Sural Nerve Research Articles

Increased blood urea nitrogen levels and compromised peripheral nerve function in patients with type 2 diabetes.

Increased blood urea nitrogen (BUN) levels have been demonstrated to be associated with broader metabolic disturbances and the incidence of type 2 diabetes (T2D), potentially playing a role in the development of diabetic complications, including diabetic peripheral neuropathy. To examine the relationship between BUN levels and peripheral nerve function in patients with T2D. This observational study involved the systematic recruitment of 585 patients with T2D for whom BUN levels and estimated glomerular filtration rate were measured. Electromyography was used to assess peripheral motor and sensory nerve function in all patients, and overall composite Z-scores were subsequently calculated for nerve latency, amplitude, and conduction velocity (NCV) across the median, ulnar, common peroneal, posterior tibial, superficial peroneal, and sural nerves. Across the quartiles of BUN levels, the overall composite Z-score for latency (F = 38.996, P for trend < 0.001) showed a significant increasing trend, whereas the overall composite Z-scores for amplitude (F = 50.972, P for trend < 0.001) and NCV (F = 30.636, P for trend < 0.001) exhibited a significant decreasing trend. Moreover, the BUN levels were closely correlated with the latency, amplitude, and NCV of each peripheral nerve. Furthermore, multivariate linear regression analysis revealed that elevated BUN levels were linked to a higher overall composite Z-score for latency (β = 0.166, t = 3.864, P < 0.001) and lower overall composite Z-scores for amplitude (β = -0.184, t = -4.577, P < 0.001) and NCV (β = -0.117, t = -2.787, P = 0.006) independent of the estimated glomerular filtration rate and other clinical covariates. Additionally, when the analysis was restricted to sensory or motor nerves, elevated BUN levels remained associated with sensory or motor peripheral nerve dysfunction. Increased BUN levels were independently associated with compromised peripheral nerve function in patients with T2D.

Glial fibrillary acidic protein: a potential biomarker for small fiber neuropathy?

Abstract Background Objective and easily applicable biomarkers for diabetic polyneuropathy (DPN) are warranted. Circulating nerve-specific proteins have emerged as valuable biomarkers for central nervous system disease but few of these have been tested in peripheral neuropathy. Glial Fibrillary Acidic Protein (GFAP) is highly expressed in non-myelinating Schwann cells while UCH-L1 is a neuron expressed stress protein not previous analyzed in DPN. In this pilot study, we explore serum GFAP and UCH-L1 levels in patients with/without DPN and controls. Methods Persons with DPN (n = 28), without DPN (n = 31), and controls (n = 30) were evaluated in a cross-sectional design. Sural nerve conduction (velocity and amplitude) was evaluated by NC-stat DPNCheck™ and quantitative sensory testing of cold detection and pain was performed. GFAP and UCH-L1 levels were compared across study groups and the unadjusted correlation with nerve assessments evaluated. Results Serum GFAP were lower in persons with DPN (20.9 ± 10.9 pg/ml) than in persons without DPN (26.2 ± 14.1 pg/ml) (p = 0.04) or controls (31.7 ± 26.0 pg/ml) (p = 0.02). GFAP levels were not different in persons without DPN and controls (p = 0.61). UCH-L1 levels were not different between study groups (p = 0.48). GFAP levels correlated with cold pain threshold (Rho= − 0.320, p = 0.02) but failed to reach significance for cold detection (Rho= − 0.236, p = 0.09). No correlation was observed between GFAP and nerve amplitude (p = 0.58) or conductivity (p = 0.86). Conclusion Serum GFAP levels are reduced in persons with DPN compared to persons without DPN and controls. Reduced serum GFAP levels may be associated with reduced markers of small nerve fiber damage obtained from quantitative sensory testing in people with diabetes.

