Prognostic factors in patients who underwent surgery for common peroneal nerve injury：a nest case-control study

Abstract Background: Common peroneal nerve (CPN) injury is one of the most common nerve injuries in the lower extremities and the motor functional recovery of injured common peroneal nerve (CPN) was often unsatisfactory, the mechanism of which is still controversial. The purpose of this retrospective study was to determine the prognostic factors in patients who underwent surgery for CPN injury and provide a tool for clinicians to assess the patients’ prognosis. Methods: This is a retrospective cohort study of all patients who underwent neural exploration for injured CPN from 2009 to 2019. A total of 387 patients with postoperative follow-up more than 12 months were included in the final analysis. We used univariate logistics regression analyses to explore explanatory variables which were associated with recovery of neurological function. By applying multivariable logistic regression analysis, we determined variables incorporated into clinical prediction model, developed a nomogram by the selected variables, and then assessed discrimination of the model by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results: The case group included 67 patients and the control group 320 patients. Multivariate logistic regression analysis showed that area (urban vs rural, OR=3.35), occupation(“blue trouser” worker vs “white-trouser” worker, OR=4.39), diabetes (OR=11.68), cardiovascular disease (OR=51.35), knee joint dislocation (OR=14.91), proximal fibula fracture (OR=3.32), tibial plateau fracture (OR=9.21), vascular injury (OR=5.37) and hip arthroplasty (OR=75.96) injury increased the risk of poor motor functional recovery of injured CPN, while high preoperative muscle strength (OR=0.18) and postoperative knee joint immobilization (OR=0.11) decreased this risk of injured CPN. AUC of the nomogram was 0.904 and 95% CI was 0.863-0.946. Conclusions: Area, occupation, diabetes, cardiovascular disease, knee joint dislocation, proximal fibula fracture, tibial plateau fracture, vascular injury and hip arthroplasty injury are independent risk factors of motor functional recovery of injured CPN, while high preoperative muscle strength and postoperative knee joint immobilization are protective factor of motor functional recovery of injured CPN. The prediction nomogram can provide a tool for clinicians to assess the prognosis of injured CPN.