Common Peroneal Nerve Injury Research Articles

Isokinetic cross-training effect in foot drop following common peroneal nerve injury

Isokinetic cross-training effect in foot drop following common peroneal nerve injury

Sciatic and Peroneal Nerve Injuries After Endovascular Ablation of Lower Extremity Varicosities

Varicose veins have traditionally been treated by surgical intervention. When performed in the lower limb, surgical vein stripping can potentially cause injury to the saphenous, sural, tibial, and peroneal nerves due to anatomic proximity. Newer, minimally invasive procedures, such as endovenous laser ablation and endovenous radiofrequency ablation, are more commonly used today. Although the potential for neural injury is greatly reduced, endovenous laser ablation and endovenous radiofrequency ablation have been documented to cause neural damage. Here, we report rare complications of 2 cases of varicosity endovascular ablation. One case involves ablation of the lesser saphenous vein and resulted in injury to the proximal common peroneal and tibial as well as distal sciatic nerves. The second case involves ablation of the vein of Giacomini that resulted in a common peroneal nerve injury. We stress the importance of preoperative anatomic mapping of the highly variable venous and neural systems in the area of ablation to minimize neural complications.

The management of common peroneal nerve injury: Predictors of outcome following repair–the rule of 12's

The management of common peroneal nerve injury: Predictors of outcome following repair–the rule of 12's

The ErbB2 inhibitor Herceptin (Trastuzumab) promotes axonal outgrowth four weeks after acute nerve transection and repair

Accumulating evidence suggests that neuregulin, a potent Schwann cell mitogen, and its receptor, ErbB2, have an important role in regulating peripheral nerve regeneration. We hypothesized that Herceptin (Trastuzumab), a monoclonal antibody that binds ErbB2, would disrupt ErbB2 signaling, allowing us to evaluate ErbB2's importance in peripheral nerve regeneration. In this study, the extent of peripheral motor and sensory nerve regeneration and distal axonal outgrowth was analyzed two and four weeks after common peroneal (CP) nerve injury in rats. Outcomes analyzed included neuron counts after retrograde labeling, histomorphometry, and protein analysis. The data analysis revealed that there was no impact of Herceptin administration on either the numbers of motor or sensory neurons that regenerated their axons but histomorphometry revealed that Herceptin significantly increased the number of regenerated axons in the distal repaired nerve after 4 weeks. Protein analysis with Western blotting revealed no difference in either expression levels of ErbB2 or the amount of activated, phosphorylated ErbB2 in injured nerves. In conclusion, administration of the ErbB2 receptor inhibitor after nerve transection and surgical repair did not alter the number of regenerating neurons but markedly increased the number of regenerated axons per neuron in the distal nerve stump. Enhanced axon outgrowth in the presence of this ErbB2 inhibitor indicates that ErbB2 signaling may limit the numbers of axons that are emitted from each regenerating neuron.

An evidence-based structured review to assess the results of common peroneal nerve repair.

When is common peroneal nerve repair worthwhile? What is the effect of delayed repair? What is the maximum length of graft that can be used? This study aimed to address these questions by assessing the current literature and ascertaining the predictors of outcome that would guide peripheral nerve surgeons in determining the correct treatment of common peroneal nerve injury. After an extensive literature review, 28 studies (1577 repairs) were assessed. The authors evaluated outcomes, using the British Medical Research Council grading for motor recovery, where M4 or above was considered a good outcome, and related them to delay, graft length, mechanism of injury, and age. Good outcomes (M4 and M5) were obtained in 45 percent of cases; more specifically, 80 percent for neurolysis, 37 percent for direct suture, and 36 percent for nerve graft. Excluding neurolysis, good outcomes were obtained in 44 percent of repairs performed within 6 months but in only 12 percent of repairs performed after 12 months (p=0.0046), and in 64 percent of repairs using grafts shorter than 6 cm but in only 11 percent of repairs using grafts longer than 12 cm (p=0.0002). Age did not influence outcome (p=0.2750). Common peroneal nerve repair was worthwhile in approximately half of all cases. The authors suggest that the results of common peroneal nerve repair will be suboptimal if surgery is performed more than 12 months after injury or if a graft of more than 12 cm is required.

