Posts

Osteochondroma Arising from the Head of the Fibula: A Rare Cause of Drop Foot in Pediatric Age

Volume 3 | Issue 1 | Jan-Jun 2017 | Page 2-5 | Pérez-Ortiz Sergio, Blas-Dobón JA, Peralta-Nieto J, Gómez-Barbero P


Authors : Pérez-Ortiz Sergio [1], Blas-Dobón JA [1], Peralta-Nieto J [1], Gómez-Barbero P [1].

[1] Hospital Universitario Doctor Peset, Valencia, Spain

Address of Correspondence
Dr. Sergio Perez  Ortiz

Hospital Universitario Doctor Peset, Valencia, Spain.

Email: serperort@gmail.com


Abstract

Background: The common peroneal nerve (CPN) or external popliteal nerve is the most frequently involved nerve in entrapment syndromes in the lower extremities. Its proximity to the head of the fibula makes it particularly susceptible to damage by different injury mechanisms. Osteochondromas arising from the proximal fibula are a rare cause of common peroneal nerve injury.
Methods: We report a case of a 13-year-old Caucasian male patient referred to our hospital with drop foot and palpable mass in the head of the right fibula. Physical examination revealed a severe paresis, grade 2 objectified by the scale of the Medical Research Council (MRC) in the extensor hallucislongus, extensor digitorumlongus and tibialis anterior muscles and hypoesthesia in the dorsal surface of foot and portions of the anterior, lower-lateral leg. In magnetic resonance imaging (MRI) a tumor in the head of the fibula compressing the CPN is observed. Electromyographic studies confirmed the presence of severe partial axonotmesis of the right peroneal nerve.
The patient underwent surgery for decompression of the peroneal nerve and resection of the proximal fibula osteocartilaginousexostosis. The histopathological analysis confirmed the diagnosis of osteochondroma.
Results: At the 12-month postoperative follow-up the patient recovered sensitivity and presented, according to the MRC scale, muscle strength of 4 out of 5 in thepreviouslynamed muscles, being able to walk without orthotic devices. In the electromyography, subacuteaxonotmesis with important signs of active reinnervation observed
Conclusions : Osteochondroma in the head of the fibula is a rare cause of CPN injury, that can go easily unnoticed and has to be considered in the differential diagnosis of the drop foot in pediatric ages. Diagnosis and treatment should not be delayed to get a good neurological recovery because, otherwise, it could be irreversible.
Keywords: Drop foot, peroneal palsy, osteochondroma, tumor, nerve injury, surgery, nerve decompression, tumor of the fibula, pediatrics.


