Common peroneal nerve palsy

Two cases of common peroneal nerve palsy after coronary artery bypass grafting surgery are described and the possible causative mechanisms are discussed.     

Common peroneal nerve palsy following knee arthroscopy.

We report the case of a 43-year-old woman who underwent knee arthroscopy. Postoperatively, she developed a lesion of the common peroneal nerve, which was confirmed by neurophysiological studies. Exploration showed the nerve to be in continuity and externally undamaged. At review 17 months later, there was incomplete recovery. We believe this lesion was caused by a traction injury related to patient positioning, which has not been reported previously.     

Congenital clubfoot

Congenital clubfoot is one of the most common congenital skeletal deformities with an incidence of 1-2/1000 newborns. The deformity is characterized by pathological changes of joints, bones (especially the talus), muscles, tendons and soft tissues which result in subtalar malpositions known as talipes equinus, varus adductus and cavus. Secondary clubfoot is always part of an underlying systemic or neurologic disease and can occur at birth or develop over time. The treatment of clubfoot should start early after birth and is primarily conservative, involving manipulation and serial casting. Among conservative techniques available today, the Ponseti method is the treatment of choice. Applying this treatment protocol surgical therapy can be reduced in amount and extent. Extensive surgical therapy is only necessary in exceptional cases.     

Common peroneal nerve palsy after lateral unicompartmental knee arthroplasty

Unicompartmental knee arthroplasty is now being used more commonly to treat single compartment disease of knee, with very encouraging results. We report on a rare case of common peroneal nerve palsy; 8 years after lateral unicompartmental knee arthroplasty. This palsy was caused by pressure on the common peroneal nerve, due to posterior migration of tibial component.     

Congenital clubfoot.

A series of 58 children with 75 idiopathic congenital clubfeet is presented. Early soft tissue release was performed in 77 per cent. The main purpose of the study was to clarify the causes of postoperative relapse. The results were poor in 12 feet, 11 (19 per cent) were reoperated. On re-evaluation of the "poor" cases we found severe social problems involved, including parental neglect.     

Interosseous transfer of tibialis posterior for common peroneal nerve palsy

The interosseous route remains popular for tibialis posterior tendon transfer for drop-foot. It leaves a smaller range of movement than the circumtibial route, but lengthening the calcaneal tendon may improve this. The results of this present series indicate that, in order to predict a good functional result, the ankle must be held in at least 20 degrees of dorsiflexion at the time of tendon transfer.     

Common peroneal nerve palsy as a postoperative complication in lateral meniscus repair

Arthroscopic lateral meniscus repair using an inside-out technique can potentially be hazardous to the common peroneal nerve. This is true even for a longitudinal incision posterior to the posterior border of the iliotibial band, which allows visualization of the lateral joint capsule. A 37-year-old woman presented with common peroneal nerve dysfunction after an arthroscopic lateral meniscus repair using this technique. After confirmation of nerve entrapment by magnetic resonance imaging (MRI), an early exploration to decompress the involved nerve eventually resulted in the recovery of neurological function. In addition, an all-inside technique using a FasT-Fix suture device was used as an effective and safe remedy after untying the earlier sutures from the lateral meniscus repair that were trapping the nerve.     

Common peroneal nerve palsy: an unexpected complication of liver surgery

BACKGROUND: Common peroneal nerve palsy is a well-recognized complication following surgery in lithotomy position, particularly colorectal and gynecologic surgery. But it is quite rare after liver surgery because patients are usually placed in supine position. CASE REPORT: There were three cases of common peroneal nerve palsy after liver surgery in the past 2 years, including two cases of liver transplantation and one case of extended right hepatectomy. Two cases were bilateral and one case was unilateral. They were placed in supine position and the mean operative time was 8 hours. Patients complained symptom of foot drop within 1 week after operation. Electromyographic examinations showed evidence compatible with common peroneal nerve palsy. All of them improved with conservative treatment within 6 months. CONCLUSION: Common peroneal nerve palsy may develop after liver surgery even in supine position. Injury to common peroneal nerve should be a concern before and during the operation. This complication could be managed conservatively with an uneventful result.     

Congenital equinovarus clubfoot]

A congenital clubfoot is often associated with a neuromuscular disease, a chromosomal anomaly, or a syndrome. The present review will only study the idiopathic clubfoot seen in an otherwise normal child. It is considered nowadays that a clubfoot is secondary to a defect in the spontaneous "rotation-elevation" mechanism which should occur between the 9th and 10th week of fetal development. Several possible factors influence the embryonic development: genetic, neurologic, muscular, environmental, and toxic factors. Modern notions of anatomy and physiology of the foot allow a better understanding of the deformations seen in a clubfoot: calcaneo-forefoot block, talonavicular joint double "belonging", notion of "relative" hindfoot supination. The osteo-articular deformations involve mainly the talus, the calcaneus, the navicular. They are associated to articular stiffness secondary to soft tissue retractions like the posterolateral, anteromedial, and the anterolateral fibrous knots. Prenatal diagnosis can be made using the ultrasound which is usually performed at 20 weeks of gestation. Nevertheless, only the clinical exam at birth will evaluate the degree of severity of the clubfoot based upon its reducibility, the presence of skin creases, and the importance of muscular atrophy. Imaging techniques (especially standard x-ray) are useless diagnostic tools. They will be necessary for the follow-up, the evaluation of residual defects, and for the possible surgical indications. Conservative treatment is used first, and in the hands of experienced teams will give a sufficient correction in 70 to 80% of the patients. The surgical treatment is used to complete the correction obtained by conservative means. Surgical treatment will free the retracted soft tissues. Postoperatively the foot will be immobilized in the appropriate position for 2 to 3 months. Clubfoot treatments are associated with complications which have to be known to avoid them if possible and/or to be able to take the appropriate therapeutic actions when necessary. The results of clubfoot treatment are satisfactory in the majority of patients despite the treatment difficulties and the possible relapses during growth. Follow-up is mandatory until the end of growth.     

Common peroneal nerve palsy secondary to peroneus longus abscess: case report

Muscle abscess presenting as nerve palsy is rare and has not been previously reported in the common peroneal nerve (CPN). The objective of this case report is to describe the diagnosis and treatment of an uncommon presentation of peroneal abscess in the leg of an otherwise healthy man. We present a case of CPN palsy in a 50-year-old immunocompetent man with no other comorbid medical condition secondary to peroneus longus abscess. The diagnosis was suggested by magnetic resonance imaging examination and confirmed by intraoperative findings. After surgical drainage of the abscess, the patient made a complete recovery. A review of the literature confirms that peroneus longus abscess giving rise to CPN palsy has not been described. Early diagnosis and surgical drainage of the compressing abscess can produce a favorable outcome.     

Bilateral peroneal nerve palsy following emergent stabilization of a pelvic ring injury

External noninvasive compressive devices are becoming popular for emergent stabilization of pelvic ring disruptions. The ease of application utilizing available materials such as sheets, the noninvasive nature of such measures, and perceived absence of complications has made this a popular stabilization modality. The authors report a case of bilateral peroneal nerve palsy related to the use of external compressive wraps in a patient with pelvic ring injury.