A 17 year old female presents herself to her GP with a complaint of numbness on

Question

A 17 year old female presents herself to her GP with a complaint of numbness on the dorsum of her right foot and difficulty in lifting her foot: specifically, her toes don't want to lift up. She reports that 2 days ago she was riding her bike and she had unexpectedly hit the edge of a pot hole and fell hitting her leg on the curb. She reports that it really hurt at that time and later that day she noticed some swelling and bruising. She is concerned because the numbness has become worse and it is becoming more difficult to walk. Upon examination you find that there is a large hematoma (bruise) and edema (swelling) at the right proximal and lateral fibula that is painful to the touch. Sensory deficits are noted across the dorsum of her foot and she has difficulty dorsiflexing and everting her right foot against resistance in comparison to her left. She has a stable knee joint and quadriceps tendon reflex and a stable ankle joint with normal calcaneal tendon reflex. Radiographic analysis revealed a non-displaced fracture at the neck of the right fibula. In practice questions- 1) What nerve has been compressed/damaged? 2) Due to the hematoma and edema what other (beyond the fracture) clinical condition should be considered? 3) If when the girl had fallen the bike frame hit the back of her knee (popliteal space) what other muscle actions could be difficult to perform?

Explanation / Answer

1. The nerve crosses the fibular neck is common peroneal nerve and is susceptible to injury from a fibular neck fracture.

2.The other clinical condition which should be considered due to hematoma and edema is compartment syndrome. Compartment syndrome is increased pressure within one of the body's compartments which contains muscles and nerves. Compartment syndrome most commonly occurs in compartments in the leg or arm.

There are two main types of compartment syndrome: acute and chronic.

Acute compartment syndrome occurs after a traumatic injury such as a car crash. The trauma causes a severe high pressure in the compartment which results in insufficient blood supply to muscles and nerves. Acute compartment syndrome is a medical emergency that requires surgery to correct. If untreated, the lack of blood supply leads to permanent muscle and nerve damage and can result in the loss of function of the limb.

Chronic exertional compartment syndrome is an exercise-induced condition in which the pressure in the muscles increases to extreme levels during exercise. The pressure creates a decrease in blood flow to the affected area which leads to a deprivation of oxygen to the muscles.

Here in this case acute compartment syndrome should be considered.

3. The muscles which make the boundry of popliteal space are semimembranosus & semitendinosus muscle, biceps femoris muscle, gastrocnemius muscle and plantaris muscles. Hence the actions of theses muscles could be difficult to perform if bike frame hit the back of her knee.

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