Garcia-Fernandez Jaime, Belcheva Alexa, Oliver Will, Keating John F
The University of Edinburgh Medical School, 47 Little France Crescent, EH16 4TJ Edinburgh, Scotland, UK.
The Royal Infirmary of Edinburgh, Trauma and Orthopaedics Surgery, 51 Little France Crescent, Old Dalkeith Road, EH16 4SA Edinburgh, Scotland, UK.
Trauma Case Rep. 2023 Aug 21;47:100916. doi: 10.1016/j.tcr.2023.100916. eCollection 2023 Oct.
Common peroneal nerve (CPN) injury is a rare but significant complication of knee trauma. Given its low incidence, there is limited published evidence, but reports have shown dislocations and fractures associated with varus deformity are more likely to injure the nerve, causing foot drop. This study aims to document the incidence and outcome of CPN palsy in tibial plateau fractures (TPF).
We reviewed 746 cases of tibial plateau fractures treated between 2011 and 2020. We analysed patients' demographics, injury mechanisms, clinical course, and complications, and identified those with CPN palsies. Fractures were classified using the Schatzker, Luo and AO/OTA systems. The details of the CPN injury, including nerve conduction studies, duration of symptoms and outcome were recorded.
We identified 11 patients who had concurrent TPFs and CPN palsies, an overall incidence of 1.47 %. Most fractures involved the medial column (n = 9), with the C3 fragmentary TPF pattern being the most common (n = 4). The incidence of CPN injury was higher in medial fractures (5 %) and bicondylar fractures (3 %). We also found that most patients (n = 9) recovered full neurological function within 2 years.
This is the first study looking at a patient cohort sustaining concurrent TPFs and CPN injuries. It is a rare complication but should be looked for in high-risk medial and bicondylar fractures. We found that prognosis is better in TPF-associated CPN palsy than in other knee trauma, and that the majority of patients can expect a full recovery of nerve function.
腓总神经（CPN）损伤是膝关节创伤中一种罕见但严重的并发症。鉴于其发病率较低，已发表的证据有限，但报告显示，与内翻畸形相关的脱位和骨折更有可能损伤该神经，导致足下垂。本研究旨在记录胫骨平台骨折（TPF）中CPN麻痹的发生率和预后。
我们回顾了2011年至2020年期间治疗的746例胫骨平台骨折病例。我们分析了患者的人口统计学、损伤机制、临床病程和并发症，并确定了患有CPN麻痹的患者。骨折采用Schatzker、Luo和AO/OTA系统进行分类。记录CPN损伤的详细情况，包括神经传导研究、症状持续时间和预后。
我们确定了11例同时患有TPF和CPN麻痹的患者，总发生率为1.47%。大多数骨折累及内侧柱（n = 9），C3型粉碎性TPF模式最为常见（n = 4）。内侧骨折（5%）和双髁骨折（3%）中CPN损伤的发生率较高。我们还发现，大多数患者（n = 9）在2年内恢复了完全的神经功能。
这是第一项针对同时发生TPF和CPN损伤的患者队列的研究。这是一种罕见的并发症，但在高风险的内侧和双髁骨折中应予以关注。我们发现，TPF相关的CPN麻痹的预后比其他膝关节创伤更好，并且大多数患者有望完全恢复神经功能。
