Anatomic correlation of common fibular nerve palsy encountered after short leg casts

Yıl 2021, Cilt: 15 Sayı: 2, 116 - 120, 31.08.2021

Fatih Dikici Özcan Gayretli , İlke Ali Gürses , Ayşin Kale , Mehmet Emin Erdil , Adnan Öztürk Ahmet Usta Osman Coşkun

Öz

Objectives: Short leg casts are routine applications in orthopaedic practice. The aim of the study was to investigate the course of the common fibular nerve and its branches (deep and superficial fibular nerves) around the fibular neck in order to describe a convenient method for applying the lower extremity casts with low risk of fibular nerve entrapment.
Methods: Fifty lower extremities of 26 cadavers were examined. The point where common fibular nerve itself or its branches (deep and superficial fibular nerves) crossed over the fibular neck were dissected. The points where the nerve or its branches have risk of compression between the fibula and the cast were investigated in relation to fibular length.
Results: The average fibular length was 356.9±26.4 mm. The common fibular nerve did not pass over the fibular neck in any specimen, instead, its branches crossed over it. The average distance from the tip of the fibular head to deep fibular nerve and superficial fibular nerve were 42.9±6.5 mm and 52±6.3 mm, respectively. The mean ratio of fibular length to these distances were 8.5±1.2 and 7.0±0.8, respectively.
Conclusion: As short knee casts is a frequent application in clinical practice, it is important to determine a safe upper border for the casts to protect common fibular nerve or its branches. We recommend that the upper border of short leg casts should not exceed the upper 1/7th of the fibular length of the patient in order to avoid fibular nerve palsy.

Anahtar Kelimeler

compression, fibular nerve palsy, short leg cast

Teşekkür

ACKNOWLEDGEMENTS We thank our donor cadavers and their immediate families for their invaluable gifts and for making this research possible.

Kaynakça

• Flanigan RM, DiGiovanni BF. Peripheral nerve entrapments of the lower leg, ankle, and foot. Foot Ankle Clin 2011;16:255–74.
• Kang PB, Preston DC, Raynor EM. Involvement of superficial peroneal sensory nerve in common peroneal neuropathy. Muscle Nerve 2005;31:725–9.
• Lee JH, Lee BN, An X, Chung RH, Kwon SO, Han SH. Anatomic localization of motor entry point of superficial peroneal nerve to peroneus longus and brevis muscles. Clin Anat 2011;24:232–6.
• Masakado Y, Kawakami M, Suzuki K, Abe L, Ota T, Kimura A. Clinical neurophysiology in the diagnosis of peroneal nerve palsy. Keio J Med 2008;57:84–9.
• Güzelküçük Ü, Skempes D, Kumnerddee W. Common peroneal nerve palsy caused by compression stockings. Am J Phys Med Rehabil 2014;93:609–11.
• O’Brien CM, Eltigani T. Common peroneal nerve palsy as a possible sequelae of poorly fitting below-knee thromboembolic deterrent stockings (TEDS). Ann Plast Surg 2006;57:356–7.
• Otani M, Nozaki M, Kobayashi M, Goto H, Tawada K, Waguri-Nagaya Y, Okamoto H, Iguchi H, Watanabe N, Otsuka T. Comparative risk of common peroneal nerve injury in far anteromedial portal drilling and transtibial drilling in anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2012;20:838–43.
• Ramanan M, Chandran KN. Common peroneal nerve decompression. ANZ J Surg 2011;81:707–12.
• Stewart JD. Foot drop: where, why and what to do? Pract Neurol 2008;8:158–69.
• Sun H, Luo CF, Yang G, Shi HP, Zeng BF. Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol 2013;23:809–18.
• Thompson AT, Gallacher PD, Rees R. Lateral meniscal cyst causing irreversible peroneal nerve palsy. J Foot Ankle Surg 2013;52:505–7.
• Woodly SJ, editor. Pelvic girdle and lower limb. In: Standring S, editor. Gray’s anatomy: the anatomical basis of clinical practice. 42nd ed. Kidlington, UK: Elsevier Limited; 2021. p. 1333–430.
• Aigner F, Longato S, Gardetto A, Deibl M, Fritsch H, Piza-Katzer H. Anatomic survey of the common fibular nerve and its branching pattern with regard to the intermuscular septa of the leg. Clin Anat 2004;17:503–12.
• Arnold WD, Elsheikh BH. Entrapment neuropathies. Neurol Clin 2013;31:405–24.
• Flores LP, Koerbel A, Taragiba M. Peroneal nerve compression resulting from fibular head osteophyte-like lesions. Surg Neurol 2005;64:249–52.
• Deutsch A, Wyzykowski RJ, Victoroff BN. Evaluation of the anatomy of the common peroneal nerve. Defining nerve-at-risk in arthroscopically assisted lateral meniscus repair. Am J Sports Med 1999;27:10–5.
• Mnif H, Koubaa M, Zrig M, Zammel N, Abid A. Peroneal nerve palsy resulting from fibular head osteochondroma. Orthopedics 2009;32:528.
• Moore KL, Dalley AF. Clinically oriented anatomy. 4th ed. Philadelphia (PA): Lippincott Williams and Wilkins; 1999. pp. 582–5.
• Rubel IF, Schwarzbard I, Leonard A, Cece D. Anatomic location of the peroneal nerve at the level of the proximal aspect of the tibia: Gerdy’s safe zone. J Bone Joint Surg Am 2004;86:1625–8.
• Aydogdu S, Yercan H, Saylam C, Sur H. Peroneal nerve dysfunction after high tibial osteotomy. An anatomical cadaver study. Acta Orthop Belg 1996;62:156–60.
• Reebye O. Anatomical and clinical study of the common fibular nerve. Part 1: anatomical study. Surg Radiol Anat 2004;26:365–70.