Triple dislocation around the knee joint: a case report

Background Dislocation of the knee is a serious and potentially limb-threatening injury. There are three types of dislocation around the knee joint: patellofemoral, tibiofemoral, and tibiofibular. Tibiofemoral dislocation is the variant that is deemed the most serious, with a higher risk of compromise to the popliteal artery and common peroneal nerve. Although simultaneous dislocations of two types have been described, there has been no such description of all three types occurring simultaneously. Case presentation We present a case of a 40-year-old hairdresser who suffered a fall off her moped in Spain, and simultaneously dislocated all three articulations around the knee. Diagnosis was achieved with clinical examination, plain films, and computed tomography and magnetic resonance imaging scans. Management consisted of initial surgical debridement and reduction with stabilization of the affected joints. Conclusion Dislocation of the knee is an uncommon but life changing and potentially limb-threatening injury. It should always be suspected in trauma patients who present with multiligamentous knee injuries. The main concern is of neurovascular compromise to the lower leg, namely, the popliteal artery and common peroneal nerve. The treatment of multiligamentous knee injuries for most patients is surgical treatment with physiotherapy and adequate stabilization of the knee joint. Close monitoring of progress of the knee in terms of persistent laxity, range of movement, and functional status is required for at least 1-year post injury. Current evidence suggests that, despite good functional outcomes for knee dislocations in the short term, the prevalence of post-traumatic osteoarthritis is high in the long term.

Intraneural cyst of the peroneal nerve in child

This article presents an observation of an intraneural cyst of the peroneal nerve in a 16-year-old boy after a knee injury. Surgical treatment of an intraneural cyst of the peroneal nerve was performed 9 months after the appearance of peroneal nerve neuropathy. One month after the operation, the peroneal muscle strength increased from 2 to 4 points on the MRC scale; positive dynamics after the operation was also noted according to the data of electroneuromyography and ultrasound examination. Children often observed intraneural cyst of the peroneal nerve at the knee (90% of cases among all sites intraneural cysts). For diff erential diagnosis with compression-ischemic neuropathy and nerve cysts, clinical and neurophysiological data should be supplemented by ultrasound and/or MRI examination. Early diagnosis and surgical treatment are critical to the full recovery of motor and sensory function.

Acute onset of chronic infl ammatory demyelinating polyneuropathy in combination with COVID-19

Acute onset of chronic infl ammatory demyelinating polyneuropathy (A-CIDP) presents signifi cant diffi culties in differential diagnosis with acute infl ammatory demyelinating polyneuropathy (AIDP). The article presents review of literature about diff erential diagnosis between A-CIDP and AIDP and a clinical case of A-CIDP at 26-year-old man. The disease started after vaccination against infl uenza and an episode of enteritis, the clinical picture matched Guillain–Barré syndrome criteria, according to electromyography data: demyelinating lesion of the left facial nerve, motor and sensory fi bers of the median and ulnar nerves on both sides, demyelinating lesions of motor fi bers of the tibial nerve and peroneal nerve on both sides. Chronic infl ammatory demyelinating polyneuropathy was diagnosed. Lack of eff ect from plasma exchange was the reason for changing the treatment to pulse therapy with prednisolone (with a subsequent transition to a 1 mg/kg dose and further reduction until canceled within 16 weeks). Response to prednisolone — rapid recovery of motor functions, which worsened signifi cantly due to a new coronavirus infection during treatment in the neurology department. Further continuation of prednisolone therapy made it possible to restore motor functions completely, except mild prosopoparesis. At the same time, deep refl exes were absent; no signifi cant EMG dynamics was observed. Considering the eff ect of glucocorticosteroids and lack of positive dynamics on the second electromyography, the patient was diagnosed as A-CIDP.

Crossed reflex responses to flexor nerve stimulation in mice

Motor responses in one leg to sensory stimulation of the contralateral leg have been named "crossed reflexes" and extensively investigated in cats and humans. Despite this effort, a circuit-level understanding of the crossed reflexes has remained missing. In mice, advances in molecular genetics enabled insights into the "commissural spinal circuitry" that ensures coordinated leg movements during locomotion. Despite some common features between the commissural spinal circuitry and the circuit for the crossed reflexes, the degree to which they overlap has remained obscure. Here, we describe excitatory crossed reflex responses elicited by electrically stimulating the common peroneal nerve that mainly innervate ankle flexor muscles and the skin on antero-lateral aspect of the hind leg. Stimulation of the peroneal nerve with low current intensity evoked low amplitude motor responses in the contralateral flexor and extensor muscles. At higher current strengths, stimulation of the same nerve evoked stronger and more synchronous responses in the same contralateral muscles. In addition to the excitatory crossed reflex pathway indicated by muscle activation, we demonstrate the presence of an inhibitory crossed reflex pathway, which was modulated when the motor pools were active during walking. The results are compared with the crossed reflex responses initiated by stimulating proprioceptors from extensor muscles and cutaneous afferents from the posterior part of the leg. We anticipate that these findings will be essential for future research combining the in vivo experiments presented here with mouse genetics to understand crossed reflex pathways at the network level in vivo.

Movahedi Tendon Transfer in Common Peroneal Nerve Palsy

The article's abstract is not available.

Complex aspects of clinical-functional evaluation and ambulatory therapeutic-rehabilitation approach in a young patient with post stroke - spasticity and peroneal nerve palsy

Introduction. Spasticity, a common post-stroke complication associated with signs and symptoms of upper motor neuron syndrome (1), occurs with a 35% prevalence one year after brain injury (2) and can be severely disabling in young patients (3), regarding locomotor dysfunction and also regarding the quality of life. Stroke incidence in young patients increased in the last decades, being correlated with the increasing substance abuse and sedentariness, excessive alcohol consumption, and smoking (4). Peroneal nerve palsy is the most common cause of neuropathy of the lower limb and, in most cases, is caused due to nerve lesion in the fibula head area (5). Material and method. We present the complex case of a young male patient, former alcohol and narcotics user, who suffered an ischemic stroke in the right middle cerebral artery teritory along with a posttraumatic paresis of the right peroneal nerve. The patient presents motor deficit – right spastic hemiplegia, right foot drop, locomotion and self-care disorders. Results and discussions. The patient followed medical treatment (antiepileptic, neurotrophic factors, vitamins, antiplatelet) and rehabilitation treatment adapted to the current clinical-functional status (thermotherapy, lasertherapy, magnetotherapy and individual kinesiotherapy), with slow favorable evolution of the improvement of locomotion and quality of life disorders. Conclusions. Therapeutic-rehabilitation management of the spastic patient with disability due to brain injury and peripheral traumatic neuropathy represents a challenge because it doesn’t exist a miraculous treatement (yet) to cure completely these nervous injuries. Keywords: post stroke spasticity, peroneal nerve palsy, rehabilitation,