Assessment of Functional Outcome of Bicolumnar Dual Plating for Bicondylar Fractures of Tibial Plateau

Introduction: Operative treatment of bicondylar fractures of tibial plateau is challenging and controversial. Aims: The aim of this study is to reveal the functional outcome of it by using bicolumnar dual plates and screws. Methods: This is a prospective hospital based interventional study carried out in the department of Orthopaedics of Nepalgunj Medical College Teaching Hospital. Thirty two Schatzker type V or AO (Association of Osteosynthesis) type 41 C1 & C2 fractures were treated between January 2016 and December 2019 with bicolumnar dual plating. The functional clinical outcomes were analyzed and evaluated using modified Rasmussen score. Results: Thirty two patients were included in the study. Out of which twenty four were male and eight were female. Average age was 32.21 years, eighteen were right sided and fourteen were left sided. Duration of surgery was 106 mins (range 90-120 mins) and the average duration of hospitalization was 7.81 days (range 4-14 days). Five patients of impending compartment syndrome and three patients with common peroneal nerve palsy were managed conservatively and also were included in the study. Two patients with superficial wound infection needed minimal debridement. One patient had varus angulation of 100 at third follow up after he fell from bed but surgical intervention were not needed. All fractures united. The average time for fracture healing was 21.5 weeks (range 16-32 weeks). At the Eighteen months follow up, the average knee range of motion was 1310(range 1100-1400). The functional outcome were evaluated using modified Rasmussen scoring system, which was 27.34 (range 22-30). Conclusion: Bicolumnar dual plating for bicondylar fractures of tibial plateau can provide excellent and stable fixation allowing early range of motion and gives excellent to good functional outcome.

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.

Movahedi Tendon Transfer in Common Peroneal Nerve Palsy

The article's abstract is not available.

A Case Series of Intraneural Ganglion Cyst Involving the Common Peroneal Nerve: Potential Cause for Foot Drop

Background: Intraneural ganglion cysts (IGC) are non-neoplastic mucinous cysts that form when thick mucinous fluid accumulates in the epineurium of peripheral nerves, with the majority of cases occurring in the para-articular or articular areas. Case Presentation: The two cases of a 69-year-old man and a 59-year-old man who acquired peroneal nerve neuropathy as a result of an intraneural ganglion cyst are presented here. The L.L.R.M. Medical College Department of Orthopedics provided care for them. There was complete nerve recovery in all patients after substantial cyst wall dissection and secretion removal. Conclusion: An intraneural ganglion cyst and trauma may exacerbate nerve damage, despite the fact that it is difficult to detect the cyst before surgery. An early diagnosis and prophylactic actions are typically associated with better outcomes. KEY WORDS: Intraneural ganglion, Common peroneal nerve, Foot drop.

Anatomic Multiple Ligament Reconstructions of the Knee

Background: Multiple ligament injuries of the knee occur in a variety of settings, often from athletic activities. Multiple cruciate and collateral ligament injuries may be associated with hamstring tendon rupture, common peroneal nerve (CPN) injury, meniscus, bone, and cartilage damage. Indications: After evaluation for concomitant life-threatening and vascular injuries (especially of the popliteal artery), the knee is assessed through a thorough physical examination and imaging series, including varus, valgus, and posterior stress radiography, and magnetic resonance imaging (MRI). Research over the last 30 years has suggested that operative treatment in the acute setting (<3 weeks) in a single-stage procedure may have improved results to delayed/staged reconstruction. Early range of motion starting on postoperative day 1 is important to prevent development of arthrofibrosis. Technique: We describe the technique used to surgically manage a patient suffering from anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and complete posterolateral corner (PLC) rupture. Neurolysis of the CPN is performed to free the irritated nerve from scar tissue, along with biceps femoris tendon and lateral capsular repairs. Anatomic-based reconstructions are performed. The ACL reconstruction is with a single bundle using a patellar tendon autograft, PCL reconstruction is a double bundle with Achilles and tibialis anterior tendon allografts, and PLC reconstruction is accomplished with a split Achilles tendon allograft. The correct orientation of tunnel placement must be planned to avoid tunnel convergence; these angles have been determined through 3D modeling. The optimal sequence for graft tensioning has been established and follows the pattern: PCL, ACL, PLC, and then medial-sided structures if necessary. Results: Successful outcomes have been reported for both medial and lateral based injuries, and follow-up studies have also shown equivalent results between acute and chronic outcomes, and for multiligament injuries involving the ACL and PCL if anatomic reconstructions with appropriate tunnel angles, passage and tensioning sequence of grafts, and rehabilitation regimens are performed. Discussion/Conclusion: Single-stage anatomic reconstruction is the gold standard for managing multiple ligament injuries in the knee. Commencement of early 0° to 90° knee range of motion and PCL-supporting bracing are critical to prevent arthrofibrosis and protect the grafts from attenuation.

Electrical stimulation of the common peroneal nerve and its effects on the relationship between corticomuscular coherence and motor control in healthy adults

