Peroneal Nerve Lesion Research Articles

Clinical Outcome After Surgical Treatment of Traumatic Peroneal Nerve Injury: An Analysis of Risk Factors After Different Surgical Approaches.

This study aims to analyze potential risk factors that may influence the clinical outcomes following surgical treatment of traumatic peroneal nerve lesions. We conducted a retrospective analysis of patients with traumatic peroneal nerve injuries treated with decompression, split repair, or nerve grafting between 2010 and 2020. Motor function and potential risk factors were evaluated. Out of 93 patients, 42 (45%) underwent decompression, 15 (16%) received split repair, and 36 (39%) required autologous nerve grafting. Up to one year after surgery, weakness of the anterior tibial muscle improved from a median of M0 to M3. After one year following nerve decompression, functional recovery was observed in 28 (65%) cases, in 9 (21%) cases after split repair, and in 7 (16%) cases following autologous nerve grafting. A defect greater than 8 cm was associated with significantly poorer improvement of extensor hallucis longus (p = 0.037, HR 0.109). We found no significant associations between age, diabetes mellitus, arterial hypertension, obesity, and postoperative outcomes. According to the present data, a significant number of patients achieved functional improvement following surgical treatment, indicating that this procedure should be considered an important treatment option in selected cases.

432 A Rare Case of Ipsilateral Foot Drop Due to Common Peroneal Nerve Palsy at the Level of Fibular Head Following Total Hip Arthroplasty

Abstract Background Common peroneal nerve (CPN) palsy after primary total hip arthroplasty (THA) is a rare complication with poor functional outcome and has a prevalence of 0.3-2.1%. Case Presentation A 77-year-old gentleman was diagnosed with severe osteoarthritis of the left hip and underwent a hybrid left total hip replacement via posterior approach in right-lateral position. There was no usage of spinal anaesthesia, leakage from the wound, intra-operative nerve injury or any localised haematoma. Post-operatively on day 3, he was noted to have foot drop with loss of foot eversion and dorsiflexion with sensory loss along the distribution of the superficial peroneal and tibial nerve. Clinical Outcomes Nerve conduction study of left lower limb showed absent left superficial peroneal sensory response, absent left peroneal to extensor digitorum brevis and tibialis anterior motor responses with denervation across the anterior and lateral left lower leg muscles suggestive of a severe partial lesion of the left common peroneal nerve at the level of fibular head. Patient was placed in a foot drop splint with follow-up neurological evaluation. Discussion Post-operative CPN palsy are mostly neuropraxias caused due to direct compression, either by surgical instruments or anatomical structures, or from tension or ischemia to the nerve during intra-operative limb manipulation or limb lengthening. Additionally, usage of cement less components combined with Enoxaparin or due to any haematoma may compress the nerve. Age, BMI and initial severity of sensory and motor neurological deficits are prognostic factors indicating recovery. Full recovery is between 16-56% of cases at an average of 15 months.

Distal Nerve Transfers in High Peroneal Nerve Lesions: An Anatomical Feasibility Study.

The peroneal nerve is one of the most commonly injured nerves of the lower extremity. Nerve grafting has been shown to result in poor functional outcomes. The aim of this study was to evaluate and compare anatomical feasibility as well as axon count of the tibial nerve motor branches and the tibialis anterior motor branch for a direct nerve transfer to reconstruct ankle dorsiflexion. In an anatomical study on 26 human body donors (52 extremities) the muscular branches to the lateral (GCL) and the medial head (GCM) of the gastrocnemius muscle, the soleus muscle (S) as well as the tibialis anterior muscle (TA) were dissected, and each nerve's external diameter was measured. Nerve transfers from each of the three donor nerves (GCL, GCM, S) to the recipient nerve (TA) were performed and the distance between the achievable coaptation site and anatomic landmarks was measured. Additionally, nerve samples were taken from eight extremities, and antibody as well immunofluorescence staining were performed, primarily evaluating axon count. The average diameter of the nerve branches to the GCL was 1.49 ± 0.37, to GCM 1.5 ± 0.32, to S 1.94 ± 0.37 and to TA 1.97 ± 0.32 mm, respectively. The distance from the coaptation site to the TA muscle was 43.75 ± 12.1 using the branch to the GCL, 48.31 ± 11.32 for GCM, and 19.12 ± 11.68 mm for S, respectively. The axon count for TA was 1597.14 ± 325.94, while the donor nerves showed 297.5 ± 106.82 (GCL), 418.5 ± 62.44 (GCM), and 1101.86 ± 135.92 (S). Diameter and axon count were significantly higher for S compared to GCL as well as GCM, while regeneration distance was significantly lower. The soleus muscle branch exhibited the most appropriate axon count and nerve diameter in our study, while also reaching closest to the tibialis anterior muscle. These results indicate the soleus nerve transfer to be the favorable option for the reconstruction of ankle dorsiflexion, in comparison to the gastrocnemius muscle branches. This surgical approach can be used to achieve a biomechanically appropriate reconstruction, in contrast to tendon transfers which generally only achieve weak active dorsiflexion.

