328 Outcome Analysis of Common Peroneal Nerve Neuroplasty at Lateral Fibular Neck

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 272-272
Author(s):  
John Souter ◽  
Kevin Swong ◽  
Matthew McCoyd ◽  
Magan Nielsen ◽  
Neelam Balasubramanian ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Peroneal Nerve ◽  
Medical Center ◽  
Common Peroneal Nerve ◽  
Significant Trend ◽  
Sensory Loss ◽  
Outcome Analysis ◽  
Motor Deficits ◽  
Safe Procedure

Abstract INTRODUCTION Common Peroneal Nerve (CPN) neuropathy is the most common entrapment neuropathy of the lower extremities. Patients present with sensory loss along the anterolateral leg and dorsum of the foot, or weakness of the foot dorsiflexors and evertors. METHODS This is an IRB-approved retrospective review of a prospectively maintained database of patients who underwent decompressive surgery for CPN neuropathy with a minimum of 3 months follow up at Loyola University Medical Center. Motor scores were totaled using the Oxford Scale, with an improvement defined as resolution of pain or sensory loss or improvement in motor score by at least a 1-grade. RESULTS >30 patients were analyzed. Of the 26 patients who presented with abnormal lower extremity motor scores, 24 had at least 1 grade improvement in motor scores, and 2 experienced no change. 26 patients presented with lower extremity decreased sensation, and 12 of these patients reported improved sensation, while 14 patients reported no change. Patients with an increased time to surgery (>67 weeks) had a non-significant trend towards worse outcomes (p = .06). Patients who presented with weakness had a significant trend towards improvement (p = .0006) compared to patients presenting with pain and sensory deficits. CONCLUSION Surgical decompression of the CPN at the lateral fibular neck is an effective and safe procedure. Patients presenting with pain or sensory loss did not show a significant trend towards improvement with surgery, while patients presenting with motor deficits had a significant improvement with surgery. There was a trend of worse outcomes with a symptoms-to-surgery time greater than 67 weeks.

Iatrogenic common peroneal nerve injury during harvesting of semitendinosus tendon for anterior cruciate ligament reconstruction

2021 ◽  
Vol 14 (4) ◽  
pp. e240736
Author(s):  
Raf Mens ◽  
Albert van Houten ◽  
Roy Bernardus Gerardus Brokelman ◽  
Roy Hoogeslag
Keyword(s):  
Anterior Cruciate Ligament ◽  
Nerve Injury ◽  
Peroneal Nerve ◽  
Cruciate Ligament ◽  
Common Peroneal Nerve ◽  
Peroneal Nerve Injury ◽  
The Common ◽  
Anterior Cruciate ◽  
Incision Technique

We present a case of iatrogenic injury to the common peroneal nerve (CPN) occurring due to harvesting of a hamstring graft, using a posterior mini-incision technique. A twitch of the foot was noted on retraction of the tendon stripper. After clinically diagnosing a CPN palsy proximal to the knee, the patient was referred to a neurosurgeon within 24 hours. An electromyography (EMG) was not obtained since it cannot accurately differentiate between partial and complete nerve injury in the first week after injury. Because the nerve might have been transacted by the tendon stripper, surgical exploration within 72 hours after injury was indicated. An intraneural haematoma was found and neurolysis was performed to decompress the nerve. Functioning of the anterior cruciate ligament was satisfactory during follow-up. Complete return of motor function of the CPN was observed at 1-year follow-up, with some remaining hypoaesthesia.