Anatomical Variations in the Formation of the Sural Nerve: A Pilot Study in a Sample of Lithuanian Cadavers

Anatomical Variations in the Formation of the Sural Nerve: A Pilot Study in a Sample of Lithuanian Cadavers

Ultrasound-Guided Sural Nerve and Tibial Nerve Block Provides Comparable Analgesia to Popliteal Sciatic Nerve Block Following Calcaneal Surgery: A Single Center Randomized Controlled Double-Blind Study.

Popliteal sciatic nerve blocks have gained popularity as an anesthesia choice for calcaneal surgery. While the simpler technique of sural and tibial nerve blocks offers potential, its safety and efficacy require validation through a head-to-head clinical study. This study compared the efficacy of ultrasound-guided sural and tibial nerve blocks (ST) with popliteal sciatic nerve block (PS) for operative and postoperative analgesia. A total of 80 patients (40 per group) undergoing calcaneal surgery were randomized to receive either ST or PS nerve blocks. Patients in both groups were provided with an intravenous patient-controlled analgesia (PCA) device containing flurbiprofen. Visual analogue scale (VAS) pain scores were recorded at awakening, 2, 6, 12, and 24h postoperatively. In addition, block onset time, procedure duration, patient satisfaction, and application of postoperative analgesics were also recorded. VAS scores were comparable between groups throughout the 24-hour observation period (VAS range 0-3, p > 0.05). ST blocks demonstrated faster onset (8.2 ± 1.5 vs 12.4 ± 2.1minutes, p<0.001) and shorter procedure time (11.5 ± 2.1 vs 16.8 ± 2.4minutes, p<0.001). Patient satisfaction scores were similar between groups (8.5 ± 0.8 vs 8.3 ± 0.9, p=0.31). Ultrasound-guided sural and tibial nerve blocks provide effective operative and postoperative analgesia comparable to popliteal sciatic nerve block. The blocks are easy to perform, have a faster onset, and achieve high patient satisfaction, making them a valuable alternative for calcaneal surgery.

Intra-septal sensory branch as an alternative to the sural nerve grafting in radial nerve reconstruction: Anatomical and histomorphological study.

Intra-septal sensory branch as an alternative to the sural nerve grafting in radial nerve reconstruction: Anatomical and histomorphological study.

Unmasking the mimic: Leprosy neuropathy misdiagnosed as chronic inflammatory demyelinating polyneuropathy: A case report from Saudi Arabia.

Leprosy neuropathy can mimic chronic inflammatory demyelinating polyneuropathy (CIDP), especially in non-endemic areas. We report a 72-year-old Saudi woman initially misdiagnosed with CIDP based on nerve conduction studies. The patient presented with widespread pruritus, erythematous cutaneous lesions, and progressive sensorimotor symptoms. Despite treatment with intravenous immunoglobulin, her condition worsened. Subsequent sural nerve and skin biopsies revealed acid-fast bacilli, confirming leprosy. This case highlights the importance of considering leprosy in the differential diagnosis of neuropathies, even in regions where it is rare. Nerve ultrasound, a valuable diagnostic tool in differentiating leprosy from CIDP, should be incorporated into the diagnostic workup of atypical neuropathies.

Severe old lumbar fracture and dislocation with cauda equina nerve transection: A case report.

Severe old lumbar fractures and dislocations with associated cauda equina nerve transection are rare clinical presentations which pose significant management challenges. This case report highlights a unique instance of such an injury, emphasizing novel surgical strategies for reconstruction and recovery. A 30-year-old male patient was admitted after sustaining a severe open fracture and degree IV posterior dislocation of L3 vertebra, accompanied by cauda equina nerve transection, spinal cord injury and multiple organ injuries. Following initial stabilization, the patient underwent surgical reduction and internal fixation two months after the injury. The procedure involved cauda equina nerve reconstruction using sural nerve grafts. Postoperatively, the patient showed improved bladder function and regained some mobility. However, he later developed arachnoiditis ossificans of the cauda equina, resulting in severe pain, which required additional surgical intervention. In conclusion, this case underscores the importance of timely intervention in severe thoracolumbar injuries and presents a successful approach to nerve reconstruction.