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

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.

Common peroneal nerve palsy after primary total hip arthroplasty.

The study wants to evaluate the incidence, the clinical evolution, and treatment of common peroneal nerve (CPN) palsy after primary total hip arthroplasty. Our clinical prospective study was made between January 2016 and December 2020. The study group comprised 1240 total hip replacements over a period of fiveyears. Six cases were diagnosed with CPN palsy (0.48%). Five were women and one man, aged from 52 to 71years old. The common peroneal nerve lesion was diagnosed clinically and by electromyography. The follow-up period was at least 24months post-operatively. In all six cases, there was a complete common peroneal nerve palsy, documented by electromyography. The poorest results were obtained in the older patients and those who had the highest body mass index, which at twoyears post-operatively achieved only a partial sensory rehabilitation, with complete motor deficit. All patients can walk unassisted, without support, with one case having complete rehabilitation achieved 18months postoperatively and three with partial rehabilitation. CPN palsy after primary THA is a very serious complication with poor functional outcome. There is no consensus regarding the treatment. The age and the intensity of the rehabilitation program are the only significant factors for the medical rehabilitation after this debilitating post-operative complication.

COMMON PERONEAL NERVE INJURIES AT THE KNEE: OUTCOMES OF NERVE REPAIR

Background. Common peroneal nerve (CPn) lesion at the knee is one of the most frequent neurologic injury of the lower limb. Among the etiologies there are also open and closed trauma. If direct nerve repair is not possible, nerve grafting is indicated as a primary or delayed procedure. Nerve and tendon transfer are other possible therapeutic options. Material and methods. In this retrospective double center study, 35 patients with post-traumatic CPn lesion at the knee, that underwent surgical repair, were analyzed. Exclusion criteria were severe concomitant neurological pathologies, complex injury of the lower leg including major vessels lesion and or tibial nerve injury. The objective of the study is to demonstrate the degree of foot dorsiflexion recovery based on the type of trauma and the corresponding performed surgery: the Medical Research Council classification (M0-M5) was used as rating scale. Results. There were 23 closed and 12 open injuries. Time of surgery varied from 6 to 11 months after closed trauma, whereas 2 open traumas were explored at emergency and the remaining 10 patients were explored 3 to 9 months after injury. Neurolysis was performed in 12 cases. Neurorraphy was performed in 2 cases. Sural nerve grafting was performed in 21 patients, with a length range of 6-10,5 cm and 4-9 cm for closed and open trauma respectively. Conclusions. Our series confirms that repairs of traumatic CPn injuries have an unfavorable outcome. Motor recovery score ≥ M3 was obtained in only 10 cases (28,57%). Neurolysis and nerve suture show better results than nerve graft alone, although no statistically significant differences emerged; CPn reconstructions with grafts show unsatisfactory results, particularly if the length of the grafts exceeds 6 cm and when patients are treated over 6 months after the trauma. Patients with closed trauma achieve less satisfactory results than those with open injury (13 vs 58%) and this was statistically significant (p < 0.05), so palliative surgery may be indicated as the first surgical approach for these patients to achieve good foot dorsiflexion.

A minimally invasive cerclage of the tibia in a modified Goetze technique: operative technique and first clinical results