The Safety of Ultrasound Guided Tenotomy for Upper and Lower Extremity Tendinopathies: A Retrospective Study

2020 ◽  
Author(s):  
Benjamin Fick ◽  
Daniel Stover ◽  
Ruth Chimenti ◽  
Mederic Hall
Keyword(s):  
Lower Extremity ◽  
Physical Function ◽  
Complication Rate ◽  
Plantar Fascia ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Short Term ◽  
Long Term Follow Up

Abstract Background: Ultrasound guided tenotomy (USGT) is a minimally invasive treatment option for patients with chronic tendinopathy who fail to benefit from conservative exercise interventions. The complication rate and effectiveness of USGT remain poorly defined in the literature. Purpose: This study aimed to evaluate the risks associated with USGT and outcomes across upper extremity and lower extremity tendinopathy/fasciopathy sites. Methods Patients who had USGT at the elbow, patellar, or Achilles tendons or along the plantar fascia were identified by retrospective review of charts. Screening for complications (infection, tendon rupture, and hypersensitivity) and satisfaction with the procedure were assessed at routine short-term follow-up visits and at long-term follow-up via phone/email. Outcomes (pain, quality of life) were assessed using the region specific pain scales and the Short Form-12, respectively, at baseline prior to the procedure, short-term follow up, and long term follow up. Results: A total of 262 patients were identified through chart review. There was a low complication rate of 0.7% including one superficial wound infection and one case of wound hypersensitivity. Prior to USGT, the majority of patients reported moderate/daily pain that decreased by short-term and long-term follow-up to mild/occasional pain (p < 0.05). Additionally, most patients reported abnormally low physical function prior to USGT that was within normal range of physical function by long-term follow-up (p < 0.05). The majority of responders (63% at the plantar fascia to 92% at the Achilles midportion) reported being either ‘very satisfied’ or ‘somewhat satisfied’ with the procedure at short-term follow-up. Conclusions: This study found that USGT is a safe procedure with a low complication rate in a heterogeneous sample. Study findings provide preliminary evidence on the utility of USGT to reduce pain and improve function with a high rate of patient satisfaction.

Major lower extremity amputations in a developing country: 10-Year experience at a tertiary medical center

Vascular ◽  
2020 ◽  
pp. 170853812096508
Author(s):  
Mohamad A Chahrour ◽  
Mouafak Homsi ◽  
Mohammad R Wehbe ◽  
Caroline Hmedeh ◽  
Jamal J Hoballah ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Developing Country ◽  
Positive Impact ◽  
Medical Center ◽  
Perioperative Complications ◽  
Care Center ◽  
Major Amputation ◽  
Ambulatory Status ◽  
Rehabilitation Centers

Background Lower extremity amputation (LEA) is a major surgical procedure with a high risk of significant morbidity and mortality. The objective of this study was to describe mortality and functionality outcomes following this procedure in a developing country. Methods This is a retrospective study of all patients undergoing LEA for non-traumatic etiology between 2007 and 2017. Medical records were used to retrieve demographics, comorbidities, and perioperative complications of identified patients. Patients were contacted to follow-up on their medical, postoperative care, and ambulatory status. Mortality and postoperative functionality rates were analyzed. Results The study included 78 patients. Median follow-up duration was 24 months. Hypertension (81%) and diabetes (79%) were the most common comorbidities. Mortality rates at 30 days, 1, and 5 years were 10.3, 29.2, and 65.5%, respectively. Mortality was significantly associated with age > 70 at amputation ( p = 0.042), hypertension ( p = 0.003), chronic kidney disease ( p = 0.031), and perioperative sepsis ( p = 0.01). Only 1.6% of patients were discharged into a specialized care center, and only 27% of patients were ambulatory postoperatively, although 90.5% were fitted with a prosthesis. Conclusions Survival following major amputation in a developing country is currently comparable to more developed regions of the world. Major discrepancy seems to exist in ambulatory status following the procedure. Discharge placement policies should be properly set, and rehabilitation centers funding should be increased. Awareness may also be warranted to educate patients and families about the value and positive impact of rehabilitation centers.

