Anterior Compartment Of Leg Research Articles

Exertional Rhabdomyolysis Affecting Anterior Compartment of Unilateral Lower Leg

Exertional Rhabdomyolysis Affecting Anterior Compartment of Unilateral Lower Leg

Calcific Myonecrosis of the Lower Extremities: A Case Report

Calcific myonecrosis is a rare and latent condition of the lower extremities after a trauma and is characterized by the formation of a fusiform mass lesion in the anterior compartment of the leg showing peripheral dystrophic calcification and central liquefaction. We report the radiologic findings of calcific myonecrosis in a patient with a lower extremity calcified mass lesion.

Avulsion of the Perforating Branch of the Peroneal Artery Secondary to an Ankle Sprain: A Cause of Acute Compartment Syndrome in the Leg

In this report, we describe the case of an adult male who developed an acute compartment syndrome localized to the anterior compartment of the leg following an ankle sprain. Compartment syndrome in association with ankle sprain is unusual, and has been previously described in association with avulsion of the perforating peroneal artery. Because of the potential for severe morbidity, we feel that it is important to make foot and ankle surgeons aware of this unusual injury.

An anterior fibulocalcaneus muscle: An anomalous muscle discovered in the anterior compartment of the leg

Anomalous fibulocalcaneus muscles were discovered bilaterally in the anterior compartment of the leg during a routine dissection of a 76-year-old Caucasian male in the medical gross anatomy laboratory. These muscles originated from the fibula, anterior crural septum, and the investing fascia of the fibularis tertius, and they passed anterior to the lateral malleolus and inserted on the calcaneus, anterosuperior to the fibular trochlea. To our knowledge, these anterior fibulocalcaneus muscles have not been described previously.

The ‘missing piece’ sign: distant migration of a patellar tendon cerclage wire

A 37-year-old man presented with a tender palpable lump medial to his left patella. Two years previously he underwent surgical repair of a patellar tendon rupture including a protecting cerclage wire. He was informed that the wire did not require removal. There was no further history of trauma subsequent to the surgery. He had no other musculoskeletal problems and no past history of relevance. Clinical examination revealed a midline scar over the left knee with a tender palpable wire on the medial side of the patella. There were no other significant clinical findings in the knee. Plain radiographs revealed three wire fragments around the knee (Figure 1). These three fragments did not appear to account for the full circumference of the patellar tendon, raising the concern of a missing piece of wire. A further radiographic survey revealed that the missing wire fragment lay at the anterolateral aspect of the ankle joint (Figures 2 and 3). On surgical exploration, the wire was located between the peroneus tertius and extensor digitorum longus tendons with the tip just proximal to the superior retinaculum. It was assumed to have found its way from the subcutaneous space anterior to the knee into the anterior compartment of the leg and migrated distally to abut the talus.

Clinically Important Anatomical Variation of Cutaneous Branches of Superficial Peroneal Nerve in the Foot

A detailed knowledge of the branching patterns and the variations of the cutaneous nerves of the extremities will help to decrease iatrogenic injury to these nerves. A case of abnormal distribution of the superficial peroneal nerve, observed during the routine dissection of the right leg of an 81 year old male cadaver at AIMST University, Kedah, Malaysia is reported here. The nerve after supplying the peroneal muscles of lateral compartment gave a medial dorsal cutaneous branch and a lateral dorsal cutaneous branch. The medial dorsal cutaneous branch descended in front of the middle of the ankle to the dorsum of the foot and supplied the skin of medial side of the great toe, the medial side of the 1 st metatarsal region and the 1 st web space including the adjacent sides of great and second toes. The lateral dorsal cutaneous branch descended in front of the lateral malleolus to enter the lateral aspect of the dorsum of the foot where it divided into medial and lateral terminal branches to supply adjacent sides of the 2nd, 3rd, 4 th and 5th toes. On the other hand, the deep peroneal nerve after supplying the muscles of anterior compartment of leg continued on dorsum of foot without dividing into terminal branches and without supplying the skin of first web space and adjacent sides of great and second toes. It ended by supplying the extensor digitorum brevis muscle. Surgical and clinical significance of this rare variation of the superficial peroneal nerve is discussed and relevant literature is reviewed.

