Detaillierte Beitrags-Information
| Beitragstitel | Entrapment of the Superficial Peroneal Nerve Following a Tri-malleolar Fracture: Report of a Case |
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| Beitragscode | P081 |
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| Präsentationsform | Poster |
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| Abstract |
Introduction Although peripheral nerve injuries secondary to long bone fractures are well described, entrapment of the superficial peroneal nerve after a lateral malleolar fracture was rarely described in literature [1, 2]. We report a case of a bony entrapment of the left superficial peroneal nerve following a closed tri-malleolar fracture. Case report A 54 year-old male sustained a dislocated tri-malleolar fracture of the left ankle and consulted to the emergency department more than six hours after the traumatism. Due to this late presentation, he underwent an initial closed reduction and cast-immobilization; we chose to perform a delayed open reduction and internal fixation. In the preoperative period, the patients complained of severe pain on the lateral side of the ankle radiating down the dorsal aspect of the foot and that was only partly relieved by opioids and by opening up the cast. Surgery was performed after the soft tissue swelling subsided, ten days postinjury. Performing the lateral approach, we found that the superficial peroneal nerve had an abnormal posterior position and appeared to cross the fibula at only 6cm proximal to the tip of the malleolus and after dissection it was shown to be trapped between the ends of the fracture. Careful neurolysis was carried out and the nerve spontaneously resumed its natural position in front of the fibula. A new cast was applied at the end of surgery. The postoperative course was uneventful and the pain was moderate and responded well to paracetamol and tramadol. Discussion This report illustrates two learning messages. First, even if unusual, the entrapment of the superficial peroneal nerve can occur in association with a dislocated ankle fracture and should be considered in case of unusual pain after reduction, even in the absence of clear neurological deficit. Second, even if a careful dissection represents the mainstay of any surgical approach, surgeons should consider the possibility of an abnormal course of the nerve which will require more attention; clinical suspicion should be raised in case of abnormal pain and, of course in case of neurological deficit. 1 - Corey RM, Salazar DH, Entrapment of the Superficial Peroneal Nerve Following a Distal Fibula Fracture. Foot Ankle Spec. 2017 Feb;10(1):69-71. 2 - Mino DE, Hughes EC Jr, Bony entrapment of the superficial peroneal nerve. Clin Orthop Relat Res. 1984 May;(185):203-6. |