Background Sensory input via neuromuscular electrical stimulation (NMES) may contribute to synchronization between motor cortex and spinal motor neurons and motor performance improvement in healthy adults and stroke patients. However, the optimal NMES parameters used to enhance physiological activity and motor performance remain unclear. In this study, we focused on sensory feedback induced by a beta-band frequency NMES (β-NMES) based on corticomuscular coherence (CMC) and investigated the effects of β-NMES on CMC and steady-state of isometric ankle dorsiflexion in healthy volunteers. Twenty-four participants received β-NMES at the peak beta-band CMC or fixed NMES (f-NMES) at 100 Hz on different days. NMES was applied to the right part of the common peroneal nerve for 20 min. The stimulation intensity was 95% of the motor threshold with a pulse width of 1 ms. The beta-band CMC and the coefficient of variation of force (Force CV) were assessed during isometric ankle dorsiflexion for 2 min. In the complementary experiment, we applied β-NMES to 14 participants and assessed beta-band CMC and motor evoked potentials (MEPs) with transcranial magnetic stimulation. Results No significant changes in the means of beta-band CMC, Force CV, and MEPs were observed before and after NMES conditions. Changes in beta-band CMC were correlated to (a) changes in Force CV immediately, at 10 min, and at 20 min after β-NMES (all cases, p < 0.05) and (b) changes in MEPs immediately after β-NMES (p = 0.01). No correlations were found after f-NMES. Conclusions Our results suggest that the sensory input via NMES was inadequate to change the beta-band CMC, corticospinal excitability, and voluntary motor output. Whereas, the β-NMES affects the relationship between changes in beta-band CMC, Force CV, and MEPs. These findings may provide the information to develop NMES parameters for neurorehabilitation in patients with motor dysfunction.

Complications of surgical reconstruction of multiligament injuries of the knee joint: diagnosis, prevention and treatment

The main complications of surgical reconstruction of multiligament injuries of the knee joint are residual or recurrent instability, arthrofibrosis, popliteal artery injury, common peroneal nerve injury, compartment syndrome, fluid extravasation, symptomatic heterotopic ossification, wound problems and infection, deep venous thrombosis, and revision surgery. Careful surgical planning and execution of the primary surgical reconstruction of multiligament injuries of the knee joint can minimize the risk of the aforementioned complications. Careful postoperative follow-up is required to detect complications. Early recognition and prompt treatment are of paramount importance. To obtain good results in the revision surgery of failed multiligamentary knee reconstructions, it is crucial to perform a thorough and exhaustive evaluation to detect all the causes of failure. Addressing all associated injuries during revision surgery will lead to the best possible subjective and objective results, although functional outcomes are often modest. However, advanced age and high-energy injuries have been associated with the poorest functional outcomes after revision surgery of failed multiligament injuries of the knee joint. Cite this article: EFORT Open Rev 2021;6:973-981. DOI: 10.1302/2058-5241.6.210057

FOOT DROP FOLLOWING COVID-19 INFECTION. A CASE REPORT AND ITS OUTCOME

INTRODUCTION: Corona virus disease-19 (COVID-19) is one among the worst pandemics faced by mankind and there are various neurological manifestations either direct or indirect effect of Corona virus. Here we report a case of foot drop secondary to entrapment peroneal injury in COVID-19 patient as a sequelae of prone positioning. CASE REPORT: A 55-year-old gentleman was diagnosed with RT PCR positive COVID19 and was hospitalized for severe respiratory syndrome. HRCT thorax done showed CORADS score of 6 with severity index of 14/25. During this period, patient was on treatment according to ICMR guidelines and prone position for about 20 hours/day for 20 days for severe pneumonia. During follow up after 15 days of discharge, he had developed features of foot drop secondary to common peroneal nerve palsy which was later conrmed by electro diagnostic studies and nerve ultrasound. Patient was started on oral steroids and along with supportive measures. He is followed up for a period of 3 months and has noted 50% improvement in his symptoms. CONCLUSION: While prone positioning should continue to be utilized in COVID-19 pneumonia as dictated by the current literature, precaution has to be taken with it. Changing patient positioning at shorter intervals and timely mobilization are necessary.

Magnetic resonance imaging evaluation of common peroneal nerve injury in acute and subacute posterolateral corner lesion: a retrospective study

Objective: To evaluate qualitative and quantitative magnetic resonance imaging (MRI) criteria for injury of the common peroneal nerve (CPN) in patients with acute or subacute injuries in the posterolateral corner (PLC) of the knee, as well as to evaluate the reproducibility of MRI evaluation of CPN alterations. Materials and Methods: This was a retrospective study of 38 consecutive patients submitted to MRI and diagnosed with acute or subacute injury to the PLC of the knee (patient group) and 38 patients with normal MRI results (control group). Two musculoskeletal radiologists (designated radiologist A and radiologist B, respectively) evaluated the images. Nerve injury was classified as neurapraxia, axonotmesis, or neurotmesis. Signal strength was measured at the CPN, the tibial nerve (TN), and a superficial vein (SV). The CPN/TN and CPN/SV signal ratios were calculated. The status of each PLC structure, including the popliteal tendon, arcuate ligament, lateral collateral ligament, and biceps tendon, was classified as normal, partially torn, or completely torn, as was that of the cruciate ligaments. For the semiquantitative analysis of interobserver agreement, the kappa statistic was calculated, whereas a receiver operating characteristic (ROC) curve was used for the quantitative analysis. Results: In the patient group, radiologist A found CPN abnormalities in 15 cases (39.4%)-neurapraxia in eight and axonotmesis in seven-whereas radiologist B found CPN abnormalities in 14 (36.8%)-neurapraxia in nine and axonotmesis in five. The kappa statistic showed excellent interobserver agreement. In the control group, the CPN/TN signal ratio ranged from 0.63 to 1.1 and the CPN/SV signal ratio ranged from 0.16 to 0.41, compared with 1.30-4.02 and 0.27-1.08, respectively, in the patient group. The ROC curve analysis demonstrated that the CPN/TN signal ratio at a cutoff value of 1.39 had high (93.3%) specificity for the identification of nerve damage, compared with 81.3% for the CPN/SV signal ratio at a cutoff value of 0.41. Conclusion: CPN alterations are common in patients with PLC injury detected on MRI, and the level of interobserver agreement for such alterations was excellent. Calculating the CPN/TN and CPN/SV signal ratios may increase diagnostic confidence. We recommend systematic analysis of the CPN in cases of PLC injury.