Peroneal Nerve Injury Due to Hip Surgery Located at the Knee Level: A Case Report

Abstract

Background: The hip surgery may be complicated with an iatrogenic peroneal nerve injury. The spontaneous recovery of these patients is usually poor, and majority of them require additional surgical treatment. In this paper, we presented a case of iatrogenic peroneal nerve injury following posttraumatic hip surgery, which was decompressed at the knee level, and achieved complete postoperative recovery.
 The case: A 32-year-old woman was admitted to our department due to EMNG-verified peroneal nerve lesion. Eight months before, the patient was injured in a traffic accident, followed by knee dislocation, hip dislocation, and acetabular fracture. After open reduction of the acetabular fracture performed by the orthopedic surgeons, the peroneal nerve palsy followed. At the admission, the clinical findings included left sided incomplete peroneal nerve palsy (MRC=2), pain in the lateral lower leg (VAS=3), and gait disturbances. Using EMNG, the nerve lesion was located at the knee level, while US indicated suspectable nerve compression, due to visible nerve thickening. The PNSQoL and SF-36 scores indicated a significant decline in patients' quality of life (QOL). Following GETA, the external neurolysis, decompression, and complete nerve deliberation were performed at the knee level, with preservation of all nerve branches. The patient reported immediate relief, while completely recovered 8 months following the surgery (MRC = 5, VAS = 0). In order to assess postoperative QOL, a prolonged follow-up is needed.
 Conclusion: The iatrogenic peroneal nerve injury following hip surgery may not always be located in the hip region. A proper anamnesis, physical examination, and diagnostic evaluation are necessary for proper treatment of these patients.