The mechanotransduction protein STOML3 is required for proprioceptor plasticity following peripheral nerve regeneration.

Nerve regeneration is associated with the plasticity of sensory neurons such that even muscle afferents directed to the skin form mechanosensitive receptive fields appropriate for the new target. STOML3 is an essential mechanotransduction component in many cutaneous mechanoreceptors. Here, we asked whether STOML3 is required for functional and anatomical plasticity following peripheral nerve regeneration. We used a cross-anastomosis model adapted to the mouse, in which the medial gastrocnemius nerve was redirected to innervate hairy skin previously occupied by the sural nerve. We recorded from muscle afferents innervating the skin and found that in wild-type mice their receptive properties were largely identical to normal skin mechanoreceptors. However, in mice lacking STOML3, muscle afferents largely failed to form functional mechanosensitive receptive fields, despite making anatomically appropriate endings in the skin. Our tracing experiments demonstrated that muscle afferents from both wild-type and stoml3 mutant mice display remarkable anatomical plasticity, forming new somatotopically appropriate synaptic terminals in the region of the dorsal horn representing the sural nerve territory. The dramatic reduction in stimulus-evoked activity from the cross-anastomosed gastrocnemius nerve in stoml3 mutant mice did not prevent central anatomical plasticity. Our results have identified a molecular factor required for functional plasticity following peripheral nerve injury.

125 Case Series Report: The use of ultrasound in detecting neuromas in amputees with osseointegrated prostheses

Objectives/Goals: Imaging neuromas, benign tumors of nerve tissue, can be difficult in amputees with osseointegrated (OI) prostheses, in which a metal rod is implanted into the residual limb. Magnetic resonance imaging can be inadequate due to the implanted metal. The aim of this study is to assess the use of ultrasound to detect neuromas in patients with OI prostheses. Methods/Study Population: This is a single-institutional observational study of 7 patients undergoing lower limb OI prostheses. Lower extremity nerve ultrasounds with 2-D grayscale and Doppler were completed at postoperative follow-up visits following OI prosthesis implantation. Specifically, the sciatic nerve, tibial nerve, common peroneal nerve, and sural nerve were targeted for imaging. Neuromas found on ultrasound were measured by maximal length in three planes. Results/Anticipated Results: Our study to date includes two patients with OI prostheses. The remaining patients will be accrued by the end of December. The first patient with a left below-the-knee amputation completed imaging 3 years after OI prosthesis implantation. The common peroneal nerve showed preserved fascicular architecture and morphology, with no distinct neuroma formation. However, the sural nerve demonstrated a 6 × 5 × 4 mm neuroma with minimal pain with deep palpation. The tibial nerve demonstrated a 14 × 11 × 8 mm neuroma within the medial calf musculature, with mild pain with deep palpation. The second patient with a right above-the-knee amputation was imaged 10 months after OI prosthesis implantation. The sciatic nerve demonstrated preserved fascicular morphology and terminated in a smooth taper. There was no defined neuroma. Discussion/Significance of Impact: In conclusion, we have preliminarily shown in the first two patients that ultrasound can successfully image neuromas in patients with OI prostheses in the postoperative period. Furthermore, despite a patient that was 3 years postoperative with two neuromas, the neuromas produced minimal to mild pain with targeted palpation.

Involvement Beyond Peripheral Nerves in Pure Neuritic Leprosy: An MR Imaging Study.