Surgical treatment of recurrent proximal tibio-fibular joint ganglion cysts

BackgroundComplex symptomatic ganglion cysts arising from the proximal tibio-fibular joint (PTJ) are not an uncommon presentation in specialist knee clinics and can be managed by aspiration or excision. There is, however, a high rate of recurrence and often there is progressive involvement of the common peroneal nerve (CPN) and its branches, and permanent nerve damage may result. MethodsThis study is a review of the outcome of recalcitrant and recurrent cyst disease with CPN involvement treated by proximal fibulectomy. Nine patients with clinical and radiological diagnosis of a ganglion cyst involving the proximal tibio-fibular joint were treated by proximal fibulectomy. Average age was 47.2years (19 to 75). Patients were followed up clinically and radiologically. Medical notes were reviewed to assess clinical/pathological characteristics, surgical outcome, recurrence rate and the symptoms of instability and nerve function. ResultsNone of the patients were lost to follow-up. After an average follow-up of 83months (15 to 150), none of the patients had clinical or radiological evidence of recurrence. All patients were pain-free and had a complete resolution of nerve symptoms and no evidence of CPN injury. None of the patients complained of localised pain or knee instability and there were no wound healing problems. ConclusionsMRI now confirms TFJ-ganglion cysts to be more common than previously recognised. Where there is refractory disease with progressive nerve symptoms and evidence of nerve sheath involvement, joint excision by proximal fibulectomy gives a satisfactory functional result in controlling disease and preventing further nerve damage. Level of evidenceIV

Comparison to effect and safety of using tourniquet during different time interval of total kneearthroplasty

Objective To explore the effect and safety of using tourniquet to patients during differenttime interval of total knee arthroplasty. Methods A total of 80 cases of patients, who had total knee arthroplasty at our hospital from 2010 to 2012, were divided into the experimental group and the control group randomly, according to the computer random grouping method, 40 cases each. The patients in the experimental group were used the tourniquet method when the osteotomy began. The tourniquet was used to the control group during the whole operation process. Various intraoperative indexes were compared between groups ： hemoglobin content （ 1, 3 and 5 day postoperatively）, red blood cell count and postoperative complications. Results The operation time and lose of blood volume of patients in the experimental group were （136.7 ± 18.6） min and （167.8 ± 16.8 ） ml. The operation time and lose of blood volume of patients in the control group were （138.6 ± 19.4） min and （ 174.8 ± 14.6） ml. There were no significant differences between these two groups of patients （ t = 0. 447, 1. 989, respectively; P 〉 0.05 ）. The hemoglobin content of 1,3 and 5 days postoperatively of the experimental group were （7.6 ± 0.8 ）, （ 15.9 ± 1. 1 ） and （ 16.3 ~ 1.3 ） g/L, respectively. The hemoglobin content of 1, 3 and 5 days postoperatively of the control group were （7.9 ± 0.7 ）, （ 16.4 ± 1.2 ） and （ 16.8 ± 1.1 ） g/L, respectively. The comparison between groups were without statistical differences （ t = 1. 785, 1. 943, 1. 857, respectively; P 〉 0.05 ）. The red blood cell count of 1, 3 and 5 days postoperatively of the experimental group were （0. 18 20.02）, （1.23 20.22） and （1.58 ±0.39） ×1012/L, respectively. The red blood cell count of 1, 3 and 5 days postoperatively of the control group were （0. 19 ~ 0.03）, （ 1.34 ±0.28 ） and （ 1.74 ± 0.42） × 1012/L, respectively. The comparison between groups were without statistical differences （t = 1. 754, 1. 954, 1. 766, respectively; P 〉0.05）. The incidence of postoperative complication in the control group was 52.5%, among which 6 cases suffered deep vein thrombosis, 4 cases suffered phase II wound infection, 7 cases suffered knee joint cavity heamatoma and 4 cases suffered common peroneal nerve injury. The incidence of postoperative complication in the experimental group was 5.0% , among which 1 cases suffered deep vein thrombosis, and 1 ease suffered heamatoma of knee joint cavity. There was no significant difference （ X2 = 22. 029, P 〈 0.05 ）. Conclusions Application the tourniquet method to patients during different time interval of total knee arthroplasty can reduce patients＇ postoperative complications, and it makes great contribution to patients＇ postoperative recovery. Key words: j- Knee; Arthroplasty; Replacement; Tourniquet; Time interval

Posterior Tibial Tendon Transfer Improves Function for Foot Drop After Knee Dislocation