IntroductionIn spiral fractures of the tibia, the stability of an osteosynthesis may be significantly increased by additive cerclages and, according to biomechanical studies, be brought into a state that allows immediate full weight bearing. As early as 1933, Goetze described a minimally invasive technique for classic steel cerclages. This technique was modified, so that it can be used for modern cable cerclages in a soft part saving way.MethodAfter closed reduction, an 8 Fr redon drain is first inserted in a minimally invasive manner, strictly along the bone and placed around the tibia via 1 cm incisions on the anterolateral and dorsomedial tibial edges using a curette and a tissue protection sleeve.Via this drain, a 1.7 mm cable cerclage can be inserted. The fracture is then anatomically reduced while simultaneously tightening the cerclage. Subsequently, a nail or a minimally invasive plate osteosynthesis is executed using the standard technique.Using the hospital documentation system, data of patients that were treated with additional cerclages for tibial fractures between 01/01/2014 and 06/30/2020 were subjected to a retrospective analysis for postoperative complications (wound-healing problems, infections and neurovascular injury). Inclusion criteria were: operatively treated tibial fractures, at least one minimally invasive additive cerclage, and age of 18 years or older. Exclusion criteria were: periprosthetic or pathological fractures and the primary need of reconstructive plastic surgery. SPSS was used for statistical analysis.Results96 tibial shaft spiral fractures were treated with a total of 113 additive cerclages. The foregoing resulted in 10 (10.4%) postoperative wound infections, 7 of which did not involve the cerclage. One lesion of the profundal peroneal nerve was detected, which largely declined after cerclage removal. In 3 cases, local irritation from the cerclage occurred and required removal of material.ConclusionIn the described technique, cerclages may be inserted additively at the tibia in a minimally invasive manner and with a few complications, thus significantly increasing the stability of an osteosynthesis. How this ultimately affects fracture healing is the subject of an ongoing study.

Early and mid-term outcomes of open popliteal artery aneurysm repair with prosthetic grafts

ObjectiveThe aim of the present study was to assess the early and mid-term outcomes of open surgical repair (OSR) for popliteal artery aneurysms (PAAs) with prosthetic grafts. MethodsThe pre-, intra-, and postoperative data for all the patients who had undergone OSR for PAAs with prosthetic grafts at our Institution between January 2009 and July 2019 were included in a prospectively maintained database, which was retrospectively analyzed. Primary patency was defined as uninterrupted flow (<50% stenosis) in the graft with no additional procedures performed. Secondary patency was defined as the restoration of graft patency. ResultsA total of 82 patients had undergone OSR for 104 PAAs (median age, 71 years; interquartile range [IQR], 67-78 years; 82 men) with prosthetic grafts. Of the 104 PAAs, 72 (68%) had been asymptomatic. The median diameter was 30 mm (IQR, 24-37 mm). A medial approach was used for 35 PAAs (34%) and a posterior approach for 69 (65%). The repairs consisted of aneurysmectomy or aneurysm ligation without removal with an interposition graft placed and end-to-end anastomoses. The median operative time was 120 minutes (IQR, 103-142 minutes). The estimated blood loss was 281 mL (IQR, 150-281 mL). Only one patient treated with a posterior approach sustained a permanent peroneal nerve lesion. A second patient also treated via the posterior approach had required surgical revision for bleeding on postoperative day 2. No temporary lesions were recorded. No early amputations were required, and no perioperative deaths occurred. The median length of stay was 3 days (IQR, 3-4 days). An expanded polytetrafluoroethylene graft was used in 92 cases (88%) and a Dacron graft in 12 cases (12%). An 8-mm graft was used in 64 cases (62%). The median follow-up was 34.6 months (IQR, 8.5-62.7 months). No related mortality occurred. Of the 104 PAAs, 19 had required reintervention, with primary and secondary patency of 78% and 88% at 3 years, respectively. The median interval to reintervention was 28.3 months. ConclusionsOSR of PAAs with prosthetic grafts is safe and feasible, with good mid-term results and satisfactory primary and secondary patency at 3 years.

Lesão do Nervo Tibial Provocada por Meias de Compressão Abaixo do Joelho

Introduction : Peripheral mononeuropathies are one of the leading causes of access to health care. Case Report : A 70-year-old woman felt non-specific pain in the popliteal region. After the exams, it was thought to be a radiculopathy. Therefore, the patient was medicated with muscle relaxants and anti-inflammatories without improvement of complaints, though. On examination, she had apparent pain during palpation of the semitendinosus and semimembranosus tendons. This way, it was decided to make an ultrasound scan of the popliteal region, being verified that the tibial nerve had an increased dimension in comparison to the contralateral one. The patient reported that, for the past two months, she had been using elastic stockings up to the knee region. A nerve block was performed with lidocaine, which led to a successful regression of the symptomatology. Discussion : Tibial nerve lesions tend to be uncommon as opposed to peroneal nerve lesions, since it is found in a relatively deep region. Conclusion : This case report highlights the importance of having a good clinical history combined with a detailed physical examination and the valuable details given by the ultrasound analysis at the time of the evaluation, in order to complement the data collected. Keywords: Peripheral Nerve Injuries/diagnostic imaging; Peripheral Nerve Injuries/therapy; Stockings, Compression; Tibial Nerve/injuries.