Anatomic variations of superficial peroneal nerve: clinical implications of a cadaver study.

Superficial peroneal nerve and its branches are frequently at risk for iatrogenic damage. Although different studies on anatomical variations of superficial peroneal nerve are available in the medical literature, such reports are rare from India. Hence the present study was undertaken on Indian population. A total of 60 specimens of inferior extremities from 30 properly embalmed and formalin fixed cadavers were dissected and examined for the location and course of the superficial peroneal nerve including number, level, course and distributions of branches. The superficial peroneal nerve in 28.3% specimens was located in the anterior compartment of the leg. In 8.3% specimens the superficial peroneal nerve branched before piercing between the peroneus longus and extensor digitorum longus muscle whereas in 11.7% specimens it branched after piercing the aforementioned muscles and before piercing the deep fascia. In 41 out of 60 specimens the sensory division of superficial peroneal nerve branched into the medial dorsal cutaneous nerve and intermediate dorsal cutaneous nerve distal to its emergence from the deep fascia and proximal to its relation to the extensor retinaculum. In 20 out of 60 specimens the accessory deep peroneal nerve, an additional branch from the sensory division of superficial peroneal nerve, through its course in the anterior compartment of the leg passed deep to the extensor retinaculum and supplied the ankle and the dorsum of foot. Hopefully the present study will help in minimizing iatrogenic damage to the superficial peroneal nerve and its branches while performing arthroscopy, local anesthetic block, surgical approach to the fibula, open reduction and internal fixation of lateral malleolar fractures, application of external fixators, elevation of a fasciocutaneous or fibular flaps for grafting, surgical decompression of neurovascular structures, or miscellaneous surgery on leg, foot and ankle.

Simvastatin Induced Rhabdomyolysis of Anterior Compartment of Leg Resulting in Foot Drop

Simvastatin Induced Rhabdomyolysis of Anterior Compartment of Leg Resulting in Foot Drop

Comparison of oxidative capacity among leg muscles in humans using gated 31P 2‐D chemical shift imaging

In many small animals there are distinct differences in fiber-type composition among limb muscles, and these differences typically correspond to marked disparities in the oxidative capacities. However, whether there are similar differences in the oxidative capacity among leg muscles in humans is less clear. The purpose of this study was to compare the rate of phosphocreatine (PCr) recovery, a functional in vivo marker of oxidative capacity, in the lateral and medial gastrocnemius, soleus, and the anterior compartment of the leg (primarily the tibialis anterior) of humans. Subjects performed plantar flexion and dorsiflexion gated exercise protocols consisting of 70 sets of three rapid dynamic contractions (<2.86 s) at 20 s intervals (total: 23.3 min). Starting after the sixth set of contractions, (31)P 2-D CSI (8 x 8 matrix, 14-16 cm FOV, 3 cm slice, TR 2.86 s) were acquired via a linear transmit/receive surface coil using a GE 3T Excite System. The CSI data were zero-filled (32 x 32) and a single FID was produced for each time point in the lateral and medial gastrocnemius, soleus, and anterior compartment. The time constant for PCr recovery was calculated from tau = -Deltat/ln[D/(D + Q)], where Q is the percentage change in PCr due to contraction during the steady-state portion of the protocol, D the additional drop in PCr from rest, and Deltat is the interval between contractions. The tau of PCr recovery was longer (p < 0.05) in the anterior compartment (32 +/- 3 s) than in the lateral (23 +/- 2 s) and medial gastrocnemius muscles (24 +/- 3 s) and the soleus (22 +/- 3 s) muscles. These findings suggest that the oxidative capacity is lower in the anterior compartment than in the triceps surae muscles and is consistent with the notion that fiber-type phenotypes vary among the leg muscles of humans.

