Correction of genu recurvatum by the Ilizarov method. (1/39)

The Ilizarov apparatus was used to carry out opening-wedge callotasis of the proximal tibia in ten patients who had suffered premature asymmetrical closure of the proximal tibial physis and subsequent genu recurvatum. In four knees, the genu recurvatum was entirely due to osseous deformity, whereas in six it was associated with capsuloligamentous abnormality. Preoperatively, the angle of recurvatum averaged 19.6 degrees (15 to 26), the angle of tilt of the tibial plateau, 76.6 degrees (62 to 90), and the ipsilateral limb shortening, 2.7 cm (0.5 to 8.7). The average time for correction was 49 days (23 to 85). The average duration of external fixation was 150 days (88 to 210). Three patients suffered complications including patella infera, pin-track infection and transient peroneal nerve palsy. At a mean follow-up of 4.4 years, all patients, except one, had achieved an excellent or good radiological and functional outcome.  (+info)

Intraneural mucoid pseudocysts. A report of ten cases. (2/39)

A mucoid pseudocyst of a peripheral nerve is a rare and benign tumour of controversial origin. We have reviewed ten patients with a mean follow-up of 3.2 years. The tumour affected the common peroneal nerve in eight and the ulnar nerve in two. The mean time between the onset of symptoms and diagnosis was 7.4 months (1.2 months to 2 years). On examination, there was pain in eight patients and swelling in seven. Motor deficit in the corresponding nerve territory was found in all. The diagnosis was usually confirmed by MRI. Treatment was always surgical. All the patients recovered, with a mean time to neurological recovery of 10.75 months. Recurrence was seen in only one patient and was treated successfully by further surgery. Our results are similar to those reported by other authors. A successful surgical outcome depends on early diagnosis before neurological damage has occurred.  (+info)

Intermediate follow-up of high tibial osteotomy: a comparison of two techniques. (3/39)

All high tibial osteotomies (HTOs) performed in the Royal Bournemouth Hospital from June 1987 to February 1995 were retrospectively analyzed looking at the preoperative and postoperative radiographs, preoperative and postoperative range of motion (ROM), alignment, and knee scores. Patient perception was also recorded. In all there were 68 high tibial osteotomies (HTOs), of which 40 were performed by Maquet's dome method and 28 were done by closing wedge osteotomy. Average follow up was 8.6 years (range: 5.2 to 13 years) and 16 (23.5%) cases went on to have total knee arthroplasty after an average interval of 3.7 years. The results of the two methods are compared. Average preoperative HTO alignment was a varus of 4.72 degrees and average postoperative HTO alignment was a valgus of 1.48 degrees. The average radiological grade of osteoarthritis and compartments affected was comparable in the two groups. Overall 35 (51.5%) patients were dissatisfied with their results. A larger percentage of people (57.5%) who had a Maquet's dome osteotomy were unhappy with their operation as compared to 42.9% of people who were unhappy following a closing wedge osteotomy. There was consistent undercorrection after dome osteotomy, with an average alignment of a varus of 1.45 degrees compared to a valgus of 5.67 degrees after a closing wedge procedure. The preoperative subluxation was greater in the patients with a relatively poor result, 3.86 mm compared to 2.03 mm in those with a good result. It is felt that the rather poor results following osteotomy in this series was due to insufficient correction obtained and the advanced stage of osteoarthritis resulting in subluxation. In this series the correction obtained with closing wedge method was better than with the dome method, although it was inadequate with both methods. Although the wedges appeared to do better than the domes, this was not statistically significant. Overall, there was no significant correlation of our results with post osteotomy alignment. Preoperative lateral tibial subluxation was, however, a poor prognosticator of results.  (+info)

Isolated superficial peroneal nerve lesion in pure neural leprosy: case report. (4/39)

Patients with leprosy may have only nerve involvement without skin changes. These cases are known as pure neural leprosy and can be seen in 10% of leprosy patients. Most patients have mononeuritic or multiple mononeuritic neuropathy patterns. The isolated lesion of the superficial peroneal nerve is uncommonly seen. We report a patient with involvement of this nerve in which there was no thickening of superficial nerves. The performed nerve biopsy showed inflammatory infiltration, loss of fibers and presence of Mycobacterium leprae. We believe that in prevalent leprosy countries we should take in mind the possibility of isolated pure neural leprosy in some patients without skin lesion. In these cases the diagnosis of leprosy is impossible on clinical grounds and nerve biopsy is mandatory.  (+info)

Neurovascular compression of the common peroneal nerve by varicose veins. (5/39)

Compression of the common peroneal nerve occurs sometimes, but compression caused by varicose veins has not been reported before. We report a case of common peroneal nerve compression syndrome which was confirmed and treated surgically. A 63-year-old woman complained of paraesthesia on the lateral aspect of the right leg, which was worse in the evening. A primary varicose vein arising from non-saphenous tributaries was seen in the posterior calf. Her symptoms resolved with the wearing of compression hosiery for 2 weeks. At operation, the common peroneal nerve was found to be surrounded by tortuous varicosities. After decompression the paraesthesia on the lateral aspect of the right leg resolved completely with no evidence of residual neuralgia.  (+info)

Palsy of the common peroneal nerve after traumatic dislocation of the knee. (6/39)

Injury to the common peroneal nerve was present in 14 of 55 patients (25%) with dislocation of the knee. All underwent ligament reconstruction. The most common presenting direction of the dislocation was anterior or anteromedial with associated disruption of both cruciate ligaments and the posterolateral structures of the knee. Palsy of the common peroneal nerve was present in 14 of 34 (41%) of these patients. Complete rupture of the nerve was seen in four patients and a lesion in continuity in ten. Three patients with lesions in continuity, but with less than 7 cm of the nerve involved, had complete recovery within six to 18 months. In the remaining seven with more extensive lesions, two regained no motor function, and one had only MRC grade-2 function. Four patients regained some weak dorsiflexion or eversion (MRC grade 3 or 4). Some sensory recovery occurred in all seven of these patients, but was incomplete. In summary, complete recovery occurred in three (21%) and partial recovery of useful motor function in four (29%). In the other seven (50%) no useful motor or sensory function returned.  (+info)

Knee dislocation of a morbidly obese patient: a case report. (7/39)

Knee dislocations of morbidly obese patients after a trivial fall are not uncommon. We report a case of closed reduction for a dislocated right knee of a 26-year-old obese woman. After closed reduction under general anaesthesia, her knee was supported by pillows in 30 degrees flexion. No external splint was used because of the enormous size of the leg. At day 4 after reduction, the patient had numbness over the dorsum of the right foot and was unable to dorsiflex. She was diagnosed as having peroneal nerve palsy and was fitted with a foot drop splint. One week after reduction, she started active, assisted knee mobilisation and tip-toe weight bearing. At 24 months after reduction, the patient was able to walk unaided and had 100 degrees of knee flexion. She had a good foot function and a grade II in the Lachman's test, with no varus or valgus instability. This case highlights the importance of early mobilisation, which can result in good outcome even without operative treatment.  (+info)

Entrapment of a displaced common peroneal nerve following knee ligament reconstruction. (8/39)

We present a case of disruption of the posterolateral corner of the knee with avulsion of the tendon of biceps femoris. Repair and reconstruction included an allogenic tendon graft to replace the posterior cruciate ligament. Surgery was followed by a complete common peroneal nerve palsy. Revision surgery revealed that the nerve had been displaced anteriorly by avulsion of the biceps tendon and the tendon graft encircled it. Release of the nerve restored normal function at five months.  (+info)

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