Peroneal palsy as a complication of developmental hip dysplasia surgery

Nerve injuries are rare complications of surgical management of developmental dysplasia of the hip (DDH). Over-stretching can cause injuries of femoral, sciatic and peroneal nerves. In this report, we present a 6-year-old girl with Tönnis type IV bilateral DDH whose postoperative period was complicated with foot drop due to the breakage of the spica cast. Open reduction and Pemberton pericapsular osteotomies, high femoral osteotomies for derotation and shortening had been performed on both hips of the patient. Patient had been kept in a spica cast for six weeks. At the 6th week follow up visit it was observed that spica cast was broken at the knee. When the cast was removed foot drop was noted on left foot. Electromyoneurography (EMNG) revealed total axonal degeneration of the peroneal nerve at the level of the fibular head. The conservative therapy for 18 months failed to result in any improvement in common peroneal nerve function. Therefore, peroneal nerve decompression, neurolysis and posterior tibial tendon transfer had been performed. At the 4th year follow up visit the patient had active dorsiflexion of the ankle, no need for AFO and the foot was plantigrade and painless. We presented this case report in order to inform the orthopedic surgeons performing DDH surgeries about a possible complication of the spica cast and to emphasis the necessity of good care of the spica cast.

Keywords:

Complication, Hip dysplasia Peroneal palsy, Surgery,

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Bekler, H., et al. (2007). "Tibialis posterior tendon transfer for drop foot deformity." Acta orthopaedica et traumatologica turcica 41(5): 387-392. Evans, J., et al. (1994). "Compression neuropathy of the common peroneal nerve caused by a ganglion." Microsurgery 15(3): 193-195. Garozzo, D., et al. (2002). "Common peroneal nerve injuries in knee dislocations: results with one-stage nerve repair and tibialis posterior tendon transfer." Journal of Orthopaedics and Traumatology 2(3): 135-137. Halm, J. A. and T. Schepers (2012). "Damage to the superficial peroneal nerve in operative treatment of fibula fractures: straight to the bone? Case report and review of the literature." The Journal of Foot and Ankle Surgery 51(5): 684-686. Hellinger, J. and H. Schmidt (1982). "The pericapsular osteotomy of the os ilium in the treatment of flat acetabula." Archives of orthopaedic and traumatic surgery 101(1): 53-57. Karakurt, L., et al. (2004). "Early results of treatment for developmental dysplasia of the hip in children between the ages of one and four years." Acta orthopaedica et traumatologica turcica 38(1): 8-15. Kessler, J. I., et al. (2001). "Use of allografts in Pemberton osteotomies." Journal of Pediatric Orthopaedics 21(4): 468-473. Lalonde, F. D., et al. (2002). "Surgical correction of residual hip dysplasia in two pediatric age-groups." JBJS 84(7): 1148-1156. Lippin, Y., et al. (1993). "Postburn peroneal nerve palsy—a report of two consecutive cases." Burns 19(3): 246-248. McCrory, P., et al. (2002). "Nerve entrapments of the lower leg, ankle and foot in sport." Sports Medicine 32(6): 371-391. Mont, M. A., et al. (1996). "The operative treatment of peroneal nerve palsy." JBJS 78(6): 863-869. Pekmezci, M. and M. Yazici (2007). "Salter osteotomy: an overview." Acta Orthop Traumatol Turc 41(Suppl 1): 37-46. Pemberton, P. A. (1965). "Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip." JBJS 47(1): 65-86. Pichler, W., et al. (2009). "The risk of iatrogenic injury to the deep peroneal nerve in minimally invasive osteosynthesis of the tibia with the less invasive stabilisation system: a cadaver study." The Journal of bone and joint surgery. British volume 91(3): 385-387. Salter, R. B., et al. (1984). "Innominate osteotomy in the management of residual congenital subluxation of the hip in young adults." Clinical orthopaedics and related research(182): 53-68. Toğrol, E., et al. (2000). "Bilateral peroneal nerve palsy induced by prolonged squatting." Military medicine 165(3): 240-242. Tomaino, M., et al. (2000). "Peroneal nerve palsy following knee dislocation: pathoanatomy and implications for treatment." Knee Surgery, Sports Traumatology, Arthroscopy 8(3): 163-165. Watemberg, N., et al. (2000). "Common peroneal neuropathy due to surfing." Journal of the Peripheral Nervous System 5(4): 249-249. Wilkinson, M. and R. Birch (1995). "Repair of the common peroneal nerve." The Journal of bone and joint surgery. British volume 77(3): 501-503.

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Yayın Aralığı: Yılda 4 Sayı
Başlangıç: 1980
Yayıncı: Ondokuz mayıs Üniversitesi Tıp Fakültesi

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