Displacement of the common peroneal nerve in posterolateral corner injuries of the knee

Bottomley, Nicholas; Williams, Andy; Birch, Rolfe; Noorani, Ali; Lewis, Angus; Lavelle, Jonathon

doi:10.1302/0301-620x.87b9.16122

Cited by 48 publications

(39 citation statements)

References 2 publications

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“…In a study of six cases having similar injuries, only one had complete common peroneal nerve transaction 12 . In another study of 54 cases of posterolateral corner injuries, only 9 patients had common peroneal nerve palsy of which 7 cases were associated with avulsion of the fibular head [13] ; however, there is no mentioning of the common peroneal nerve laceration. In our study, the patient; 1, 3, 4 were surgical intervened due to the presence of complete avulsion of fibular head, grade II/III; varus stress test, and/or peroneal nerve injury.…”

Section: Discussionmentioning

confidence: 95%

Presentation and options in management of avulsion fracture fibular head: A prospective study of rare entity

Sharma¹,

Parmar²,

Kapoor³

et al. 2017

Int. J. Orthop. Sci.

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Introduction: Avulsion fracture of the fibular head is a rare entity. Significance of this entity is lies in association with injuries to the ligaments and neurovascular structures attached to it. Presentation of these injuries is quite variable. Management of this injury is still controversial in spite of various available fixation methods. We report various different presentation and options in management of this rarely reported injury. Material and method: A prospective, single centre study of six patients of fracture fibular head was presented with injury to knee joint. All were male with average age 31 years (range 19-44 years). Left knee joint was involved in the four and right was in the two patients. All cases were of sports injury. Final diagnosis was proved by X-ray, 3D CT and magnetic resonance imaging. Three cases among them had complete avulsion of fibular head, 3 cases had undisplaced fracture fibular head; among one case was complicated by fracture shaft tibia. Patients with complete avulsion were treated by open reduction and fixation by using various methods. Complications and outcome were recorded in follow-up for 6 to 24 months (mean 21 months). Results were evaluated using Lysholm knee scores. Results: The average Lysholm knee score was 91.33 points. Excellent result (score 95-100) was seen in 1 case, good results (score 84-94) were seen in 3 cases and fair result (score 65-83) was seen in 1 case. The excellent and good result was 83%. Conclusions: Our study shows that avulsion of fibular head can present from undisplaced fragment to complete avulsion with grade I to III ligamentous injury or/and with peroneal nerve injury. These injuries can manage with various treatment options from conservative to fixation of avulsed fragment by various devices, depending on severity and combined injury.

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Section: Discussionmentioning

confidence: 95%

Presentation and options in management of avulsion fracture fibular head: A prospective study of rare entity

Sharma¹,

Parmar²,

Kapoor³

et al. 2017

Int. J. Orthop. Sci.

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“…This descriptive classification is based on the position of the displaced tibia in relation to the femur [21]. Using this terminology, Kennedy encountered five main categories of dislocation: anterior, posterior, lateral, medial, and rotatory [20].…”

Section: Classification Of Traumatic Knee Dislocationsmentioning

confidence: 99%

“…With this in mind, clinical evidence of common peroneal nerve palsy in the setting of a traumatic knee dislocation necessitates a clinical and radiologic assessment for a posterolateral corner injury or fibular head avulsion fracture (arcuate sign) [40,41] because 44% of patients with such an injury will have peroneal nerve damage [21,32].…”

Section: Neurologic Assessmentmentioning

confidence: 99%

Radiologic Review of Knee Dislocation: From Diagnosis to Repair

Walker

McDougall

Patel

et al. 2013

American Journal of Roentgenology

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Although uncommon, traumatic knee dislocations are an important potentially limb-threatening injury, which if not emergently recognized and appropriately managed, can result in significant patient morbidity, joint dysfunction, chronic pain, and long-term disability. A radiologist familiar with the imaging appearance and potential neurovascular complications associated with these injuries can play an integral role in the multidisciplinary team that manages this increasingly recognized clinical entity.

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“…Among all dislocations, the posterolateral mechanism is most likely to cause severe and permanent peroneal nerve injury. 3,[22][23][24] Energy level of the injury is extremely important and gives information concerning potential soft-tissue injury, risk of arterial injury, and will inform the overall surgical approach. High-velocity mechanisms such as motor vehicle accidents, pedestrians struck by vehicles, motorcycle accidents, and falls from a height, are more prone to have associated neurologic injuries.…”

Section: Injury Mechanism and Pathoanatomymentioning

confidence: 99%

Drop Foot After Knee Dislocation

Cush

Irgıt

2011

Sports Medicine and Arthroscopy Review

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Although knee dislocations are relatively rare, serious complications make treatment difficult. Common peroneal nerve (CPN) palsy is a debilitating complication and its incidence has been reported as high as 50%. Even after successful ligament construction, unresolved CPN palsy is a major factor contributing to poor outcomes after knee dislocations. CPN palsy is more common with open dislocations, rotatory dislocations, and especially occurs in patients with posterolateral corner injuries. CPN palsy can be readily diagnosed clinically, although a high index of suspicion is needed. The risk versus benefits of surgical exploration in the acute setting is still under debate. Conservative management can be appropriate in the early phase of treatment, however, for persistent nerve damage, surgery is the treatment of choice because it results in better functional outcomes. Neurolysis, primary nerve repair, nerve grafting, and posterior tibialis tendon transfer have all been used by surgeons as viable surgical treatment options. As late surgical treatment of CPN typically results in poor prognosis, awareness of this injury, thorough physical examination and documentation of the nerve injury, and close follow-up are of paramount importance.

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Displacement of the common peroneal nerve in posterolateral corner injuries of the knee

Cited by 48 publications

References 2 publications

Presentation and options in management of avulsion fracture fibular head: A prospective study of rare entity

Presentation and options in management of avulsion fracture fibular head: A prospective study of rare entity

Radiologic Review of Knee Dislocation: From Diagnosis to Repair

Drop Foot After Knee Dislocation

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