Knee dislocation may be associated with an injury to the common peroneal nerve with a subsequent foot drop. Previous studies have demonstrated good functional results after posterior tibial tendon transfer in patients with foot drop. No studies, to our knowledge, have focused exclusively on knee dislocation as the cause of common peroneal nerve injury leading to foot drop. We determined the percentage of patients developing common peroneal nerve paresis after knee dislocation, the symptom improvement rate in these patients, and patient-reported outcomes (American Orthopaedic Foot and Ankle Society [AOFAS] ankle-hindfoot score), ankle dorsiflexion strength, and ROM in patients with no symptom improvement treated with posterior tibial tendon transfer. Two hundred forty-seven patients with knee dislocation, defined as an injury to both the ACL and PCL with an additional injury to the lateral and/or medial ligaments (Schenck Classification II to IV), were registered in a single institution's database between 1996 and 2011. The database was queried for the frequency of documented injuries to the common peroneal nerve and, among those, the frequency of spontaneous resolution after this injury. Patients demonstrating no active dorsiflexion 12 months after injury generally were offered posterior tibial tendon transfer. Postoperatively, patients were evaluated for AOFAS score, ankle dorsiflexion strength, and ROM. Forty-three patients (17%) had a common peroneal nerve paresis at admission. At 1-year followup, 15 of 43 patients (35%) had experienced symptom improvement. One patient experienced spontaneous improvement later than 1 year after injury. One patient was lost to followup. A below-knee amputation was performed in one patient due to the initial trauma. Seven patients were satisfied with their function using a brace or had medical contraindications to surgical treatment, while four patients refused the proposed operation with a tendon transfer, leaving 14 patients treated with posterior tibial tendon transfer. In the 12 patients available for evaluation, mean AOFAS score was 91 of 100. Mean (± SD) dorsiflexion strength was 118 (± 55) Nm on the operated side and 284 (± 94) Nm on the unaffected side (p < 0.001). Mean ROM was 67° (± 15°) on the operated side and 93° (± 14°) on the unaffected side (p < 0.001). Based on these findings, we recommend posterior tibial tendon transfer for treatment of foot drop that persists at least 1 year after knee dislocation. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Bilateral common peroneal nerve injury after pediatric cardiothoracic surgery: A case report and review of the literature

Nerve injuries after thoracic and cardiovascular surgery have been reported but generally concern the brachial plexus, phrenic nerve, recurrent laryngeal, and facial nerve. Common peroneal nerve injury (CPNI) following cardiopulmonary bypass has been reported in adults (4); however bilateral injury is extremely uncommon. Age, low body weight, co-morbidities such as peripheral arteriosclerotic disease, diabetes mellitus, and arrhythmias were associated with CPNI following cardiothoracic surgery in adults. Common peroneal nerve injury (CPNI) following cardiopulmonary by-pass has been reported in adults; however, bilateral injury is extremely uncommon. The superficial course of CPN makes it vulnerable to traction or compression. We report a 5-year-old girl manifesting with bilateral CPNI following prolonged cardiopulmonary by-pass. To the best of our knowledge, she is the first pediatric patient presenting with bilateral CPNI following cardiothoracic surgery and cardiopulmonary by-pass.

Nerve Injury Complicating Multiligament Knee Injury: Current Concepts and Treatment Algorithm

Multiligament knee injuries account for <0.02% of all orthopaedic injuries, and 16% to 40% of these patients suffer associated injury to the common peroneal nerve (CPN). The proximity of the CPN to the proximal fibula predisposes the nerve to injury during local trauma and dislocation; the nerve is highly vulnerable to stretch injury during varus stress, particularly in posterolateral corner injuries. CPN injuries have a poor prognosis compared with that of other peripheral nerve injuries. Management is determined based on the severity and location of nerve injury, timing of presentation, associated injuries requiring surgical management, and the results of serial clinical evaluations and electrodiagnostic studies. Nonsurgical treatment options include orthosis wear and physical therapy. Surgical management includes one or more of the following: neurolysis, primary nerve repair, intercalary nerve grafting, tendon transfer, and nerve transfer. Limited evidence supports the use of early one-stage nerve reconstruction combined with tendon transfer; however, optimal management of these rare injuries continues to change, and treatment should be individualized.

Nerve Injury Complicating Multiligament Knee Injury: Current Concepts and Treatment Algorithm

Multiligament knee injuries account for <0.02% of all orthopaedic injuries, and 16% to 40% of these patients suffer associated injury to the common peroneal nerve (CPN). The proximity of the CPN to the proximal fibula predisposes the nerve to injury during local trauma and dislocation; the nerve is highly vulnerable to stretch injury during varus stress, particularly in posterolateral corner injuries. CPN injuries have a poor prognosis compared with that of other peripheral nerve injuries. Management is determined based on the severity and location of nerve injury, timing of presentation, associated injuries requiring surgical management, and the results of serial clinical evaluations and electrodiagnostic studies. Nonsurgical treatment options include orthosis wear and physical therapy. Surgical management includes one or more of the following: neurolysis, primary nerve repair, intercalary nerve grafting, tendon transfer, and nerve transfer. Limited evidence supports the use of early one-stage nerve reconstruction combined with tendon transfer; however, optimal management of these rare injuries continues to change, and treatment should be individualized.