Painless foot drop: an unusual acute presentation of new onset type 1 diabetes mellitus.

SummaryA 26-year-old Caucasian female with no past medical history or family history of auto-immune disease presented to the emergency department with new onset painless left foot drop. A panel of blood tests revealed blood glucose of 49.9 mmol/L and raised blood ketone levels. The patient was referred to the diabetes team who made a clinical diagnosis of type 1 diabetes (T1DM) and insulin treatment was initiated. Elevated levels of diabetes auto-antibodies were subsequently detected. Nerve conduction studies demonstrated a left common peroneal nerve lesion with conduction block at the fibular head. After 2 weeks of insulin treatment, a significant improvement of her foot drop was observed and after 8 weeks she was walking normally. The most probable cause of her foot drop was acute diabetic mononeuropathy. To our knowledge, there are no similar cases in adult patients reported in the literature. Our case highlights the importance of physicians being aware of atypical presentation of new onset T1DM.Learning points There is an increasing incidence of T1DM with more than half of patients presenting after the age of 20. Diabetic peripheral neuropathy can present both acutely and as a mononeuropathy. Although rare, clinicians should be aware of mononeuropathy as a presenting symptom of T1DM to avoid delay in the treatment initiation. This case highlights an unusual presentation of T1DM and illustrates the importance of the early diagnosis and management of T1DM.

Spontaneous intraneural hematoma of the common fibular nerve due to oral anticoagulation.

Compression syndromes affecting the common fibular nerve are common and frequently caused by direct pressure upon the fibular tip region. Here, we describe a case of a 50-year-old male presenting with sudden foot drop, which had developed spontaneously. He was on oral anticoagulants due to hereditary thrombophilia (factor-V-Leiden). Neurophysiology examination revealed a common peroneal nerve lesion at the fibular tip. T1-weighted magnetic resonance imaging (MRI) showed a not further classifiable hyperintensity within the common peroneal nerve. Surgical exploration revealed a diffuse intraneural hematoma, which was not evacuated. During follow-up, the nerve function recovered almost completely. In retrospect, MRI findings indicated a hematoma supported by the history of anticoagulant medication.

Common Peroneal Neuropathy Caused by Intraneural Ganglion Cyst, Electrophysiological Findings Related to Fascicular Involvement and Operative Findings in Two Cases

Foot drop can occur as a manifestation of a number of pathological and clinical conditions and is a fairly common disability encountered in electrodiagnostic clinics. This report describes two cases of atraumatic foot drop. Both cases were electrophysiologically diagnosed as common peroneal neuropathy around the fibular head. Radiographic and surgical findings confirmed intraneural ganglion cyst of common peroneal nerve and the surgical resection was performed. Although the radiographic and surgical findings were compatible with the lesion of common peroneal nerve, the precise analysis of the electrophysiologic findings could differentiate the fascicular involvement in two cases. Keywords: Common peroneal neuropathy; Electrodiagnosis; Intraneural ganglion cyst

The Effect of Low-Frequency Electrical Stimulation on Denervation Atrophy in Man

The effect of low frequency electrical stimulation (LES) on denervation atrophy and recovery of the muscles was examined in a group of 73 patients with a single or a combined total lesion of the median, ulnar or peroneal nerves. The differences between the patients were evaluated by means of clinical muscle force testing, EMG, dynamometry (ulnar and median nerve lesions), computer tomography (ulnar nerve lesions) and ultrasonography (median and peroneal nerve lesions). A beneficial effect of LES could not be shown.

