Treatment of traction combined injury of peroneal nerve

Abstract

Recovery of the movement function of foot after the injury of peroneal nerve (PN) did not happen in 47.6 %. This is an indication for surgical treatment. Traction injuries of PN combined with the injuries of knee joint (KJ) ligaments are even more challenging to treat. Goal: to work out an algorithm to treat these patients and give practical recommendations on the ground of analysis of clinical data. Methods: the results of treatment of 35 patients (average age 31.8 ± 11.9 years) with the injury of PN and KJ ligaments were analyzed. The injury of lateral collateral ligament was combined in 18 patients with posterior cruciate ligament rapture, in 25 patients with anterior cruciate ligament rapture, in 8 patients all 3 injuries were diagnosed. Neurolysis was performed in 16 patients (48.5 %), neurorraphy in 2 patients (6.1 %), plastics of nerve in 4 patients (12.1 %), orthopedic reconstruction in 6 patients (18.1 %), neurolysis and orthopedic reconstruction in 4 patients (12.1 %), plastics of nerve with orthopedic reconstruction in 1 patient (3.1 %). Results: primarily a ligament reconstruction to stabilize KJ and then the revision of injured PN were performed. In cases of posterior instability of KJ plastics of posterior cruciate ligament was performed under arthroscopic control. In case of anterior cruciate ligament injury plastics of ligament was performed under arthroscopic control using titanium and biodegradable fixation device. In case of anatomic injury of PN treatment tactics depended upon the length of damage, condition of nerve ends and surrounding soft tissues. Conclusion: to restore the function of lower extremity in patients with the injury of KJ ligaments combined with PN injury the set of surgical intervention should be done. Restoration of KJ stability should be always done initially. Reconstruction of its ligaments should be performed with revision and restoration of PN.