Multimodality Neurophysiological Monitoring During Tibial/Fibular Osteotomies for Preventing Peripheral Nerve Injuries

Intraoperative Neurophysiological Monitoring (IONM) is not used routinely during tibial and fibular osteotomy procedure…

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Intraoperative Neurophysiological Monitoring (IONM) is not used routinely during tibial and fibular osteotomy procedures. Pediatric patients who present with Tibia Vara (Blount's disease), juvenile osteochondrosis, Genu Valgum (Knock-Knees), etc. are surgically treated with tibial and fibular osteotomy. These patients have a high risk of postoperative weakness or foot drop with or without sensory deficits. The incidence of postoperative neurological deficits ranges from 2% to 20%. The postoperative neurological complications can be minimized by utilizing IONM
Tibia Vara (Blount's Disease)
It is a growth disorder of the Tibia (shin bone) that causes the lower leg to angle inward, resembling a bowleg.
Juvenile Osteochondrosis
Occur in children characterized by interruption of the blood supply of a bone, in particular to the epiphysis, followed by localized bony necrosis and later, re-growth of the bone.
Genu Valgum:
Commonly called "knock-knees" is a condition where the knees angle in and touch one another when the legs are straightened.
Concerns during Tibial and Fibular osteotomies include ipsilateral lower limb motor and sensory function, due to peroneal nerve injuries by osteotomy at the fibular neck. Total Intravenous Anesthesia (TIVA) without any muscle relaxant, inhalational agent, or dexmedetomidine is reccommended.