Peroneal Nerve Compression in Figure Skaters

Compression of the peroneal nerve can cause sensory and motor deficits which can compromise the function of the foot. Neither common superficial nor deep peroneal nerve injuries, complicating figure skating, have been reported previously. We present three cases of peroneal nerve compression in figure skaters who underwent neurolysis for these peripheral nerve problems with excellent outcome. Peroneal nerve injury in figure skaters may be an underappreciated sports medicine problem.

Composite Reconstruction of the Hip Following Resection of Periacetabular Tumors: Middle-Term Outcome

The records of 18 patients with periacetabular tumors who underwent composite reconstruction of the hip following resection of periacetabular tumors were analyzed retrospectively. The mean follow-up period was 49.4 months (range, 28–100 months). During follow-up, 3 patients died and one had recurrence. Fifteen patients achieved favorable walking function; 8 had normal hip function and 7 had partial recovery of flexion function of the hip. The mean MSTS rating for hip function was 76.9%. Two patients had common peroneal nerve injury which was resolved in one of them. Middle-term follow-up showed that composite reconstruction of the hip following resection of periacetabular tumors can effectively remove tumors and provide favorable hip function for these patients. This approach is simple and less costly, and can be widely used.

Traumatic proximal tibiofibular dislocation with neurovascular injury

23 years old male presented with inferolateral dislocation of proximal tibiofibular joint associated with popliteal artery and common peroneal nerve injury. The extension of the injury to involve the interosseus membrane up to the distal tibiofibular joint. The association of popliteal artery injury is not reported before to the best of our knowledge.

Complex regional pain syndrome following protracted labour*

Obstetric nerve palsies are common and long-term sequelae are fortunately rare. The development of a complex regional pain syndrome is an unusual and less reported complication of labour-related neuropathy. A 28-year-old primigravida who experienced prolonged labour and instrumental delivery under spinal anaesthesia complained of persisting weakness and numbness postpartum, affecting the left lower limb. Urgent magnetic resonance imaging demonstrated no abnormality and a common peroneal nerve injury was later confirmed by nerve conduction studies. Unfortunately, the neuropathy did not resolve as expected and oedema, burning paraesthesia and allodynia affecting the left foot developed within two weeks. She was treated with gabapentin, ibuprofen, topical capsaicin and regular physiotherapy. After six months, the foot drop had resolved and the chronic pain element was significantly diminished.

Treatment of posterolateral tibial plateau fractures via the fibular osteotomy approach

Objective To explore the effect of treating posterolateral tibial plateau fractures via the fibular osteotomy approach.Methods From August 2009 to August 2011,17 patients with posterolateral tibial plateau fractures,including 12 males and 5 females,aged from 24 to 76 years (average,37.8 years),were treated via the fibular osteotomy approach in our hospital.According to the Schatzker classification,8 cases were type Ⅱ,3 cases were type Ⅲ,6 cases were type V.After operation,X-rays were taken in all patients,and Rasmussen's radiological and functional gradings were used to evaluate radiological and functional outcomes of knees.Results All patients obtained follow-up,ranged from 9 to 35 months (average,18months).The healing time of the fracture ranged from 10.0 to 18.0 weeks (average,13.5 weeks).During the period of followed-up,there was no loss of reduction; one case presented with symptoms of common peroneal nerve injury,such as local hypesthesia in distal lateral lower leg and dorsi pedis,which recovered two weeks postoperatively.According to Rasmussen's radiological grading,the mean score of the knee joint was 17.5(range,14.0 to 18.0).The range of motion of the knee joint ranged from -5°to 135°(average,123.5o).According to Rasmussen's functional grading,the mean score of the knee joint was 26.9 (range,22 to 30).Conclusion Treating posterolateral tibial plateau fractures via the fibular osteotomy approach can obtain sufficient exposure,good reduction and fixation,and avoid flexion contracture of the knee and peripheral vascular nerve injury.Moreover,postoperative function and stability of the knee joint recover well. Key words: Tibial fractures; Fibula; Osteotomy

Neural electrophysiological localization diagnosis on patients with common peroneal nerve injury in capitulum fibulae