Unusual supernumerary muscle in the anterior compartment of the leg

Unusual supernumerary muscle in the anterior compartment of the leg

Acute non-traumatic compartment syndrome of anterior compartment of leg; an unusual presentation: A case report

2. Case report50-year-old male, a cottage industry owner, presented at 02:00complainingoffeelingcold,shiveringandwithseverepaininrightleg. He had no prior history of leg pain. The previous morning hehad played football for the first time for 15 min when the outsidetemperaturewasabouttwodegreecelsius.Hehad nofall,twistingof leg/foot, or direct trauma to the leg. Throughout the day he hadperformed his routine activities without any discomfort or pain.Approximately 12 h laterhestartedfeeling cold. Hewas putunder5layersofblanketswhichdidnothelpandtheshiveringpersisted.Within anhourhedeveloped paininright legand lowerabdomen.He vomited twice and passed loose stools once.Oral NSAID’S prescribed by a GP did not relieve his pain.AnotherGPgaveananalgesicinjectionalongwithatranquiliser.Asthe pain persisted he presented to the emergency services.He was afebrile. Local examination revealed a swollen, wood-hard, tender, anterior compartment of the leg with dilatedsuperficial veins (Figs. 1 and 2). Passive dorsiflexion of the toesand ankle were painful. Extensor hallucis longus and extensordigitorum longus had grade 1/5 motor power and tibialis anteriorgrade 2/5. The dorsum of the foot had hypoesthesia. Dorsalis pedisand posterior tibial pulses were well palpable.Baseline haematocrit and biochemistry values were withinnormal limits. The radiographs were normal.The patient was immediately taken to theatre for decompres-sion. Fasciotomy by Mubarak’s single longitudinal lateral incisionwas done within 6 h of onset of leg pain.

Pathophysiological aspects of lower limb oedema in patients with proximal femoral fractures

Objectives: To examine the changes in Starling components, regulating the transcapillary fluid transport, in patients with proximal femoral fractures (PFF). Material and methods: Twenty-eight patients with proximal femoral fracture were classified into femoral column fracture (FCF) and pertrochanteric fracture (PTF) groups. The following measurements were made in both groups of patients on the 7th post-operative day: colloid osmotic pressure of plasma and subcutaneous interstitial fluid (COPpl and COPif), capillary filtration coefficient (CFC) and interstitial fluid pressure (Pif) in the anterior muscle compartment of the leg and calf muscle blood flow, in both lower extremities. Results: The transcapillary colloid osmotic gradient was significantly reduced (p<0.02) in patients with PTF, and they also showed a significant increase in CFC values (p=0.038). Moreover, Pif was elevated (1.9 mmHg, SD 2.1, p=0.01) and calf muscle blood flow was significantly higher (p=0.02), than in the contralateral limb in patients with PTF. Conclusion: The transcapillary colloid osmotic gradient is significantly reduced in patients with PTF. This may partly explain why patients with PTF develop more oedema in the lower limb than those with FCF. CFC and calf blood flow are also significantly increased in the fractured limb, which allows increased transcapillary filtration.

The clinical anatomy of the ligament of Barkow at the proximal tibiofibular joint

Mention of the ligament of Barkow at the proximal tibiofibular joint is rarely found in the literature and it is not represented in most anatomical atlases. To our knowledge, quantitation of this structure has not been performed. As injury to the knee region is so common, a comprehensive knowledge of this regional anatomy is important to the clinician and surgeon alike. Forty lower limbs from embalmed cadavers underwent dissection of the proximal leg with special attention toward the presence or absence of ligament of Barkow. When identified, measurements of this structure were made. The ligament of Barkow was identified in 95% of specimens. For right sides, the mean width was 1.5 cm and the mean length was 1.2 cm. For left sides, the mean width of this ligament was 1.2 cm and the mean length was 1.5 cm. The mean thickness of ligament of Barkow was 1.2 mm (range 0.9-1.4 mm). The upper edge of this ligament was on average 3 cm inferior to the inferior most aspect of the proximal tibiofibular joint. The lower edge of ligament of Barkow was a mean distance of 7 mm from the anterior tibial artery at its entrance into the anterior compartment of the leg. One ligament was found to be fully ossified; thereby, creating a bony bar superior to the anterior tibial vessels. Our hopes are these data will help further elucidate the ligament of Barkow. Imaging studies are now necessary to further elucidate functional and pathological involvement of this structure.