Endoscopic third ventriculostomy: outcome analysis in 368 procedures

2010 ◽  
Vol 5 (1) ◽  
pp. 68-74 ◽  
Author(s):  
Oumar Sacko ◽  
Sergio Boetto ◽  
Valérie Lauwers-Cances ◽  
Martin Dupuy ◽  
Franck-Emmanuel Roux
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Hospital Admissions ◽  
Outcome Analysis ◽  
Morbidity Rate ◽  
Third Ventriculostomy ◽  
Safe Procedure ◽  
Chronic Hydrocephalus ◽  
Risk Of Failure ◽  
Increased Risk

Object Although endoscopic third ventriculostomy (ETV) has been accepted as a procedure of choice for the treatment of obstructive hydrocephalus, the outcome of this treatment remains controversial with regard to age, cause, and long-term follow-up results. The goal of this study was to assess the risk of failure associated with these factors in a retrospective cohort study. Methods Between 1999 and 2007, 368 ETVs were performed in 350 patients (165 patients < 18 years of age) with hydrocephalus at the University Hospital of Toulouse. Failure of ETV was defined as cases requiring any subsequent surgical procedure for CSF diversion or death related to hydrocephalus management. Results Tumors (53%), primary aqueductal stenosis (18%), and intracranial hemorrhage (13%) were the most common causes of hydrocephalus. The median follow-up period was 47 months (range 6–106 months), and the overall success rate was 68.5% (252 of the 368 procedures). Patients < 6 months of age had a 5-fold increased risk of ETV failure than older patients (adjusted hazard ratio [HRa] 5.0; 95% CI 2.4–10.4; p < 0.001). Hemorrhage-related (HRa 4.0; 95% CI 1.9–8.5; p < 0.001) and idiopathic chronic hydrocephalus (HRa 6.3, 95% CI 2.5–15.0, p < 0.001) had a higher risk of failure than other causes. Most failures (97%) occurred within 2 months of the initial procedure. The overall morbidity rate was 10%, although most complications were minor. Finally, the introduction of ETV in the authors' department reduced the number of shunt insertions and hospital admissions for shunt failures by half and was a source of cost savings. Conclusions Endoscopic third ventriculostomy is a safe procedure and an effective treatment option for hydrocephalus. Factors indicating potential poor ETV outcome seem to be very young children and hemorrhage-related and chronic hydrocephalus in adults.

Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma

2001 ◽  
Vol 94 (6) ◽  
pp. 905-912 ◽  
Author(s):  
Thomas Kretschmer ◽  
Gregor Antoniadis ◽  
Veit Braun ◽  
Stefan A. Rath ◽  
Hans-Peter Richter
Keyword(s):  
Traumatic Injury ◽  
Common Peroneal Nerve ◽  
Iatrogenic Injury ◽  
Optimal Time ◽  
Motor Deficits ◽  
Time Interval ◽  
Content Type ◽  
Iatrogenic Injuries ◽  
Fine Print

Object. The purpose of this study was to discover the number and types of iatrogenic nerve injuries that were surgically treated during a 9-year period at a relatively busy nerve center. The specific nerves involved, their sites of injury, and the mechanisms of injury were also documented. Methods. The authors retrospectively evaluated the surgically treated iatrogenic lesions by reviewing case histories, operative reports, and follow-up notes in 722 cases of trauma. These cases were treated between January 1990 and December 1998 because of pain, dysesthesias, and sensory and/or motor deficits. Iatrogenic injury was a much larger category of trauma than predicted. One hundred twenty-six (17.4%) of the 722 surgically treated cases were iatrogenic in origin. Most of these injuries occurred during a previous operation. To a major extent, nerves of the extremities were affected, and a relatively large number of injuries occurred in the neck and groin. Incidence was highest in the spinal accessory nerve (14 cases), the common peroneal nerve (11 cases), the superficial radial nerve (10 cases), the genitofemoral nerve branches (10 cases), and the median nerve (nine cases). At least two thirds of the patients did not undergo surgery for the iatrogenic injury within an optimal time interval due to delayed referral. Follow-up data were available in 97 of the 126 patients. Surgical outcomes demonstrated improvement in 70% of patients. Operative results were especially favorable in patients suffering from iatrogenic injuries to the accessory and superficial sensory radial nerves. Conclusions. Iatrogenic injuries should be corrected in a timely fashion just like any other traumatic injury to nerve.

