A rare cause of ‘drop foot’ in the pediatric age group: Proximal fibular osteochondroma a report of 5 cases

Abstract

INTRODUCTIONThe fibular nerve is the most frequent site of neural entrapment in the lower extremity and the third most common site in the body, following the median and ulnar nerves. The peroneal nerve is commonly injured upon trauma. Additionally, a dropped foot might be a symptom related to the central nervous system or spinal pathologies in pediatric patients. Entrapment of the peripheral nerve as an etiologic cause should be kept in mind and further analyzed in orthopedic surgery clinics.PRESENTATION OF CASEIn this study, the evaluation and treatment results of five patients with no history of trauma, who underwent diagnostic procedures and treatment in various clinics (physical therapy and rehabilitation and neurosurgery), are reported. The patients underwent several treatments without diagnosis of the primary etiology. Upon initial consultation at our department, osteochondroma at the proximal fibula was detected after physical examination and radiologic assessment. During surgery, the peroneal nerve was dissected, starting from a level above the knee joint. Following nerve release, the osteochondroma was removed, including its cartilage cap. Consequently, recovery was observed in all five cases after surgery.DISCUSSIONMany factors may cause non-traumatic neuropathies. However, due to their rare occurrence, lesions such as osteochondromas may be overlooked at non-orthopedic clinics. Nerve entrapment due to proximal fibular osteochondroma is rare. Surgical treatment planning plays a critical role in nerve entrapment cases.CONCLUSIONDespite its frequent occurrence, a drop foot associated with peroneal nerve entrapment by an osteochondroma is not easily remembered and diagnosed. Especially in pediatric cases, inadequate clinical consultation and a lack of appropriate radiologic studies may result in a delay in diagnosing peroneal nerve lesions.

Peroneal Nerve Palsy due to Bulky Osteochondroma from the Fibular Head: A Rare Case and Literature Review

“…Compression of the CPN frequently occurs in association with lesions at the neck of the fibula in 54% of all cases; its traumatic etiology represents 40% whereas its tumoral origin stands for only 6% [ 8 ]. Spur or tumoral structure formation at the level of the proximal fibula can potentially apply pressure to the surrounding structures especially on the CPN [ 9 ].…”

“…Kim and Kline [ 12 ] reported 302 cases of peroneal nerve injuries and described only one patient who presented bilateral peroneal compression by exostosis of the head of the fibula. Only a few cases of entrapment of the peroneal nerve by cartilaginous exostosis have been reported so far [ 9 ]. It is assumed that paralysis in our case is secondary to exostosis and provoked by the trauma to the knee.…”

Osteochondromas originating from unusual locations complicating orthopedic discipline: case series

“…[20][21][22][23][24][25][26][27][28][29][30][31][32][33] After retrieval from the literature, we observed that the symptomatology was mostly related with peroneal nerve compression except the popliteal artery-related problems.…”

“…Plain radiographs (anteroposterior and lateral view) of the leg with knee revealed a large cauliflower-like growth arising from proximal fibula ( Figure 4 [13][14][15][16][17][18][19] 15 articles (except surgical technique reports) [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] 14 articles in literature [20][21][22][23][24][25][26][27][28][29][30][31][32][33] 14 articles in literature [20][21][22][23][24][25][26][27][28][29][30][31][32]…”

Diz çevresi peroneal sinir tuzak nöropatisi

“…Geçirilmiş olan travmalar sonucunda ortaya çıkan artritik değişikler, deformiteler ve anormal kallus varlığı, direkt grafiler ile değerlendirilebilir. [8,19] Fibula başı çevresindeki yapısal değişiklikler veya eksositoz gibi tümöral gelişimler de ilk olarak direkt grafi ile değerlendirilir. Manyetik rezonans (MR) görüntüleme, fibula başı çevresindeki kistik oluşumları ve solid kitlelerin ayırıcı tanısı açısından yardımcı olabilir.…”