Continuous compartment pressure monitoring vs. clinical monitoring in tibial diaphyseal fractures

A cohort of 109 consecutive patients with a tibial fracture who underwent continuous compartment pressure monitoring of the anterior compartment of the leg were reviewed and compared to a historical control group of the immediate previous 109 patients who were clinically monitored. Of these patients 33 underwent fasciotomies for acute compartment syndrome in association with tibial diaphyseal fractures. Seventeen patients had continuous compartment pressure monitoring and 16 clinical assessments alone. The fasciotomy rate of patients who underwent continuous compartment pressure monitoring was 15.6%. Patients who were not monitored had a fasciotomy rate of 14.7%. The mean time delay from injury to fasciotomy was 22 h in the monitored group and 23 h in the non-monitored group. Continuous compartment pressure monitoring did not increase the rate of unnecessary fasciotomies. We could not demonstrate a significant difference in terms of clinical outcome and time delay from injury to fasciotomy.

Myopathies distales avec mutations du gène GNE : à propos de quatre cas

Distal myopathies are rare muscular disorders clinically characterized by a predominantly distal muscular involvement. Among recessive forms, the myopathy resulting from mutations in the UDP-N-acetylglucosamine-2-epimerase/N-acetylmannosamine kinase ( GNE) gene, often designated as Nonaka myopathy, primarily affect young adults and are characterized by muscle wasting and weakness predominating on the anterior compartment of the leg, a remarkable quadriceps sparing and a frequent evolution towards ambulation loss after a few years. Finding rimmed vacuoles on muscle biopsy is a further argument for the diagnosis. However, the presentation and course may vary and we describe four patients who illustrate the clinical spectrum of the disease: the first patient had a classical form with progressive weakness over several years, the second one a rapidly progressive myopathy leading to ambulation loss within three years from onset, the third one a very slow course with no ambulation loss after several decades, and the last one a progressive form with misleading neurogenic features on the EMG. One of our four patients harbored a homozygous mutation, and three others were compound heterozygous, two of them displaying an original mutation: one had a c.2036 T > G (p.Val679Gly) substitution, the c.829 C > T (p.Arg277Cys) substitution.

Leg Anterior Compartment Syndrome Following Ankle Arthroscopy After Maisonneuve Fracture

We report a case of leg anterior compartment syndrome following ankle arthroscopy after Maisonneuve fracture. A 21-year-old football player sprained his left ankle. Plain radiography of his left ankle showed a lateral dislocation of the talus without obvious fractures. Plain radiography of his left lower extremity showed a spiral fracture of the proximal fibula approximately one third distal to the fibular head. According to these findings, we diagnosed this fracture as a Maisonneuve fracture and treated it by ankle arthroscopy and drilling of the talar osteochondral injury followed by arthroscopic ankle visualization during syndesmosis screw fixation. Six hours after surgery, the patient complained of pain in the lower extremity. We diagnosed acute compartment syndrome and performed emergent fasciotomy. One year after surgery, he was able to fully participate in athletic activities. We consider ankle arthroscopy to be available for the treatment of ankle fracture with the suspected complication of an intra-articular disorder such as a Maisonneuve fracture. However, with this type of ankle fracture, there is a higher potential risk of acute compartment syndrome developing than with other types of ankle fractures. Therefore we suggest that surgeons guard against this complication.

The Effect of Kneeling During Spine Surgery on Leg Intramuscular Pressure

Acute compartment syndrome has been an underreported complication during spine surgery with the patient positioned on the so-called 90/90 kneeling frame (with 90 degrees of both hip and knee flexion), presumably because of elevated intramuscular pressures in the dependent leg compartments. The purpose of the present study was to characterize and quantify certain parameters that affect the risk for acute compartment syndrome experimentally and to make objective comparisons with other spine surgery positions. Eight healthy volunteers were positioned in three spine surgery positions: the 90/90 kneeling position, the so-called 45/45 suspended position (with the hips and knees both flexed to 45 degrees with the legs suspended on a sling), and the prone position. Intramuscular pressures were measured in all four left leg compartments with slit catheters. Local blood pressure and applied load beneath the leg were also measured. The 90/90 kneeling position was associated with significantly increased intramuscular pressure in the anterior compartment (30.8 +/- 5.7 mm Hg) in comparison with the prone position (13.5 +/- 1.7 mm Hg) and the 45/45 suspended position (13.8 +/- 1.7 mm Hg). In the 90/90 kneeling position, these values correlated with subject weight (r = 0.72, p = 0.045) and the applied body weight load measured beneath the leg (r = 0.74, p = 0.037). The mean differences between intramuscular pressure and ankle blood pressure were more pronounced as the position of the ankle dropped below the level of the heart in the 45/45 suspended and the 90/90 kneeling positions. The 90/90 kneeling position results in elevated intramuscular pressure in the anterior compartment of the leg. This elevated pressure correlates also with subject weight. The 90/90 kneeling position may predispose patients to the development of an acute compartment syndrome during prolonged spine surgery, with heavier patients being at increased risk. In certain instances, the surgeon may consider using the 45/45 suspended position to minimize this risk.

