Abstract
BackgroundPostoperative contralateral morbidities after fracture fixation surgery by hemilithotomy positioning on traction table is uncommon. We’d report a case of unexpected common peroneal nerve palsy developed on the contralateral side manifesting with drop foot after a common orthopedic femoral nailing.Case reportA 28-year-old female sustained an unusual common peroneal nerve palsy manifesting contralateral drop foot after prolonged femoral nailing. Although the initial presentations were similar to the notorious well-leg compartment syndrome, a benign course with complete recovery in functions was observed 3 months later. After neurophysiologic exam and review of pertinent literature, this iatrogenic and transient dysfunction was delineated to be position-related neuropraxia.ConclusionPosition adjustment at intervals or complete avoidance of prolonged knee hyperflexion is recommended to prevent contralateral common peroneal nerve morbidity.
Highlights
Postoperative contralateral morbidities after fracture fixation surgery by hemilithotomy positioning on traction table is uncommon
This report documents an unexpected common peroneal nerve palsy developed on the contralateral side manifesting with drop foot after a common orthopedic femoral nailing
Prolonged unhealthy position is another cause of common peroneal neuropathy, which induces a nerve entrapment syndrome presenting as a foot drop
Summary
Ipsilateral morbidities after fracture fixation are often related to either initial trauma to the involved neurovascular structures or secondary events caused by interventional procedures or devices. The fracture was treated with closed reduction and stabilization using an 11 × 380 mm intramedullary nail (Targon®; Aesculap, Tuttlingen, Germany) The patient underwent these surgical procedures under general anesthesia, and was kept in a supine hemilithotomy position- the non-operated leg was held by a boot and positioned in 80° of hip flexion, 30° of abduction, and 105° of knee flexion without any leg holders or fixation straps around the knee (Fig. 2). With symptoms compatible with a common peroneal nerve palsy, we fitted the patient with an ankle-foot orthosis and administered After discharge, she had regular outpatient follow-ups at our rehabilitation department, and was taught home exercises and given electrical stimulation. At two months after the event she was nearly ready to discard her orthoses, and a complete recovery of the non-operated leg without permanent sequelae was observed at the 3-month follow-up
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