two Wistar rats were divided into six equal groups: group A was not submitted to nerve section; group B was submitted to nerve fibular section only. The others groups had the nerve fibular sectioned and then repaired in the lateral surface of an intact tibial nerve, with different procedures: group C: ETS with sutures; group D: ETS with sutures and NGF; group E: ETS with FG only; group F: ETS with FG containing NGF. The motor function was accompanied and the tibial muscle mass, the number and diameter of muscular fibers and regenerated axons were measured. RESULTS: All the analyzed variables did not show any differences among the four operated groups (p>0.05), which were statistically superior to group B (p<0.05), but inferior to group A (p>0.05). CONCLUSION: The end-to-side nerve repair presented the same recovery pattern, independent from the repair used, showing that the addition of nerve growth factor in fibrin glue was not enough for the results potentiating.
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Garbin, Marta, Raiane A. Moura, Yasmim C. Souza, et al. "Development of a Pericapsular Knee Desensitization Technique in Dogs: An Anatomical Cadaveric Study." Veterinary Sciences 12, no. 6 (2025): 599. https://doi.org/10.3390/vetsci12060599.
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Regional anesthesia techniques targeting articular nerve branches offer promising avenues for managing articular pain. This study developed and compared the success rates of an ultrasound-guided versus a blind pericapsular knee desensitization (PKD) technique in canine cadavers. In Phase I, gross dissection and ultrasound evaluations were performed in eight limbs to characterize the anatomy of the medial (MAN), lateral (LAN), and posterior (PAN) articular branches of the saphenous, common fibular, and tibial nerves, respectively, and to identify suitable anatomical and ultrasonographic landmarks. In Phase II, ultrasound-guided and blind PKD injections of a dye solution were randomly performed in 10 cadavers (20 limbs), followed by dissection and histological assessment of staining accuracy. The ultrasound-guided technique achieved a significantly higher overall success rate (96.7%) than the blind technique (73.3%; p = 0.02). The MAN was successfully stained in 100% of ultrasound-guided and 50% of blind injections (p = 0.03), while the LAN and PAN were stained with high but comparable success. Parent nerve involvement was minimal for MAN and PAN but frequent for the common fibular nerve following LAN injections. Histological confirmation supported the anatomical findings, although PAN identification remained inconsistent. These results support the feasibility and increased precision of ultrasound-guided PKD, providing a foundation for further clinical evaluation.
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Elgenidy, Anas, Ibrahim A. Hassan, Yasser Hamed, et al. "Sonographic Evaluation of Peripheral Nerves and Cervical Nerve Roots in Amyotrophic Lateral Sclerosis: A Systematic Review and Meta-Analysis." Medical Sciences 13, no. 2 (2025): 67. https://doi.org/10.3390/medsci13020067.
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Background: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that leads to nerve atrophy. Ultrasonography has a significant role in the diagnosis of ALS. Aim: We aimed to sonographically assess the size of all peripheral nerves and cervical nerve roots in ALS compared to controls. Methods: We searched MEDLINE (PubMed), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Scopus using comprehensive MeSH terms for the keywords nerve, ultrasound, and ALS. We extracted data regarding cross-sectional area (CSA) or diameter for the following nerves: vagus, phrenic, tibial, fibular, sural, radial, ulnar, and median nerves, and the roots of C5, C6, C7, and C8 in both ALS patients and controls. Results: Our study included 2683 participants, of which 1631 were ALS patients (mean age = 60.36), 792 were healthy controls (mean age = 57.79), and 260 were patients with other neurological disorders. ALS patients had significantly smaller nerve size compared to controls. Nerve size differences were observed in the vagus nerve [MD = −0.23], phrenic nerve [MD = −0.25], C5 nerve root [SMD = −0.94], C6 nerve root [SMD = −1.56], C7 nerve root [SMD = −1.18], C8 nerve root [MD = −1.9], accessory nerve [MD = −0.32], sciatic nerve [MD = −11], tibial nerve [MD = −0.68], sural nerve [MD = −0.32,], ulnar nerve [MD = −0.80], and median nerve [MD = −1.21]. Conclusions: Our findings showed that ALS patients have a sonographically smaller nerve size than healthy controls. Therefore, this is a potential marker for neuronal diseases.