Effectiveness of tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy / 中国修复重建外科杂志

Objective: To investigate the effectiveness of tibialis posterior tendon transfer for foot drop secondary to peroneal nerve palsy. Methods: The clinical data of 21 patients with unilateral foot drop secondary to peroneal nerve palsy between October 2009 and September 2016 was retrospectively analyzed. There were 12 males and 9 females with an average age of 32.1 years (range, 23-47 years). The causes of peroneal nerve injury were iatrogenic injury in 7 cases, tibiofibular fractures combined with compartment syndrome in 5 cases, nerve exploration surgery after stab or cut injury in 3 cases, direct violence in 4 cases, and the fibular head fracture in 2 cases. The average time from injury to operation was 5.6 years (range, 2-8 years). There was 1 case of hallux valgus and 5 cases of toe flexion contracture. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores, Foot and Ankle Ability Measure (FAAM) scores, range of motion (ROM), and dorsiflexion strength of ankle joint were used to evaluated the ankle function. Radiographic evaluation for the changes of postoperative foot alignment included Meary angle, calcaneal pitch angle, and hindfoot alignment angle. Results: All incisions healed by first intention. All patients were followed up 18-42 months (mean, 30.2 months). The dorsiflexion strength of ankle joint recovered from grade 0 to grade 3-4 after operation. There was no patient with a postoperative flat foot deformity and claw toe during follow-up. There was no significant difference in Meary angle, calcaneal pitch angle, and hindfoot alignment angle between pre- and post-operation ( P>0.05). The AOFAS score, FAAM score, and ROM of dorsiflexion significantly improved at last follow-up when compared with preoperative values ( P<0.05); while there was no significant difference in ROM of plantar-flexion between pre- and post-operation ( t=4.239, P=0.158). There were significant differences in AOFAS score, FAAM score, and ROM of dorsiflexion between affected and healthy sides ( P<0.05); but no significant difference in ROM of plantar-flexion was found ( t=2.319, P=0.538). Conclusion: Tibialis posterior tendon transfer is an effective surgical option for foot drop secondary to peroneal nerve palsy. And no postoperative flat foot deformity occurred at short-term follow-up.

A Case of Peroneal Nerve Palsy Secondary to Fibular Head Osteochondroma

Osteochondroma of the proximal fibula is relatively common, but there are only rare reports of this lesion in conjunction with peroneal nerve palsy. We report here on a case of the peroneal nerve palsy secondary to fibular head osteochondroma, and the patient experienced complete recovery of function following the excision of the tumor and neurolysis of the peroneal nerve.

Neurological Complication Following Total Knee Arthroplasty

PURPOSE: This study retrospectively evaluated the nerve injuries that occurred after total knee arthroplasty. MATERIALS AND METHODS: Among 1,582 cases of total knee arthroplasty in 1,362 patients who underwent total knee arthroplasty from 1982 to 2002, 162 cases of neurologic complications in 148 patients who were followed up for over five years, and these case were examined in this study. RESULTS: Among the 9 cases of peroneal nerve palsy in 8 patients, 6 cases of 5 patients were caused by compression of the peroneal nerve after applying a cylinder splint. One case was caused by damage of the peroneal nerve and soft tissue contracture due to peroneal compartment syndrome and two cases failed to reveal the cause of the peroneal nerve palsy. Seven cases recovered within 2 years. Among the 153 cases with sensory change that was caused by injury of the infrapatellar branch of the saphenous nerve, 76 cases recovered to 50% or more within three years postoperatively, and 105 cases recovered to 70% or more within 5 years postoperatively. Eight cases fully recovered. CONCLUSION: The causes of peroneal nerve palsy were considered to be multifactorial and almost all the cases recovered within 2 years. The injury of the infrapatellar branch of the saphenous nerve does not affect the results and the patients' satisfaction.

Henoch-Schonlein Purpura and Peroneal Nerve Palsy after Hemorrhagic Fever with Renal Syndrome / 대한신장학회지

In the course of hemorrhagic fever with renal syndrome (HFRS), mild neurological symptoms such as headache, vertigo and nausea are common. Peripheral neuropathy in HFRS is very rare. Henoch- Sch?nlein purpura (HSP) is an immunologically medicated systemic vasculitis of small blood vessels affecting the skin, gastrointestinal tract, joints and kidneys, predominantly. Neurological complications in HSP include headache, focal cerebral deficit, coma, convulsion, subarachnoid hemorrhage and chorea. Peripheral neuropathy is also very rare. However there was no case report about HSP and peroneal nerve palsy after HFRS. With a brief review of the literature, we report a case of HSP and peroneal nerve palsy following HFRS.