Pure neuritic leprosy (PNL) is an uncommon form of leprosy involving peripheral nerves alone. Some isolated case reports and observational studies have shown imaging changes in the CNS in patients with leprosy. This prospective observational study evaluates the involvement of the nervous system beyond peripheral nerve among patients with PNL with MR imaging. We screened patients presenting with features of neuropathy and/or thickened nerves. Patients were subjected to detailed clinical examination, routine tests along with nerve conduction study, and biopsy of peripheral nerve, usually the sural nerve. MRI of brachial and lumbar plexus, dorsal root ganglia, spinal cord, and brain were evaluated in patients with histopathologically confirmed Hansen neuritis. Of 86 patients screened for PNL, 52 were positive on nerve biopsy. Most patients were men (86.53%) and the mean age was 45.72 ± 15.25 years. Asymmetrical polyneuropathy was the most common nerve conduction study pattern in 55.76% (29/52) patients. We found abnormal imaging findings in 21 (40.38%) patients. Ganglionitis was the most common finding seen in 14 (26.92%) patients followed by plexitis (15.38%) and myelitis (11.53%). Patients with MRI lesions were younger and were found to have more functional impairment and raised CSF protein. In PNL, many patients have subclinical involvement of dorsal root ganglion, brachial plexus, lumbar plexus, and spinal cord. Exact pathophysiology of CNS involvement is not clear; however, imaging of the above-mentioned regions may help in early diagnosis and prevent complications. These MRI findings in PNL are important considerations when assessing patients with peripheral neuropathy.

Effectiveness analysis of channel-assisted minimally invasive repair technique combined with flexor hallucis longus tendon transfer for Achilles tendon sleeve avulsion

To evaluate the effectiveness of the channel-assisted minimally invasive repair (CAMIR) technique combined with flexor hallucis longus (FHL) tendon transfer in the treatment of Achilles tendon sleeve avulsion. A retrospective analysis was conducted on 17 patients with Achilles tendon sleeve avulsion who underwent CAMIR technique combined with FHL transfer between January 2019 and January 2023. The cohort comprised 13 males and 4 females, aged 32 to 65 years (mean, 49.7 years). Etiologies included sports-related injuries in 15 cases and blunt trauma in 2 cases. The interval from injury to surgery ranged from 4 to 368 days (median, 15 days). All patients exhibited calcification at the Achilles tendon insertion site, with 7 cases complicated by Haglund deformity. Postoperative complications were meticulously monitored, and tendon healing was assessed via MRI. Clinical outcome were evaluated using the visual analogue scale (VAS) score for pain, Tegner activity level rating scale, ankle activity score (AAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Victorian Institute of Sport Assessment-Achilles (VISA-A) score, and subjective clinical scoring systems preoperatively and at last follow-up. The operation time was 50-62 minutes (mean, 56 minutes), and the intraoperative blood loss was 5-50 mL (mean, 19.7 mL). All patients were followed up 12-67 months (mean, 38 months). No postoperative complication, such as Achilles tendon re-rupture, incision infection, deep vein thrombosis, heel raise insufficiency, or sural nerve injury, was observed. At last follow-up, MRI examination confirmed satisfactory tendon healing in all cases. Significant improvements were noted in VAS scores, Tegner activity level rating scale, AAS scores, AOFAS ankle-hindfoot scores, and VISA-A scores compared to preoperative ones ( P<0.05). At last follow-up, the subjective clinical score ranged from 6 to 10 (median, 9). The CAMIR technique combined with FHL tendon transfer is a good treatment for repair of Achilles tendon sleeve avulsion, with good recovery of ankle function and few complications.

Nerve Ultrasound Detects Nerve Atrophy in Patients With Ataxia-Telangiectasia: A Pilot Study.

Ataxia-telangiectasia (A-T) is a genetic multisystem neurodegenerative disorder characterized by cerebellar ataxia, oculocutaneous telangiectasia, extrapyramidal involvement, peripheral sensorimotor neuropathy, immunodeficiency, pulmonary disease, and an increased risk of malignancy that ultimately determines the shortened lifespan in many patients. A-T nerve ultrasonographic characteristics remain underexplored. This pilot study aimed to characterize the ultrasonographic morphology of peripheral nerves in patients with A-T. Ultrasound cross-sectional areas (CSAs) of the median, ulnar, sural, and tibial nerves were obtained from three A-T patients and were compared to reference values. Nerve conduction studies and electromyography were also performed. Given the small sample size and the exploratory nature of this study, formal statistical analyses were not performed, and descriptive statistics were presented for the data. Nerve CSAs in A-T patients were smaller than in healthy controls at all measurement sites. Nerve ultrasound revealed atrophy in the peripheral nerves of A-T patients. This reduction in nerve size may distinguish A-T and highlights the utility of nerve ultrasound as a non-invasive diagnostic tool for peripheral sensorimotor neuropathy. These findings may have important implications for early detection in clinical practice.