scholarly journals Chronic Expanding Hematoma in the Extremities: A Clinical Problem of Adhesion to the Surrounding Tissues

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Akio Sakamoto ◽  
Takeshi Okamoto ◽  
Shuichi Matsuda
Keyword(s):  
Magnetic Resonance ◽  
Lower Extremity ◽  
Peroneal Nerve ◽  
Subcutaneous Tissue ◽  
Common Peroneal Nerve ◽  
Clinical Problem ◽  
Blood Collection ◽  
Continuous Growth ◽  
Chronic Expanding Hematoma ◽  
The Common

Chronic expanding hematoma is characterized by continuous growth of a blood collection. We analyzed the clinical features of 7 patients with chronic expanding hematomas in the extremities, with an average age of 65.6 years. All lesions occurred in the lower extremities, with 4 seen in the thigh and 3 in the knee region. Six patients had subcutaneous hematomas, while 1 was deep-seated in the thigh. The magnetic resonance features of the lesion were compatible with those of a standard hematoma. A low signal intensity on T1- and T2-weighted imaging at the pseudocapsule was also characteristic. Cystic features were seen in 5 of 7 patients. All lesions were resected together with their pseudocapsule. In the subcutaneous lesions, it was necessary to resect adherent fascia, with or without involved skin. In the deep-seated thigh lesion, the common peroneal nerve was completely adherent to the pseudocapsule, a phenomenon from absence of the common peroneal nerve which appeared after resection. Chronic expanding hematomas of the extremities are predominantly located in the subcutaneous tissue of the lower extremity. The surrounding pseudocapsule is adherent to the adjacent tissues, and clinicians must be aware of this, especially when resecting a deep-seated lesion.

scholarly journals A CADAVERIC STUDY OF COMMON PERONEAL NERVE IN RELATION TO FIBULAR TUNNEL

2021 ◽  
pp. 1-4
Author(s):  
Jaskaran Singh ◽  
Bhawani Shankar Modi ◽  
Kavita Pahuja ◽  
Tejendra Singh
Keyword(s):  
Peroneal Nerve ◽  
Close Contact ◽  
Average Distance ◽  
Common Peroneal Nerve ◽  
Lower Limbs ◽  
Foot Drop ◽  
Sensory Loss ◽  
Nerve Injuries ◽  
Muscle Nerve ◽  
The Common

INTRODUCTION: The common peroneal nerve is major lateral division of the sciatic nerve supplies lateral and anterior compartment of leg, when injured may leads to debilitating conditions such as foot drop and sensory loss or numbness in its supplied area. Common peroneal nerve's position subjects it to nerve injuries at two places one behind the knee joint where the nerve is superficial and other being the course of nerve through the fibular tunnel where its being tugged between musculo-aponeurotic fibers of peroneus longus muscle. Nerve injuries to common peroneal nerve has been attributed to several factors depending upon its anatomical position such as this may be due to sudden weight loss, prolonged sitting in squatting position, meniscus injuries in athletes or whether it is any surgical procedures involving the upper part of tibia and fibula. MATERIAL & METHODS: In present study we examine 70 lower limbs equally of right and left sides, the course, branching pattern and other reference point distances were measured with the help of metallic scale and dissections were photograph. RESULT: In 60% cases nerve separate from sciatic at the apex of popliteal fossa and in 80% cases it passes through the groove and then in about 70% specimen it passes through fibular tunnel, where it remains on an average 1.33 cm below the fibular head. The average distance of the nerve division was found 2.73 cm and just below that at a distance of 4.29 cm the nerve is in close contact with the bone. CONCLUSION: In present study we have observed average 7 muscular branches with variable origin from the common peroneal nerve in fibular tunnel which are likely to be damaged during surgical incision at this site.