Common peroneal nerve palsy after robotic assisted laparoscopic colectomy: A case report / 대한마취과학회지

Common peroneal nerve palsy after surgery with lithotomy position has been widely reported, but it is an unexpected complication after surgery with supine position. We report a patient who developed common peroneal nerve palsy after surgery with supine position. A 55-year old man is planed for robotic assisted laparoscopic right hemicolectomy because of colon cancer. The patient was placed supine with Trendelenburg position at an angle about 5 degrees and tilted left about 15 degrees. The operation is uneventful, but he developed common peroneal nerve palsy on the first postoperative day. The patient was fully recovered with conservative treatment after 2 months. We consider that nerve palsy as a result of compression of common peroneal nerve related to patient positioning. So we should be careful not to develop common peroneal nerve palsy even if the patient was placed in the supine position during robotic assisted surgery.

Common Peroneal Nerve Palsy Caused by an Intraneural Ganglion : A case report

To date, very few cases with intraneural ganglion cyst of the peroneal nerve has been reported. The common symptoms include localized pain and various degrees of motor and sensory deficits. Though electrodiagnostic study has been useful in lesion localization, recent imaging studies, such as ultrasonography and magnetic resonance imaging, should be used in establishing differential diagnosis and extent of a lesion preoperatively. Treatment can be achieved by microsurgical removal of the cyst. We had a 74 year old female with right foot drop for 3 months and we diagnosed that she had intraneural ganglion of the peroneal nerve using physical examination, electrodiagnostic study, ultrasonography, and magnetic resonance imaging. Although there was no specific symptom on the left side, there was a similar lesion like that of right intraneural ganglion, that was detected by ultrasonography. However, the patient's neurologic symptoms have not improved after operation.

Common Peroneal Nerve Palsy after Lithotomy Position: Two case reports / 대한마취과학회지

Motor neuropathy of a lower extremity is well recognized potential complication of procedures performed on patients in a lithotomy position. Mechanisms of nerve injury are unclear but the incidence of perioperative nerve injuries can be reduced if anesthetists are aware of their causes and pathophysiolgies. It is important to note that reduced duration in lithotomy position may reduce the risk of lower extremity neuropathies. We experienced two case of common peroneal nerve palsy after lithotomy positioning. Diagnosis was based on history, a clinical examination and electrophysiologic studies. A neurologic examination revealed hypersthesia over the dorsum of the left foot with inability to perform active dorsiflexion. Electrophysiologic studies showed delayed latency and low amplitude of nerve action potential.

Common Peroneal Nerve Palsy Following Cardiac Surgery / 대한마취과학회지

Nerve injury associated with cardiac surgery and anesthesia is a well-recognized complication with a predilection for the upper half of the body. We report four cases of common peroneal nerve palsy following cardiac surgery that were not subject to external compression to fibular head. The diagnosis of nerve palsy was delayed because of a complicated postoperative course and intensive care, which prevented our determining the causes. The mechanisms of nerve injury are reviewed. We postulate that the etiology is multifactorial, including, old age, subnormal body habitus, prolonged knee flexion and rotation, coexisting disease, postoperative cardiovascular complications, and cardiopulmonary bypass.

Peroneal Nerve Palsy after Total Knee Arthroplasty

PURPOSE: To evaluate prognosis and causative factors of the peroneal nerve palsy that occurred after total knee arthroplasty. MATERIALS AND METHODS: From April 1994 till Feb. 2002, we performed 637 cases(449 patients) of total knee arthroplasty (TKA). Among them we experienced 9 cases(9 patients,1.4%) of peroneal nerve palsy postoperatively. For evaluation of suggestive causes of peroneal nerve palsy, we compared these paralytic group with the control group (628 cases: 440 patients) which has no peroneal nerve palsy after TKA. We analyzed basic patients factors including age, sex, body weight, preoperative diagnosis, and preoperative degree of flexion contracture and tibiofemoral angle, intraoperative tourniquet time, preoperative functional knee scores (HSS and TKSCRS). RESULTS: Eight cases were recovered completely within 12 months after TKA. A case has no change in 1 and 1/2 years after operation so we considered it as a permanent damage. There were no statistical differences between two groups. CONCLUSION: Almost all cases of peroneal nerve palsy were completely recovered spontaneously within 12 months after operation and within 6 months, clinincal sign of improvement was appeared. Until now, we couldn't find any definite causes of peroneal nerve palsy after TKA, so its causes would be multifactorial and further studies may be necessary.

Peroneal Nerve Palsy Induced by Impingement of the Screw in Tibial Component Subsidence -Case Report-

Peroneal nerve palsy after total knee arthroplasty is rare. Its etiology is multifactorial. Among them, stretching of the nerve by correction of severe preoperative valgus or flexion deformities, compression of the vascular supply of the nerve by the fascia, direct pressure on the nerve from the dressing are the well known factors which appear to cause development of peroneal nerve palsy. We experienced a case of the peroneal nerve palsy in infected total knee arthroplasty, which was accompanied with subsidence of the tibial prosthesis and report with review of the literature.