Objective To discuss the neural electrophysiological localization diagnosis on patients with common peroneal nerve injury in capitulum fibulae.Methods The conventional neural electrophysiological method:MNCV of common peroneal nerve,SNCV of superficial peroneal nerve,EMG of the muscles controlled hy common peroneal nerve.Special method:short segment stimulation method; to detect the clinically diagnosed 30 patient with connon peroneal nerve injury in capitulum fibulae.The method of short segment stimulation emphasize on both MNCV of superior and inferior part of capitulum fibulae to look for specific site ofthe injury.Results ①The 28 patients with the injury of common peroneal nerve showed reduction in MNCV of common peroneal nerve from inferior to superior part of the capitulum fibulae.②Short segment stimulation method of common peroneal nerve from inferior to superior part of the capitulum fibulae showed the most specific site of the lesion were ranged 2 ～ 6 cm between superior and inferior part of the capittlum fibulae.③Patients with common peroneal nerve injury in capitulum fibulae not all involve the EMG abnormity in anterior tibial muscle and extensor digitorum longus.Conclusions Short segment stimulation method shows higher loealization diagnostic value in patients with common peroneal nerve injury in capitulum fibulae and conventional abnormity in SNCV of superficial peroneal nerve and EMG is helpful in diagnosis. Key words: Common peroneal nerve injury; Conduction block; Short segment stimulation method; From inferior to superior part of the capitulum fibulae; Electromyography

Neuropathic complications after 157 procedures of continuous popliteal nerve block for hallux valgus surgery. A retrospective study

Continuous peripheral nerve block (CPNB), in particular at the popliteal fossa, is widely used in orthopedic surgery, allowing good postoperative analgesia. Possible neuropathic complications, however, remain poorly known. To review the characteristics of peripheral neuropathy (PN) after sciatic CPNB at the popliteal fossa, estimating prevalence, severity, evolution and possible risk factors, especially those relating to the procedure. Retrospective study of PN associated with popliteal fossa CPNB for hallux valgus surgery, between November 1st, 2005 and November 1st, 2009. All procedures were analyzed (type of anesthesia, approach, nerve location technique, number of procedures by operator) with, for each case of PN, analysis of clinical and electromyographic data. One hundred and fifty seven sciatic CPNBs were performed (92% women; mean age, 55 years). The approach was lateral (n=62), posterior (n=74) or unknown (n=21). Ultrasound guidance was combined to neurostimulation for 69 patients (44%). Three women (prevalence=1.91%), aged 19, 24 and 65 years respectively, developed associated common superficial peroneal and sural nerve injury (2), axonal on electromyography, with motor (n=1) and/or sensory (n=3) residual dysfunction. The higher prevalence found in the present study than in the literature (0 to 0.5%) raises questions of methodological bias or technical problems. The common peroneal and sural nerves seem to be exposed, unlike the tibial. Several mechanisms can be suggested: anesthetic neurotoxicity, direct mechanical lesion, or tourniquet-related ischemia and conduction block. Further studies are necessary to determine the ideal anesthetic procedure. Patients should be informed of the potential risk, however rare, even during mild surgery. The best possible technique should be implemented, with reinforced surveillance.

Calcific myonecrosis of the leg

Calcific myonecrosis is a rare post-traumatic sequela almost exclusively located in the lower extremity, which can be mistaken for an aggressive primary neoplasm. This lesion, initially described by Gallei and Thompson in 1960, is characterized by the formation of a calcified mass that appears decades after trauma. The pathophysiologic mechanism is not fully understood, although the lesion most likely results from post-traumatic ischaemia and it may be associated with a common peroneal nerve injury. The typical radiographic image is a fusiform soft tissue mass with linear calcifications. The treatment of choice is conservative in asymptomatic patients because the surgical treatment has a high complication rate.We report four cases of calcific myonecrosis treated surgically in our hospital. Three of the cases had an infection as a complication that required subsequent debridement and special therapies to achieve the resolution of the cases.

Mionecrosis calcificante de la pierna

Calcific myonecrosis is a rare post-traumatic sequela almost exclusively located in the lower extremity, which can be mistaken for an aggressive primary neoplasm. This lesion, initially described by Gallei and Thompson in 1960, is characterized by the formation of a calcified mass that appears decades after trauma. The pathophysiologic mechanism is not fully understood, although the lesion most likely results from post-traumatic ischemia and it may be associated with a common peroneal nerve injury. The typical radiographic image is a fusiform soft tissue mass with linear calcifications. The treatment of choice is conservative in asymptomatic patients because the surgical treatment has a high complication rate.We report four cases of calcific myonecrosis treated surgically in our hospital. Three of the cases had an infection as a complication that required subsequent debridement and special therapies to achieve the resolution of the cases.