J Korean Foot Ankle Soc.  2022 Mar;26(1):54-58. 10.14193/jkfas.2022.26.1.54.

Intra-Osseous Nerve Transposition in Iatrogenic Injury of the Superficial Peroneal Nerve: Two Case Reports

• Yang S
• Kim JS

• KMID: 2527013
• DOI: http://doi.org/10.14193/jkfas.2022.26.1.54

Abstract

Superficial peroneal nerve (SPN) injuries happen occasionally during surgical treatment of fibular fracture, lateral ankle ligament repair, etc. These injuries are caused because of the variable location of the SPN. It is the injuries are usually treated by steroid injections or anticonvulsants. However, neural symptoms may not respond to treatment and may persist and progress to a painful neuroma. Intractable pain may need surgical treatment. We examined two cases of iatrogenic postoperative SPN injury, and we treated them with transection of the SPN and the intraosseous transposition of the proximal nerve stump using the thrombin-fibrinogen complex with satisfactory outcomes. We report these two cases with a review of the relevant literature.

Keyword

Superficial peroneal nerve; Injury; Neuroma; Transection; Transposition

Figure

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  Figure. 1 (A) The patient complained tingling sensation and burning pain at ankle and foot dorsum after ankle ligament repair. (B) Intraoperative finding shows suspected bulging of superficial peroneal nerve medial branch (black arrow). (C) The superficial peroneal nerve was transected at the proximal normal part above neuroma. (D) Intraoperative photograph shows intraosseous transposition of superficial peroneal nerve into the hole of fibula (black arrow). We fixed the nerve ending on fibular hole using the thrombin-fibrinogen complex (Grenplast Q).

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  Figure. 2 (A, B) Preoperative radiography shows the spiral high fibular fracture with widening of syndesmosis and medial malleolar fracture. (C, D) Postoperative radiography shows trans-syndesmotic fixation for syndesmotic injury and 2 cannulated screw fixation for medial malleolar fracture and locking plate fixation for high fibular fracture.

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  Figure. 3 (A) Intraoperative finding shows partial injury of superficial peroneal nerve (black arrow). We marked at the proximal part of the injured superficial peroneal nerve without tension (white arrow). (B) Intraoperative photograph shows intraosseous transposition of superficial peroneal nerve into the empty screw hole of fibula (black arrow). We fixed the nerve ending on fibular hole using the thrombin-fibrinogen complex (Grenplast Q).

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