CASE 7

BY: Fakhruddin Hafiy bin Hamad Wahid

Case:A 48-year old gentleman gives history of motor

vehicle accident. He sustained central fracture dislocation of right hip joint. Hip joint was reduced and he was put on upper tibial pin traction. After one week, he is not able to dorsiflex his foot , or extend the toes. The foot circulation is normal.

Q1) What is the clinical diagnosis? Which nerve has been injured?

• Diagnosis is fracture dislocation of right hip with common peroneal nerve injury post upper tibial pin insertion

• The nerve that has been injured is common peroneal nerve

Q2) List the motor and sensory supply of this nerve

• Muscles of anterior compartment : tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius

• Muscles of peroneal compartment: peroneus brevis, peroneus longus

• Muscles of the foot: extensor digitorum brevis

Q3) How do you localise the level of this nerve injury?• Complete lesion-harmstrings and all muscles below knee

are paralysed, ankle jerk absent, sensation is lost below knee*, foot drop.

• Common peroneal-Foot drop (high-stepping gait), can’t dorsiflex or evert foot, lost of sensation over the front and outer half of the leg and the dorsum of the foot, wasting of muscle of anterior and peroneal compartments

• Loss of sensation: skin between first and second toes (deep peroneal) and dorsum of the foor and medial four toes (superficial peroneal)

• Palpate bony prominence for any abnormality (head of fibula)

Q4) How do you manage this case?• Splintage of the paralysed limb

– First procedure to be adopted in every case of nerve injury– Splint in the position which will most effectively relax the

affected muscles– Use foot drop splint

• If no recovery following splintage,do tibialis posterior tendon transfer or by hind foot stabilisation

• Preserve mobility of the joint• Care of the skin and nails• Physiotherapy: massage, exercise, build up,

developing of unaffected muscle• Relief of pain by analgesics

THANK YOU