Surgical Outcome of Peripheral Nerve Injury

: Our article focuses on various surgical treatments and outcomes in patients who had upper and or lower extremity musculoskeletal disorders due to peripheral nerve injuries. Here, we mainly discuss the benefits of the Nath method of surgical management in infants, children (preteen and teen), and adult patients in the following four categories of peripheral nerve damage. Brachial Plexus Injury and Upper Extremity Musculoskeletal Dysfunctions: Improvements in detail are discussed in obstetric brachial plexus palsy patients, who had the soft tissue surgical procedure, modified Quad, and the novel osseous operative technique, triangle tilt at our clinic. Upper Trunk of Brachial Plexus and Long Thoracic Nerve Damage and Winging Scapula: There are at least 18 categories of causation/etiology of upper plexus and long thoracic nerve lesions in 575 patients who visited our clinic with winging scapula, limited shoulder movements, and or pain. Further, we discuss the results of the excellent recovery of hundreds of these patients, who had decompression and neurolysis of the upper trunk of brachial plexus and long thoracic nerve. Peroneal Nerve Lesion and Foot Drop:: Our management of foot drop by nerve transfers to the deep peroneal nerve is discussed. Sural Nerve Grafting to Cavernous Nerve Impairment after Prostatectomy or Genital Surgery: We also discuss briefly our experience and results of the sural nerve grafting, which restores the function of cavernous nerves resected during radical prostatectomy. Conclusion: The lead author (RKN) has developed and implemented several innovative new surgical approaches as a reconstructive microsurgeon. These surgical techniques have proven clinical and functional improvements in patients with upper and lower extremity musculoskeletal disorders due to peripheral nerve injuries.

Drop foot Post Mitral Valve Replacement and Total correction of Tetralogy of Fallot: A Two Case Report

Background: Peripheral nerve lesion after heart surgery was reported on brachial plexus, phrenic nerve, laryngeal recurrent nerve facial nerve, lumbosacral root and spinal cord. Incidence of peroneal communis nerve lesion after heart surgery was not much reported (0,19%). Diagnostic procedure of peripheral nerve lesion are including clinical sign and symptom, electrophysiology studies and MRI. Rehabilitation management of peripheral nerve lesion are not only management of pain and nerve stimulation, but also walking aid beside cardiac rehabilitation due to cardiac problem.Methods: Reporting two case of peripheral nerve lesion after heart surgery. First case is a female, 37 years old suffered from drop foot two days after mitral valve replacement with mechanic valve. She got pain management, electrical nerve stimulation and therapeutic exercise beside cardiac rehabilitation program. Second case is a female, 9 years old, after total correction of Tetralogy of Fallot, got drop foot at day two. She also got pain management, electrical nerve stimulation and therapeutic exercise beside cardiac rehabilitation.Results: First case result was the drop foot getting better after she entered phase two of cardiac rehabilitation. In the second case, the drop foot was relieved at phase two cardiac rehabilitation and back to normal condition after one year after surgery.Conclusion: In these two case of drop foot after heart surgery, the drop foot was relieved after pain and rehabilitation management beside cardiac rehabilitation.

Drop foot Post Mitral Valve Replacement and Total correction of Tetralogy of Fallot: A Two Case Report

Background: Peripheral nerve lesion after heart surgery was reported on brachial plexus, phrenic nerve, laryngeal recurrent nerve facial nerve, lumbosacral root and spinal cord. Incidence of peroneal communis nerve lesion after heart surgery was not much reported (0,19%). Diagnostic procedure of peripheral nerve lesion are including clinical sign and symptom, electrophysiology studies and MRI. Rehabilitation management of peripheral nerve lesion are not only management of pain and nerve stimulation, but also walking aid beside cardiac rehabilitation due to cardiac problem.Methods: Reporting two case of peripheral nerve lesion after heart surgery. First case is a female, 37 years old suffered from drop foot two days after mitral valve replacement with mechanic valve. She got pain management, electrical nerve stimulation and therapeutic exercise beside cardiac rehabilitation program. Second case is a female, 9 years old, after total correction of Tetralogy of Fallot, got drop foot at day two. She also got pain management, electrical nerve stimulation and therapeutic exercise beside cardiac rehabilitation.Results: First case result was the drop foot getting better after she entered phase two of cardiac rehabilitation. In the second case, the drop foot was relieved at phase two cardiac rehabilitation and back to normal condition after one year after surgery.Conclusion: In these two case of drop foot after heart surgery, the drop foot was relieved after pain and rehabilitation management beside cardiac rehabilitation.

Safe and Effective Treatment Choice for Osteoid Osteoma: Computed Tomography-guided Percutaneous Radiofrequency Ablation.

