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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

Three patterns A, B and C of the superficial peroneal nerve as described by Blair et al. The medial dorsal cutaneous nerve (MDCN)is shown in red and the intermediate dorsal cutaneous nerve (IDCN) is shown in blue.
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Figure 4: Three patterns A, B and C of the superficial peroneal nerve as described by Blair et al. The medial dorsal cutaneous nerve (MDCN)is shown in red and the intermediate dorsal cutaneous nerve (IDCN) is shown in blue.

Mentions: The SPN is a branch of the common peroneal nerve and has both motor and sensory function. It supplies the peroneus brevis and longus muscles (motor branch) in the lateral compartment before it perforates the fascia of the lateral compartment at which point the nerve is purely sensory. Here it further divides into two well described branches the medial dorsal cutaneous nerve (MDCN) and the intermediate dorsal cutaneous nerve (IDCN) that supply the anterolateral skin of the leg and dorsum of the foot including skin over the dorsum of 1st to 3rd toes, the medial aspect of the 4th toe and excludes the first web space which is innervated by the deep peroneal nerve [8]. The various branching patterns of the MDCN and IDCN have been studied in detail [9-12]. Blairet al. described 3 patterns (Fig. 4) and noted that Type B pattern where the IDCN coursed medially to cross the lateral aspect of the fibula at mean distance 4.5 cm above the ankle joint, occurred in 16% of cases and was particularly at risk of injury [10].


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)

Three patterns A, B and C of the superficial peroneal nerve as described by Blair et al. The medial dorsal cutaneous nerve (MDCN)is shown in red and the intermediate dorsal cutaneous nerve (IDCN) is shown in blue.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Three patterns A, B and C of the superficial peroneal nerve as described by Blair et al. The medial dorsal cutaneous nerve (MDCN)is shown in red and the intermediate dorsal cutaneous nerve (IDCN) is shown in blue.
Mentions: The SPN is a branch of the common peroneal nerve and has both motor and sensory function. It supplies the peroneus brevis and longus muscles (motor branch) in the lateral compartment before it perforates the fascia of the lateral compartment at which point the nerve is purely sensory. Here it further divides into two well described branches the medial dorsal cutaneous nerve (MDCN) and the intermediate dorsal cutaneous nerve (IDCN) that supply the anterolateral skin of the leg and dorsum of the foot including skin over the dorsum of 1st to 3rd toes, the medial aspect of the 4th toe and excludes the first web space which is innervated by the deep peroneal nerve [8]. The various branching patterns of the MDCN and IDCN have been studied in detail [9-12]. Blairet al. described 3 patterns (Fig. 4) and noted that Type B pattern where the IDCN coursed medially to cross the lateral aspect of the fibula at mean distance 4.5 cm above the ankle joint, occurred in 16% of cases and was particularly at risk of injury [10].

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