scholarly journals Long-Term Patient Reported Outcomes after Correction of Traumatic Foot Drop

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0030
Author(s):  
Jessica M. Kohring ◽  
Steven Karnyski ◽  
Peter Joo ◽  
Andrew Y. Liu ◽  
Judith F. Baumhauer ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Tendon Transfer ◽  
Traumatic Injury ◽  
Common Peroneal Nerve ◽  
Subscale Score ◽  
Foot Drop ◽  
Assistive Device ◽  
Patient Reported

Category: Trauma; Ankle Introduction/Purpose: There is limited literature on patient reported outcomes after tendon transfer for traumatic foot drop. The purpose of this study was to determine long-term patient reported functional outcomes after posterior tibialis tendon (PTT) transfer in patients with foot drop resulting from a traumatic common peroneal nerve injury. Methods: Between August 2006 to January 2019, 31 patients underwent PTT transfer for foot drop secondary to a traumatic injury to their common peroneal nerve at our institution. The average follow-up was 14 months. A retrospective chart review was performed to document physical exam measures and to review postoperative radiographs for changes in foot alignment. There were 17 out of the initial 31 patients available at a mean follow-up of 5.9 years who responded to a phone questionnaire, including the Foot and Ankle Ability Measure (FAAM) questionnaire, and questions on brace and assistive device use, activity level, and satisfaction with surgery. Results: Preoperatively, all patients had an equinus contracture with no dorsiflexion strength, abnormal gait, and used an ankle- foot orthosis (AFO) or pneumatic boot for ambulation. Postoperatively, the average ankle dorsiflexion strength was 4/5 with 28/31 patients reporting a normal gait and 26/31 not using a brace for ambulation. Postoperative radiographs did not show changes in alignment or progression to flatfoot deformity. For the subset of 17 patients who responded to the phone questionnaire, the mean FAAM ADL subscale score was 68.1 and the Sport subscale score was 52.1 at an average of 5.9 years after surgery. The majority of patients (76%) were very or quite satisfied with the outcome of surgery and 15/17 (88%) patients reported they would undergo the PTT transfer procedure again. Conclusion: Posterior tibialis tendon transfer for patients with foot drop secondary to a traumatic injury to their common peroneal nerve showed a high satisfaction rate and improvement in function after surgery without the need for brace or assistive device use at long-term follow-up at an average of 6 years. Additionally, there was no progression to flatfoot deformity after posterior tibialis tendon transfer at 1 year postoperatively. [Table: see text]

scholarly journals Outcome analysis of patients after ligament-sparing microdiscectomy for lumbar disc herniation

2002 ◽  
Vol 13 (2) ◽  
pp. 1-4 ◽  
Author(s):  
Youn-Kwan Park ◽  
Joo-Han Kim ◽  
Heung-Seob Chung
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Successful Outcome ◽  
Outcome Analysis ◽  
Safe Procedure ◽  
Repeated Surgery ◽  
Independent Assessment

Object The authors describe a microsurgical technique for the preservation of the ligamentum flavum and the long-term surgery-related results, including an independent assessment of outcome. Methods Three hundred seventy-seven patients underwent ligament-sparing microsurgical discectomy for a previously untreated single-level lumbar disc herniation and were followed for more than 2 years. A successful outcome at 6 months was demonstrated in 93.9% of the patients. At a median follow-up period of 30 months, successful patient-assessed outcome was 84.1%. During the mean follow-up period of 4.2 years (range 2–6.5 years), recurrent disc herniation was detected in 18 patients (4.8%). These patients all underwent repeated surgery. The overall surgery-related rate of complications was 1.3%. Conclusions The authors conclude that ligament-sparing microdiscectomy is a safe procedure, with a favorable success rate and minimal morbidity. Reoperation is safer and easier when using this technique compared with traditional ones.

Sign in / Sign up

Export Citation Format

Share Document