IntroductionOsteoid osteoma (OO) is a painful, benign, bone-forming tumor characterized by a small central nidus surrounded by sclerotic tissue. The aim of the present study was to evaluate the clinical outcome after computed tomography (CT)-guided radiofrequency ablation (RFA) in patients with OO performed from January 2012 to June 2018 and to confirm the safety and efficacy of CT-guided RFA.MethodsBetween January 2012 and June 2018, a total of 63 patients were treated with CT-guided RFA. Pre- and post-treatment pain, further treatment after the RFA procedure, observed complications, and satisfaction with the treatment were recorded for an assessment of clinical effects in all patients. The patients were evaluated with the visual analog scale (VAS) pre-procedure and at three months post-procedure.ResultsOf the patients, 39 were males and 24 were females with a mean age of 21 ± 9.7 (range, 9 to 41) years. The mean follow-up was 16 ± 2.1 (range, 12 to 19) months. The mean duration of the procedure was 34 ± 11.4 (range, 22 to 47) min. All of the patients were diagnosed with OO pathologically. A statistically significant difference was found between the pre-procedural and post-procedural VAS scores (p<0.001). Complications were observed in six patients including one peroneal nerve lesion, three minor skin burns, and two minor skin infections.ConclusionThis study shows that CT-guided RFA is a safe and effective treatment for OO. It is thought that RFA could be the primary treatment choice for most OO with typical symptoms and radiological findings.

Open reduction combined with a variable angle foot plate for treatment of acute Lisfranc frac-ture-dislocation

Objective To analyze the clinical outcomes of a standard protocol of open reduction and internal fixation using a variable angle foot plate for a consecutive series of patients with acute Lisfranc joint injury. Methods This study retrospectively evaluated the clinical outcomes of 11 Chinese patients (13 feet) with acute Lisfranc joint injury who had been treated by open reduction and internal fixation with a variable angle foot plate from December 2016 to June 2017 at Department of Orthopaedics, West China Hospital.They were 8 men (10 feet) and 3 women (3 feet), aged from 19 to 57 years (average, 36.4 years).Of them, 10 were complicated with fracture of metatarsus, 6 with cuneiform fracture and/or dislocation, 4 with cuboid fracture, and one with cuboid fracture.According to the Myerson classification for Lisfranc frac-ture-dislocations, one case (one foot) belonged to type A, 2 (2 feet) to type B1, 5 (6 feet) to type B2, 2 (3 feet) to type C1 and one (one foot) to type C2.The outcomes were evaluated using the visual analogue scale (VAS) and the midfoot scores of American Orthopedic Foot and Ankle Society (AOFAS). Results This cohort was followed up for 18 to 24 months (average, 22 months).Their VAS scores were decreased signif-icantly from preoperative 7.3±1.2 (from 6 to 9) to postoperative 1.2±0.2 (from 0 to 2) (P<0.05); their AOFAS midfoot scores were increased significantly from preoperative 0 to postoperative 84.6±4.6 (P< 0.05).Anatomic reduction was obtained in all the patients and all the fractures united successfully without any delayed union or nonunion.Superficial necrosis of the wound edge occurred in 2 cases without deep in-fection; skin anesthesia occurred in 2 and skin hypesthesia in 4, indicating a lesion of the superficial peroneal nerve. Conclusion Fixation of acute Lisfranc joint injury with a variable angle foot plate can lead to rigid stability, precise reduction and satisfactory short-term clinical outcomes. Key words: Foot; Wounds and injuries; Bone plate; Lisfranc

Outcomes with microsurgery of common peroneal nerve lesions

The purpose of this retrospective study is to present our results with peroneal nerve lesions, to examine the relative significance of various factors, to assess their effect on outcome, and to establish guidelines of treatment for the microsurgical management of these difficult lesions. Over a 33-year period, a total of 62 patients were treated at McGill University and the Microsurgical Research Center, Eastern Virginia Medical School. The clinical records of all patients treated for peroneal nerve lesions were reviewed for retrospective analysis. Of 62 patients, 35 had microneurolysis and nerve decompression of the common peroneal nerve (CPn) as the only surgical procedure while 27 required reconstruction with nerve grafting. Postoperatively muscle power was graded from M + 4 to M - 5 in 27 patients, from M - 4 to M4 in 26 patients, from M - 3 to M + 3 in 8 patients, and from M - 2 to M + 2 in 1 patient. The behavioral video data showed a mean preoperative ankle dorsiflexion of 6.79°±5.6 and postoperative ankle dorsiflexion of 37.9°±9.3. Overall, excellent functional results were achieved in 27 of 62 patients (43%) with peroneal palsy who underwent microsurgical reconstruction, and good results were observed in 25 patients (40%). Despite previous widespread pessimism, the surgical repair of CPn lesion is worthwhile, yielding good to excellent results in the majority of patients, after a careful preoperative consultation, establishment of a sound strategy of reconstruction and using aggressive and atraumatic microsurgery.

Deafferentation Pain Following Lesion of the Common Peroneal Nerve

Deafferentation Pain Following Lesion of the Common Peroneal Nerve