Peroneal nerve palsy due to compartment syndrome after facial plastic surgery

A 25-year-old white man, right after bilateral rhytidoplasty, presented with agitation, necessitating use of haloperidol. Some hours after, he developed severe pain in his legs and a diagnosis of neuroleptic malignant syndrome (NMS) was considered. Even with treatment for NMS he still complained of pain. A diagnosis of lower limb compartment syndrome (CS) was done only 12 hours after the initial event, being submitted to fasciotomy in both legs, disclosing very pale muscles, due to previous ischemia. This syndrome was not explained only by facial surgery, his position and duration of the procedure. It can be explained by a sequence of events. He had a history of pain in his legs during physical exercises, usually seen in chronic compartment syndrome. He used to take anabolizant and venlafaxine, not previously related, and the agitation could be related to serotoninergic syndrome caused by interaction between venlafaxine and haloperidol. Rhabdomyolysis could lead to oedema and ischemia in both anterior leg compartment. This report highlights the importance of early diagnosis of compartment syndrome, otherwise, even after fasciotomy, a permanent disability secondary to peripheral nerve compression could occur.

Extensor retinaculum syndrome after distal tibial fractures: anatomical basis

Fractures of the distal extremity of the tibia include physeal injuries among teenagers and more complex fractures among adults. Displacement causes the compression of the muscles located between the distal tibia and the superior extensor retinaculum (SER). Among the muscles of anterior compartment of the leg, the extensor hallucis longus (EHL) is particularly vulnerable due to the amount of muscle fibers extending under the SER. Consequently, a partial anterior compartment syndrome could result, affecting only the distal portion located under the SER. In clinical practice, Mubarak measured the intramuscular pressure isolated under the SER and suggested the physio-pathological hypothesis of a compression of distal muscle fibers. The aim of this study is to compare the ratios of anterior compartment muscle fibers extending under the SER. Twenty legs were dissected in order to study how much of these muscles extend under the SER, their passages possibly dividing into two of the SER, as well as their vascularization and their innervation. On the last seven legs, the engagement of the muscles were measured in the spontaneous position and with a dorsal flexion of 0 degrees . The posterior muscle fibers of this compartment always descend lower than the anterior fibers. EHL muscle fibers and those of the inconsistent fibularis tertius always extend under the retinaculum, unlike those of the tibialis anterior and of the extensor digitorum longus. The EHL muscle extends under the SER more than the other muscles. Its posterior fibers are longer when this muscle goes through a dividing into two of the retinaculum. Its vascularization seems lesser, which could explain why this muscle tends to suffer more. The deep fibular nerve innervates the anterior compartment of the leg, yet no nerve branches can be found under the upper edge of the retinaculum. In all cases, the muscle fibers do not extend as much under the SER in a 0 degrees of dorsal flexion. This anatomical study allows us to explain why the EHL is more likely to suffer from this partial compartment syndrome and confirms that when the latter occurs it is necessary, in all cases, to do emergency surgery opening the distal crural fascia and necessarily including the SER.

Novel strategies for protection and repair of the central nervous system

Clinical possibilities in many neurological conditions are limited by our current inability to correct structural damage to the nervous system, and treatments to prevent damage are also limited. Current research has produced promising treatments that promote neuroprotection, plasticity, axon regeneration, remyelination and cell replacement. As these treatments go through clinical trials and enter the clinic, the treatment of several neurological conditions will change greatly.