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The utilization of nerve transfer procedures in the upper extremity following brachial plexus injury, trauma, spinal cord injury, tumors, infection or other etiologies are well established. Nerve injuries in the lower extremity pose several additional challenges, including longer distance to target motor end plates, far-proximal injuries in the lumbar plexus or pelvis, delayed presentation, and concomitant limb trauma. Nerve transfers in the lower extremity have the potential to provide functional (sensory or motor) recovery distally after direct surgical coaptation of a functional donor nerve to a non-functional recipient nerve. In addition, the ability to perform pure motor or sensory fascicular transfers allows for focused recovery while limiting donor morbidity. Indications for nerve transfers in the lower extremity are evolving, but have been utilized for non-recovering peroneal, obturator, femoral or tibial nerve palsies, to provide protective sensation to the plantar aspect of the of foot, as well as for painful neuropathies/neuromas. There is a paucity of orthopaedic literature on this topic and our review aims to highlight the current state of lower extremity nerve transfers as they relate to the practicing orthopaedist, including future directions in the field.

Proximal femur varus derotation osteotomy (VDRO) is the primary component of hip reconstruction surgery for the management of hip subluxation/dislocation in patients with neuromuscular dysplasia. Understanding the pathophysiology and abnormal proximal femur geometry is crucial to performing a successful surgery and dosing the surgical correction accurately. Children with neuromuscular hip dysplasia experience increased coxa valga, femoral anteversion and variable degrees of acetabular dysplasia. Understanding the relationship between these three anatomic aberrations can be difficult with standard two-dimension plain radiography. In this paper, we will review our novel three-dimensional imaging protocol to assess the pathologic anatomy of the proximal femur and acetabulum in children undergoing neuromuscular hip reconstruction. Understanding the anatomic relationship between the neck shaft angle, anteversion and acetabular dysplasia aids in the planning and execution of effective VDRO and hip reconstruction surgery.