this is the Orthopaedics case presentation that was a

1. CASE 7
BY: Fakhruddin Hafiy bin Hamad
Wahid

2. Case:
A 48-year old gentleman gives history of
motor vehicle accident. He sustained central
fracture dislocation of right hip joint. Hip joint was
reduced and he was put on upper tibial pin traction.
After one week, he is not able to dorsiflex his foot ,
or extend the toes. The foot circulation is normal.

3. Q1) What is the clinical diagnosis? Which nerve
has been injured?
• Diagnosis is fracture dislocation of right hip
with common peroneal nerve injury post
upper tibial pin insertion
• The nerve that has been injured is common
peroneal nerve

4. Q2) List the motor and sensory supply of this
nerve
• Muscles of anterior compartment : tibialis
anterior, extensor hallucis longus, extensor
digitorum longus, peroneus tertius
• Muscles of peroneal compartment: peroneus
brevis, peroneus longus
• Muscles of the foot: extensor digitorum brevis

6. Q3) How do you localise the level of this nerve
injury?
• Complete lesion-harmstrings and all muscles below
knee are paralysed, ankle jerk absent, sensation is lost
below knee*, foot drop.
• Common peroneal-Foot drop (high-stepping gait), can’t
dorsiflex or evert foot, lost of sensation over the front
and outer half of the leg and the dorsum of the foot,
wasting of muscle of anterior and peroneal
compartments
• Loss of sensation: skin between first and second toes
(deep peroneal) and dorsum of the foor and medial
four toes (superficial peroneal)
• Palpate bony prominence for any abnormality (head of
fibula)

7. Q4) How do you manage this case?
• Splintage of the paralysed limb
– First procedure to be adopted in every case of nerve injury
– Splint in the position which will most effectively relax the
affected muscles
– Use foot drop splint
• If no recovery following splintage,do tibialis posterior
tendon transfer or by hind foot stabilisation
• Preserve mobility of the joint
• Care of the skin and nails
• Physiotherapy: massage, exercise, build up, developing
of unaffected muscle
• Relief of pain by analgesics

8. THANK YOU