Melorheostosis Causing Compression of Common Peroneal Nerve at Fibular Tunnel

A case report of old injury of lateral collateral ligament of knee joint combined with injury of common peroneal nerve

Since common peroneal nerve is easy be injured because of superficial position of caput fibulae, less surrounding soft tissue and poor mobility, injury of common peroneal nerve is a problem worth discussing in the field of trauma orthopedics. Common peroneal nerve injury often causes foot prolapse, inability in dorsiflexion and eversion, sensory disturbance of anterolateral side of the lower leg and dorsum of foot. In this article, a case of old injury of lateral collateral ligament of knee joint combined with an avulsion fracture of fibular head resulting in injury of common peroneal nerve was reported and repaired by surgery with good effects.

An Update on Peroneal Nerve Entrapment and Neuropathy

Peroneal neuropathy is the most common compressive neuropathy of the lower extremity. It should be included in the differential diagnosis for patients presenting with foot drop, the pain of the lower extremity, or numbness of the lower extremity. Symptoms of peroneal neuropathy may occur due to compression of the common peroneal nerve (CPN), superficial peroneal nerve (SPN), or deep peroneal nerve (DPN), each with different clinical presentations. The CPN is most commonly compressed by the bony prominence of the fibula, the SPN most commonly entrapped as it exits the lateral compartment of the leg, and the DPN as it crosses underneath the extensor retinaculum. Accurate and timely diagnosis of any peroneal neuropathy is important to avoid progression of nerve injury and permanent nerve damage. The diagnosis is often made with physical exam findings of decreased strength, altered sensation, and gait abnormalities. Motor nerve conduction studies, electromyography studies, and diagnostic nerve blocks can also assist in diagnosis and prognosis. First-line treatments include removing anything that may be causing external compression, providing stability to unstable joints, and reducing inflammation. Although many peroneal nerve entrapments will resolve with observation and activity modification, surgical treatment is often required when entrapment is refractory to these conservative management strategies. Recently, additional options including microsurgical decompression and percutaneous peripheral nerve stimulation have been reported; however, large studies reporting outcomes are lacking.

Meralgia Paresthetica Caused by Melorheostosis Affecting the Ipsilateral Ilium: A Case Report

CASE

A 51-year-old woman presented with a 2-month history of pain in the right thigh. Radiography and computed tomography of the pelvis showed cortical hyperostosis of the right ilium. She was diagnosed with meralgia paresthetica (MP) caused by melorheostosis involving the right ilium. After 6 weeks of conservative management, an operation was performed for the persisting pain. At the 1-year follow-up, no findings of recurrence were observed clinically and radiographically.

CONCLUSION

MP, caused by proximal irritation of the lateral femoral cutaneous nerve, can occur because of melorheostosis, which is a rare condition.