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Superficial Peroneal Nerve Incarceration in the Fibular Fracture Site of a Pronation External Rotation Type Ankle Fracture.

Ellanti P, Mohamed KM, O'Shea K - Open Orthop J (2015)

Bottom Line: Neurovascular injuries are uncommon but can be a source of significant morbidity and associated poor outcome.The superficial peroneal nerve (SPN) in the lateral approach and the sural nerve in the posterolateral approach are at risk of injury.We report an unexpected finding of a superficial peroneal nerve incarcerated in the fibular fracture site of pronation external rotation type/ Weber-C ankle fracture.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma Orthopaedics, St. Vincents University Hospital, Elm Park, Dublin-4, Ireland.

ABSTRACT
Ankle fractures are common representing up to 10% of all fractures with an incidence that is rising. Both conservative treatment and operative management of ankle fractures can lead to excellent outcomes. Neurovascular injuries are uncommon but can be a source of significant morbidity and associated poor outcome. The superficial peroneal nerve (SPN) in the lateral approach and the sural nerve in the posterolateral approach are at risk of injury. We report an unexpected finding of a superficial peroneal nerve incarcerated in the fibular fracture site of pronation external rotation type/ Weber-C ankle fracture. To the best of our knowledge we believe this to be the first English language report of an incarcerated SPN at a fibular ankle fracture site.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photograph demonstrating the SPN coursing from an anterior position proximally into the fracture site beforereturning to a more anterior course distally.
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Figure 2: Intraoperative photograph demonstrating the SPN coursing from an anterior position proximally into the fracture site beforereturning to a more anterior course distally.

Mentions: The patient was brought to the operation theatre for open reduction internal fixation of the ankle fracture. A direct lateral approach via a lateral incision centred on the fracture site was utilised. The SPN was identified anteriorly at the proximal end of the incision and it traversed the woundposteriorly towards the fracture site. The SPN was carefully dissected and noted to be incarcerated in the fracture site (Fig. 2) beyond which it continued distally along a more anterior course. The nerve was incarcerated in the fracture site approximately 4cm proximal to the ankle joint. This was unexpected as the patient reported no paraesthesia or sensory deficit along the SPN distribution. The nerve was carefully freed from the fracture site and upon closer inspection was intact and not visibly bruised. The nerve was transposed anteriorly and protected during the procedure. The comminuted fracture site was bridged using a 10 hole 1/3rd tubular plate and two syndesmosis diastasis screws were used as the syndesmosis which was ruptured on stressing (Fig. 3).


Superficial Peroneal Nerve Incarceration in the Fibular Fracture Site of a Pronation External Rotation Type Ankle Fracture.

Ellanti P, Mohamed KM, O'Shea K - Open Orthop J (2015)

Intraoperative photograph demonstrating the SPN coursing from an anterior position proximally into the fracture site beforereturning to a more anterior course distally.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493632&req=5

Figure 2: Intraoperative photograph demonstrating the SPN coursing from an anterior position proximally into the fracture site beforereturning to a more anterior course distally.
Mentions: The patient was brought to the operation theatre for open reduction internal fixation of the ankle fracture. A direct lateral approach via a lateral incision centred on the fracture site was utilised. The SPN was identified anteriorly at the proximal end of the incision and it traversed the woundposteriorly towards the fracture site. The SPN was carefully dissected and noted to be incarcerated in the fracture site (Fig. 2) beyond which it continued distally along a more anterior course. The nerve was incarcerated in the fracture site approximately 4cm proximal to the ankle joint. This was unexpected as the patient reported no paraesthesia or sensory deficit along the SPN distribution. The nerve was carefully freed from the fracture site and upon closer inspection was intact and not visibly bruised. The nerve was transposed anteriorly and protected during the procedure. The comminuted fracture site was bridged using a 10 hole 1/3rd tubular plate and two syndesmosis diastasis screws were used as the syndesmosis which was ruptured on stressing (Fig. 3).

Bottom Line: Neurovascular injuries are uncommon but can be a source of significant morbidity and associated poor outcome.The superficial peroneal nerve (SPN) in the lateral approach and the sural nerve in the posterolateral approach are at risk of injury.We report an unexpected finding of a superficial peroneal nerve incarcerated in the fibular fracture site of pronation external rotation type/ Weber-C ankle fracture.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma Orthopaedics, St. Vincents University Hospital, Elm Park, Dublin-4, Ireland.

ABSTRACT
Ankle fractures are common representing up to 10% of all fractures with an incidence that is rising. Both conservative treatment and operative management of ankle fractures can lead to excellent outcomes. Neurovascular injuries are uncommon but can be a source of significant morbidity and associated poor outcome. The superficial peroneal nerve (SPN) in the lateral approach and the sural nerve in the posterolateral approach are at risk of injury. We report an unexpected finding of a superficial peroneal nerve incarcerated in the fibular fracture site of pronation external rotation type/ Weber-C ankle fracture. To the best of our knowledge we believe this to be the first English language report of an incarcerated SPN at a fibular ankle fracture site.

No MeSH data available.


Related in: MedlinePlus