References 

1. Çinar A, Yumrukçal F, Salduz A, Dirik Y, Eralp L. A rare cause of ‘drop foot’ in the pediatric age group: Proximal fibular osteochondroma a report of 5 cases. Int J Surg Case Rep 2014;5(12):1068-1071.
2. Dowson D. Entrapment Neuropathies. 2nd ed. Boston: Boston 7 Little, Brown and Company; 1990.
3. Flores LP, Koerbel A, Tatagiba M. Personal nerve compression resulting from fibular head osteophyte-like lesions. SurgNeurol 2005;64(3):249-252.
4. Mumenthaler M, Schliack H. Peripheral Nerves Lesions – Diagnosis and Therapy. New York: Stuttgart 7 Thieme Medical; 1991.
5. Abdel MP, Papagelopoulos PJ, Morrey ME, Wenger DE, Rose PS, Sim FH. Surgical management of 121 benign proximal fibula tumors. ClinOrthopRelat Res 2010;468(11):3056-3062.
6. Unni K. Dahlin’s Bone Tumors: General Aspects and Data on 11,087 Cases. Philadelphia, PA: Lippincot – Raven Publishers; 1996.
7. Kumar M, Malgonde M, Jain P. Osteochondroma arising from the proximal fibula: A rare presentation. J ClinDiagn Res 2014;8(4):LD01-LD03.
8. Flanigan RM, DiGiovanni BF. Peripheral nerve entrapments of the lower leg, ankle, and foot. Foot Ankle Clin 2011;16(2):255-274.
9. Paternostro-Sluga T, Grim-Stieger M, Posch M, Schuhfried O, Vacariu G, Mittermaier C, et al. Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med 2008;40(8):665-671.
10. Yildiz C, Erler K, Atesalp AS, Basbozkurt M. Benign bone tumors in children. CurrOpinPediatr 2003;15(1):58-67.
11. Springfield DS, Gebhardt MC. Bone and soft tissue tumors. In: Morrissy RT, Weisnstein SL, editors. Lowell and Winter’s Pediatric Orthopedics. Philadelphia, PA: Lippincott Williams and Wilkins; 2001. p. 507-561.
12. Saglik Y, Altay M, Unal VS, Basarir K, Yildiz Y. Manifestations and management of osteochondromas: A retrospective analysis of 382 patients. ActaOrthopBelg 2006;72(6):748-755.
13. Bovée JV. Multiple osteochondromas. Orphanet J Rare Dis 2008;3(1):1-7.
14. Biermann JS. Common benign lesions of bone in children and adolescents. J PediatrOrthop 2002;22(2):268-273.
15. Kushner BH, Roberts SS, Friedman DN, Kuk D, Ostrovnaya I, Modak S, et al.Osteochondroma in long-term survivors of high-risk neuroblastoma. Cancer 2015;121(12):2090-2096.
16. Marcovici PA, Berdon WE, Liebling MS. Osteochondromas and growth retardation secondary to externally or internally administered radiation in childhood. PediatrRadiol 2007;37(3):301-304.
17. Unger EC, Gilula LA, Kyriakos M. Case report 430: Ischemic necrosis of osteochondroma of tibia. Skeletal Radiol 1987;16(5):416-421.
18. Khosla A, Parry RL. Costalosteochondroma causing pneumothorax in an adolescent: A case report and review of the literature. J PediatrSurg 2010;45(11):2250-2253.
19. Ferriter P, Hirschy J, Kesseler H, Scott WN. Popliteal pseudo aneurysm. A case report. J Bone Joint Surg Am 1983;65(5):695-697.
20. Van den Bergh FR, Vanhoenacker FM, De Smet E, Huysse W, Verstraete KL. Peroneal nerve: Normal anatomy and pathologic findings on routine MRI of the knee. Insights Imaging 2013;4(3):287-299.
21. Paprottka FJ, Machens HG, Lohmeyer JA. Partially irreversible paresis of the deep personal nerve caused by osteocartilaginous exocytosis of the fibula without affecting the tibia is anterior muscle. J PlastReconstrAesthetSurg 2012;65(8):e223-e225.
22. Bunch K, Hope E. An uncommon case of bilateral personal nerve palsy following delivery: A case report and review of the literature. Case Rep ObstetGynecol2014;2014:746480.
23. Mnif H, Koubaa M, Zrig M, Zammel N, Abid A. Personal nerve palsy resulting from fibular head osteochondroma. Orthopedics 2009;32(7):528.
24. Baima J, Krivickas L. Evaluation and treatment of personal neuropathy. Curr Rev Musculoskelet Med 2008;1(2):147-153.
25. Sunderland S, Bradley KC. The cross-sectional area of peripheral nerve trunks devoted to nerve fibers. Brain 1949;72(3):428-449.
26. Cardelia JM, Dormans JP, Drummond DS, Davidson RS, Duhaime C, Sutton L. Proximal fibular osteochondroma with associated personal nerve palsy: A review of six cases. J PediatrOrthop 1995;15(5):574-577.
27. Paik NJ, Han TR, Lim SJ. Multiple peripheral nerve compressions related to malignantly transform hereditary multiple exocytosis. Muscle Nerve 2000;23(8):1290-1294.
28. Bernard SA, Murphey MD, Flemming DJ, Kransdorf MJ. Improved differentiation of benign osteochondromas from secondary chondrosarcomas with standardized measurement of cartilage cap at CT and MR imaging. Radiology 2010;255(3):857-865.
29. Ozden R, Uruc V, Kalaci A, Dogramaci Y. Compression of common personal nerve caused by an extra neural ganglion cyst mimicking intermittent claudication. J Brachial PlexPeripher Nerve Inj 2013;8(1):5.
30. Pedrini E, Jennes I, Tremosini M, Milanesi A, Mordenti M, Parra A, et al. Genotype-phenotype correlation study in 529 patients with multiple hereditary exocytosis: Identification of “protective” and “risk” factors. J Bone Joint Surg Am 2011;93(24):2294-2302.
31. Chin KR, Kharrazi FD, Miller BS, Mankin HJ, Gebhardt MC. Osteochondromas of the distal aspect of the tibia or fibula. Natural history and treatment. J Bone Joint Surg Am 2000;82(9):1269-1278.
32. Pigott TJ, Jefferson D. Idiopathic common personal nerve palsy – A review of thirteen cases. Br J Neurosurg 1991;5(1):7-11.


How to Cite this Article: Sergio PO, Blas-Dobón JA, Peralta-Nieto J, Gómez-Barbero POsteochondroma Arising from the Head of the Fibula: A Rare Cause of Drop Foot in Pediatric Age. International Journal of Paediatric Orthopaedics Jan-June 2017;3(1):20-23.

(Abstract)      (Full Text HTML)      (Download PDF)