Sural nerve injury risk during endoscopic gastrocnemius recession: Comparison of two approaches.

Sural nerve injury risk during endoscopic gastrocnemius recession: Comparison of two approaches.

Relationship Between Sural Nerve Function, Physical Function, and the Ability to Perform Activities of Daily Living in Hospitalized Elderly Patients With Proximal Femoral Fractures: A Prospective Observational Study.

Background Falls in older adults, specifically causing proximal femoral fractures, greatly affect daily functioning and life expectancy. Peripheral neuropathy is an established risk factor for falls. However, the relationship between nerve conduction velocity (CV), action potential (AP), and fall risk or functional recovery after rehabilitation is not well understood. This study aimed to clarify whether sural nerve function can predict fall risk and functional improvement in activities of daily living. Methods We assessed elderly patients hospitalized with proximal femoral fractures in a convalescent rehabilitation ward. Sural nerve function was evaluated using the DPNCheck (NeuroMetrix, Inc., Woburn, MA, USA), with additional data collected on demographics, blood tests, medication use at admission and discharge, incidence of falls during hospitalization, physical function (Short Physical Performance Battery, or SPPB), and activities of daily living (Functional Independence Measure, or FIM). Statistical analyses explored the associations between the sural nerve CV/AP and the collected measures. Results In 27 patients (7 men and 20 women), sural nerve CV and AP were significantly correlated with both SPPB and FIM scores. Logistic regression identified FIM toileting as a significant predictor of reduced sural nerve AP (<5 μV; odds ratio: 3.22, p = 0.025). Multiple regression analysis showed that age and AP were significant predictors of the total FIM cognitive scores at discharge, with an adjusted R² of 0.464. Conclusion This study suggests that sural nerve function may help predict functional abilities in patients with proximal femoral fractures, particularly in the FIM motor tasks. Assessing peripheral nerve function can enhance rehabilitation plans by targeting fall risk management and promoting improvements in daily activities.

Achilles Tendon Trephination Versus Peroneus Brevis Tendon Transfer in Total Avulsion Injuries in a Tertiary Hospital

Introduction: Complete avulsion of Achilles tendon is common and treatment is challenging which can be trephination with suturing anchoring technique or peroneus brevis tendon transfer. The aim of the study was to evaluate the functional outcomes of ankles following Achilles tendon repair by comparing trephination with peroneus brevis tendon transfer in total avulsion injury. Methods: A single center prospective randomized study that consisted of 31 patients with Achilles tendon injuries who presented between April, 2019 and December, 2021 on account of complete avulsion injury of the Achilles tendon. Thirty-one (31) patients were randomized into two groups: Group A consisted of 16 patients who had trephination with suture anchoring technique while group B, consisted of 15 patients who had peroneus brevis tendon transfer. Achilles tendon injuries transected at least 10 mm above the calcaneus were excluded and repaired with conventional techniques. The inclusion criteria involved those patients that had complete avulsion injury. The socio-demographic data such as sex, age, occupation, mechanism of injury was documented. The outcome parameters were Endurance test and Proprioceptive evaluation. Results: Eighteen patients (58.1%) had right heel injuries while 13 patients (41.9%) had left leg injuries. About 16[51.6%] patients had trephination while 15[48.4%] patients had peroneus brevis tendon transfer. The age range was 3.2 and 8 years, with a mean age of 5.7years and a follow-up period of 10.4 and 14.8 months. All patients had open wounds. Seventeen males [63.6%] and fourteen females [36.4%] paediatric age group were studied. Complications were re-rupture in 1 patient with tendon transfer (3.2%), superficial surgical site infection in 3 patients (9.7%) and two sural nerve damage in peroneus brevis transfer (6.5%), stiff ankle joint 2 patients (6.2%) and post operative ankle pains up to 2 years was (1) 3.2%. The probability of damaging sural nerve was higher in peroneus brevis transfer as shown in Table 2, Achilles tendon rupture 1(3.2%) and stiff ankle joint in trephination 1 (3.2%). There was no significant statistical difference between the groups with p-value ≥ 0.06. Endurance test and proprioceptive evaluations were satisfactory at 8-10 weeks post- surgery.

