Prognostic factors in patients who underwent surgery for common peroneal nerve injury: a nest case-control study

Useful functional recovery and quality of life after surgical treatment of peroneal nerve injuries

Closed injuries to the peroneal nerve recover spontaneously in about a third of patients, but surgery may be needed in the remaining 2/3. The recovery after surgery is not always satisfactory and the patients may need an orthosis or a walking aid to cope with regular daily activities. This study aimed to evaluate the useful functional recovery and quality of life (QoL) in surgically treated patients with peroneal nerve (PN) injuries. The study involved 51 patients who have undergone surgical treatment due to PN injury in our department, within a 15-year period (2006-2020). Thirty patients (59%) were treated with neurolysis, 12 (23%) with nerve repair techniques, and 9 (18%) with tendon transfer (TT). Neurolysis is employed in the least extensive nerve injuries when nerve continuity is preserved and yields a motor recovery ratio of almost 80%. Nerve repairs were followed by 58.33% of patients achieving M3+ recovery, while 41.66% recovered to the useful functional state (M4 or M5) With the use of TTs, all patients recovered to the M3+, while 66.7% recovered to M4. All our results correspond to the results of previous studies. No statistically significant differences were found regarding the QoL of the groups. There is an apparent advantage of neurolysis, over nerve repair, over TT procedure, both in terms of useful functional recovery, and foot-drop-related QoL. However, when involving all aspects of QoL, these advantages diminish. The individual approach leads to optimal results in all groups of patients.

Medical management and rehabilitation in posttraumatic common peroneal nerve palsy

Introduction. The common peroneal nerve and the tibial nerve are the two major components into which the sciatic nerve divides. The severity of common peroneal nerve damage depends on the aetiopathogenic mechanism and the place of injury. The peroneal ram of the sciatic nerve injury is the most common cause of mononeuropathy of the lower limb which can cause a signi-ficant disability if is not properly diagnosed and treated. Material and method. We present the case of a 40-year-old patient who suffered a polytrauma by road accident resulting in left tro-chanteric-diaphyseal femoral comminuted open fracture, lacerated wound on the posterolateral middle third of the left thigh, left sacral wing fracture without displacement, left L1, L2, L3 tran-sverse apophyseal fractures and splenic laceration, treated surgically and orthopedically. The pa-tient was admitted to the Medical Reabilitation Department of Sibiu for left leg motor deficit, mechanical pain and functional deficit of the left hip and ankle, gait disorders. Complex rehabi-litation treatment was initiated 3 months after the accident. Results and discussion. Common pe-roneal nerve palsy was confirmed following neurological consultation the day after admission to Orthopaedics-Traumatology Department of Sibiu where continuous extension-traction was performed in order to relax the fracture and subsequent osteosynthesis surgery of the femur fracture. The presence of a deep and lacerating wound on the posterolateral left thigh caused the nerve injury. The coagulase-negative Staphylococcus aureus overinfection of the wound required secondary suturing and subsequently led to fibrous scar formation, adversely affecting the post-injury repair of the common fibular nerve. Conclusions. In patients with posttraumatic common peroneal nerve palsy, early diagnosis and appropriate treatment, including medical rehabilitation, are essential. Medical rehabilitation should be continued on a sustained basis be-cause nerve regeneration occurs slowly. The prognosis mainly depends on the severity of the initial nerve injury. Keywords: common fibular nerve injury, polytrauma, medical rehabilitation