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Review Question - QID 217211

QID 217211 (Type "217211" in App Search)
A 24-year-old man presents to the emergency department with severe leg pain after hitting his leg on a trapeze bar as part of an acrobatics act. He was unable to walk after the injury and describes pain located on the lateral aspect of the proximal leg. He has no significant past medical or surgical history. Radiographs are obtained with the results shown in Figure A. If this patient sustained a neurovascular deficit as a result of this injury, which of the following physical exam findings would most likely be seen?
  • A

Decreased ankle plantarflexion

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Decreased first toe extension

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Decreased knee extension

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Decreased sensation over the lateral ankle

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Decreased sensation over the medial ankle

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  • A

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This patient who presents with a traumatic proximal fibular fracture would have the greatest risk of common peroneal nerve injury. Deficits in this nerve would result in decreased first toe extension.

The common peroneal nerve is one of the branches of the sciatic nerve that forms posterior to the knee and courses around the neck of the proximal fibula into the lateral compartment of the leg. There, it divides into a superficial branch, which functions to innervate the peroneal muscles, and a deep branch that functions to innervate the muscles of the anterior compartment of the leg. The common peroneal nerve, therefore, controls ankle dorsiflexion, the extension of the great toe, and eversion of the ankle. It also provides sensation to the anterior leg.

Al-Kashmiri and Delaney present a case report of a trapeze artist who suffered a common peroneal nerve injury secondary to a fatigue fracture of the proximal fibula.

Figure/Illustration A is a lateral radiograph of the knee. A comminuted fracture of the proximal fibula (yellow oval) is seen that would be close in proximity to the course of the common peroneal nerve.

Incorrect Answers:
Answer 1: Decreased ankle plantarflexion would be seen in patients with tibial nerve injuries. This nerve exists in the posterior compartment and would be more commonly damaged by tibial shaft fractures.

Answer 3: Decreased knee extension would be seen in patients with femoral nerve injuries. This nerve runs in the femoral canal of the anterior thigh and would be more susceptible to damage by hyperflexion of the hips or femoral shaft fractures.

Answer 4: Decreased sensation over the lateral ankle would be seen in patients with sural nerve injuries. This nerve runs along the lateral ankle and can be damaged in the lateral approach to the ankle joint.

Answer 5: Decreased sensation over the medial ankle would be seen in patients with saphenous nerve injuries. This nerve runs along the medial ankle and can be damaged in the medial approach to the ankle joint.

Bullet Summary:
Proximal fibula fractures can cause common peroneal nerve injuries because this nerve wraps around the fibular neck.

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