Effect of Fixed Distance Recording and Foot Length on Sensory Nerve Action Potential of Dorsal Sural Nerve in Normal Adults.

Due to its distal location in the lower limb, the dorsal sural sensory nerve is pivotal in diagnosing early and subclinical peripheral neuropathy. This study aimed to establish reference data for latency, amplitude, and conduction velocity at fixed varying distances (80, 100, and 120 mm) between active and stimulating electrodes, while examining the impact of foot length on sensory nerve action potential. A prospective nerve conduction study (NCS) included 48 healthy participants aged 19-54 years. The upper and lower limits for latency, amplitude, and conduction velocities at 80 mm distance from the stimulating electrode were 3.1 and 1.01 ms, 36.8 and 1.45 μV, and 58.87 and 20.32 m/s, respectively. Similarly, the upper and lower limits for latency, amplitude, and conduction velocities at 100 mm distance from the stimulating electrode were 3.33 and 1.63 ms, 32.81 and 1.355 μV, and 55.24 and 24.75 m/s, respectively. The upper and lower limits for latencies and conduction velocities at 120 mm distance from the stimulating electrode were 4.25 and 1.76 ms and 59.43 and 21.77 m/s, respectively. The highest and lowest recorded amplitudes at 120 mm distance were 34.47 and 2.2 μV, respectively. Notably, univariate analysis findings were significant for latency (t = 2.86, P = 0.006) and conduction velocity (t = -2.13, P = 0.03) in relation to foot length when the distance between electrodes was 80 mm. This study provides reference normative data for the East Indian population, augmenting the understanding of NCS in diagnosing peripheral neuropathy.

Association of Nerve Conduction Study Variables with Hematologic Tests in Patients with Type 2 Diabetes Mellitus.

Background and Objective: Diabetic peripheral neuropathy (DPN) is a prevalent complication of type 2 diabetes mellitus (T2DM), with nerve conduction studies (NCSs) serving as the diagnostic gold standard. Early diagnosis is critical for effective management, yet many cases are detected late due to the gradual onset of symptoms. This study explores the relationship between hematological tests and NCS outcomes in T2DM patients to improve the early detection of DPN. Material and Methods: This retrospective study involved T2DM patients exhibiting neuropathic symptoms, and patients were divided based on NCS findings into groups with normal and abnormal results to assess the diagnostic value of various hematological markers, clinical, and demographic data for DPN. Results: Among 400 participants, 57% (n = 228) had abnormal NCS results indicative of DPN. Significant differences were observed in the abnormal-NCS group, including older age, longer diabetes duration, higher levels of fasting plasma glucose, HbA1c, and apolipoprotein B, along with lower eGFR, HDL-C, and Apo A-I levels. Notably, negative correlations were found between HDL-C, Apo A-I, vitamin B12, and specific NCS measurements, while positive correlations existed with sural sensory nerve amplitudes. Multivariate analysis highlighted the importance of age, diabetes duration, hyperglycemia, and specific hematologic markers in predicting DPN. Conclusions: The findings confirm that NCSs, combined with hematologic testing, can effectively identify DPN in T2DM patients. Consistent with prior research, prolonged hyperglycemia and nephropathy progression are strongly linked to DPN development. Additionally, lower levels of HDL-C, Apo A-I, and vitamin B12 are associated with the condition, suggesting their potential utility in early diagnostic protocols.

