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15-AUGUST-2017 DINA SHAREEF RASHEED 63 YEARS
DROP LEFT FOOT AFTER DIRECT INJURY TO THE LEFT KNEE AND FAILED NEUROLYSIS OF THE
LEFT PERONEAL NERVE AND ITS DIVISIONS.
The patient was operated by me
18-April-2016 for damaged peroneal nerve
after gross injury of the left knee. Despite the
fact, that the nerve and its branches were
relatively acceptable, but atrophic and they
were differentially responding to high voltage
motor stimulation, but in the long run no
acceptable recovery of the motor fibers took
place. Sensation improved to certain level.
On examination, last time 23-May-2017 the
patient still having drop left foot. She
underwent total knee replacement
03-December-2016. EMG was requested and
performed 21-May-2017 confirming severe axonal
damage of the peroneal nerve and its
The attachment of the
tibialis posterior was released from the
navicular bone. The tendon of the tibialis
posterior was exposed at the lower third of the
foreleg and pulled up. A parallel incision
lateral to the tibia below the level of the
second incision was created and tunnel with
widening of the interossius membrane was created
posterior to the tibial bone and the tendon
pushed to that area. Using fluoroscopy, the 3d
cuneiform bone was identified and drilling was
performed. Using Depuy Coat anchor plus 2.9 mm,
the distal part of the transferred tendon was
fixed to the exposed mentioned above bone and
aided with further stitching to the periostium
to obtain more fixation. Routine closure of the
wounds. Below knee cast was applied.
Smooth postoperative recovery.
She was sent to the ward.
The patient suffered left knee injury
with traction injury to the peroneal nerve. Drop foot was
immediately noticed after accident. Neurolysis of the common
peroneal nerve and its divisions performed 16 months ago
showed integrity of the neural structures, and cNAP was
performed and it gave positive response, but weak. The
nerves were atrophic, but the have no neuroma and mostly
having fibrillary structure inside the nerves. The
patient showed improvement of the sensory pattern, such as
regression of the analgesia area and disappearance of the
burning sensation of the involved area. Motor activity
remain the same.
It seems that neurolysis must proceed
tendon transfer, to give the patient the opportunity for
Suppose that we cut the atrophic segments
and applied neural graft. From my opinion, the postoperative
results will be worse in this case.