Bhakare Dattatray, Patil Amit, Salunkhe Rahul, Bhakare Swati, Mitra Rachit
Orthopaedics and Trauma, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to Be University), Pune, IND.
Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to Be University), Pune, IND.
Cureus. 2024 Jul 24;16(7):e65318. doi: 10.7759/cureus.65318. eCollection 2024 Jul.
The aim of this study is to bring attention to a unique case and our approach to treatment in this context. We describe a case of an 11-year-old male who presented to us with an injury to his left knee following trauma with pain, swelling, shortening and deformity for one day. An X-ray revealed a transepiphyseal fracture dislocation of the left distal femur (Salter-Harris type 1 injury) and neurovascular examination was conclusive of foot drop which pointed towards injury to common peroneal nerve (CPN). The patient was taken up for closed reduction with percutaneous pinning under mobile C-arm guidance. The fracture was reduced and fixed with two cross K-wires and immobilized with the above knee anterior-posterior slab for six weeks. The wires were removed after six weeks but there was no improvement in the dorsiflexion of the left ankle. An electromyography (EMG) and nerve conduction velocity (NCV) study test was performed after 12 weeks which showed decreased amplitude and prolonged latency in the left CPN with early denervation of the muscles supplied by the left CPN. Fifteen weeks of follow-up showed complete recovery in the dorsiflexion of the left ankle with a slight lag in the extension of the left great toe making this an unusually delayed recovery of CPN palsy following a distal femur transepiphyseal fracture.
本研究的目的是引起人们对一个独特病例以及我们在此情况下的治疗方法的关注。我们描述了一例11岁男性病例，该患者因外伤导致左膝受伤，出现疼痛、肿胀、缩短和畸形，病程一天。X线检查显示左股骨远端骨骺骨折脱位（Salter-Harris Ⅰ型损伤），神经血管检查确诊为足下垂，提示腓总神经（CPN）损伤。患者在移动C型臂引导下接受了闭合复位经皮穿针固定术。骨折用两根交叉克氏针复位固定，并用上述膝上前后石膏固定六周。六周后取出克氏针，但左踝关节背屈无改善。12周后进行了肌电图（EMG）和神经传导速度（NCV）研究测试，结果显示左CPN波幅降低、潜伏期延长，左CPN所支配肌肉出现早期失神经改变。15周的随访显示左踝关节背屈完全恢复，但左拇趾背伸稍有延迟，这使得该病例成为股骨远端骨骺骨折后CPN麻痹异常延迟恢复的病例。