Focused Anatomic Review: Ultrasound-Guided Peripheral Nerve Stimulation of the Common Peroneal, Deep Peroneal, Superficial Peroneal, and Sural Nerves.

Focused Anatomic Review: Ultrasound-Guided Peripheral Nerve Stimulation of the Common Peroneal, Deep Peroneal, Superficial Peroneal, and Sural Nerves.

Comparative study of cannulated compression headless screws and anatomical locking compression hook plates for fracture of fifth metatarsal base in athletes and young adults

BackgroundThis study aimed to evaluate and compare the clinical effects and complications of cannulated compression headless screws (CHS) and anatomical locking compression hook plates (LCP) for fractures of the displaced fifth metatarsal base zone I in athletes and young adults.MethodsBetween May 2021 and June 2023, 50 patients were retrospectively evaluated. The patients were divided into two groups according to the fixation method: screw (CHS group, n = 20) or plate (LCP group, n = 30). General patient information, preoperative time, length of hospital stay, operative time, and intraoperative blood loss were recorded. Therapeutic effects were evaluated at follow-up using a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, and the incidence of postoperative complications.ResultsAll patients were followed-up for an average of 16 months (range, 12–25 months). All patients had primary union. The operative time was shorter in the CHS group (p < 0.05). The VAS score in the CHS group immediately after surgery was lower than that in the LCP group (p < 0.05). The AOFAS midfoot score was significantly better in the LCP group at 3 months postoperatively (p < 0.05), but was not significantly different at 6 and 12 months after surgery and at the last follow-up (p > 0.05). In the LCP group, frequent mild to moderate plantar pain occurred in four patients, foreign body sensation occurred in five patients, and internal fixation was removed in seven patients with a second operation one year postoperatively. In the CHS group, a foreign body sensation occurred in one patient. There were significant differences in the complications related to internal fixation between the two groups (p < 0.05). No infections or sural nerve injuries were observed.ConclusionIn athletes and young adults with displaced fractures of the fifth metatarsal base zone I, the LCP provides early mobilisation and rehabilitation while increasing the incidence of complications associated with internal fixation compared with CHS.

Preliminary report of minimally invasive corneal neurotization in patients with neurotrophic keratopathy in Southern China

PurposeTo describe the clinical features and outcomes of neurotrophic keratopathy (NK) patients treated with minimally invasive corneal neurotization (MICN).MethodsMedical records of patients with NK who were treated with neurotization surgery between January 2022 and December 2023 were retrospectively reviewed. Eleven patients underwent neurotization surgery via sural nerve grafts from the supraorbital nerves to the affected contralateral cornea. Ocular examinations as well as Cochet Bonnet esthesiometry (CBA) of the affected cornea were performed.ResultsThe baseline corneal conditions were as follows: Mackie stage 2 (3, 27%) and Mackie stage 3 (8, 63%). All the patients demonstrated improvements in corneal sensibility and corneal epithelial healing postoperatively. The CBA measurements improved from 1.8 ± 4.0 mm at baseline to 46.4 ± 13.4 mm at 12 months after surgery (P < 0.05). The mean best-corrected visual acuity of 11 patients improved from logMAR values of 1.8 ± 0.3 at baseline to 0.8 ± 0.7 at 12 months postoperatively (p < 0.05). Before surgery, corneal nerves at subbasal levels were completely absent at IVCM in all the patients. Corneal nerve morphology improved and the mean corneal nerve fibre density (CNFD) was 14.1 ± 11.8 n/mm2 12 months postoperatively. The limbal vascular density decreased from 34.1 ± 4.6% at baseline to 6.4 ± 1.7% at 12 months after surgery (p < 0.05). Two patients underwent successful penetrating keratoplasty after MICN due to corneal leucoma.ConclusionMICN is a useful surgical treatment for facilitating corneal epithelium healing and improving corneal sensitivity and visual acuity in patients with severe NK.Trial registrationThis study protocol was reviewed and approved by the Ethics Committee of Zhongshan Ophthalmic Center (no. 2024KYPJ129).