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      The dangers of hemilithotomy positioning on traction tables: case report of a well-leg drop foot after contralateral femoral nailing

      case-report

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          Abstract

          Background

          Postoperative contralateral morbidities after fracture fixation surgery by hemilithotomy positioning on traction table is uncommon. We’d report a case of unexpected common peroneal nerve palsy developed on the contralateral side manifesting with drop foot after a common orthopedic femoral nailing.

          Case report

          A 28-year-old female sustained an unusual common peroneal nerve palsy manifesting contralateral drop foot after prolonged femoral nailing. Although the initial presentations were similar to the notorious well-leg compartment syndrome, a benign course with complete recovery in functions was observed 3 months later. After neurophysiologic exam and review of pertinent literature, this iatrogenic and transient dysfunction was delineated to be position-related neuropraxia.

          Conclusion

          Position adjustment at intervals or complete avoidance of prolonged knee hyperflexion is recommended to prevent contralateral common peroneal nerve morbidity.

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          Most cited references13

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          Entrapment neuropathies: pathophysiology and pathogenesis.

          A number of theories of pathogenesis of entrapment neuropathy, due to repeated loading, have been proposed and these theories are being actively explored with animal models. Tubes placed loosely around peripheral nerves cause delayed onset, chronic pain and changes in nerve morphology including nerve sprouting. Balloons placed around or adjacent to the nerve and inflated to low pressures, rapidly produce endoneurial edema and a persistent increase in intraneural pressure. The same models demonstrate long-term changes such as demyelination and fibrosis. The applied pressure causes a decrement in nerve function and abnormal morphology in a dose-dependent manner that appears to be linked to the amount of endoneurial edema. A new model involving involuntary, repetitive fingertip loading for 6 h per week for 4 weeks has caused slowing of nerve function at the wrist similar to that seen in patients with carpal tunnel syndrome. These models have the potential to reveal the mechanisms of injury at the cellular and biochemical level and address questions about the relative importance of various biomechanical factors (e.g. peak force, mean force, force rate, duty cycle, etc.). In addition, these models will allow us to evaluate various prevention, treatment and rehabilitation protocols.
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            Traction table-related complications in orthopaedic surgery.

            Traction tables are used in numerous procedures about the hip and femur, including fracture fixation, hip arthroscopy, and less invasive arthroplasty. The use of a traction table is not without risks, however, and significant complications have been described, including injury to the perineal integument and soft tissues, neurologic impairment, and iatrogenic compartment syndrome of the well leg. The orthopaedic surgeon who uses a traction table for the surgical management of femur fracture must be familiar with the associated potential dangers and risks and must develop a plan to avoid traction table-associated complications, such as use of a radiolucent flat-top operating table for obese patients, adequate patient positioning, and the minimum possible surgical time.
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              Well-leg compartment pressures during hemilithotomy position for fracture fixation.

              To evaluate the relationship between the well-leg compartment pressures and time during hemilithotomy position for fracture fixation.
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                Author and article information

                Contributors
                886-6-353535 , u7901064@yahoo.com.tw
                Journal
                Patient Saf Surg
                Patient Saf Surg
                Patient Safety in Surgery
                BioMed Central (London )
                1754-9493
                14 May 2015
                14 May 2015
                2015
                : 9
                : 18
                Affiliations
                [ ]Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital, Dou-Liou Branch, National Cheng Kung University, Douliou, Taiwan
                [ ]Department of Orthopedics, National Cheng Kung University Hospital, No 138, Sheng-Li Road, Tainan City, 70428 Taiwan
                [ ]Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan
                [ ]Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
                [ ]Department of Physical Medicine & Rehabilitation, National Cheng Kung University Medical Center, Tainan, Taiwan
                Article
                69
                10.1186/s13037-015-0069-2
                4429807
                62e45e2e-1624-407a-944e-31ad9c7d2afd
                © Hsu et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 December 2014
                : 29 April 2015
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2015

                Surgery
                drop foot,contralateral leg,morbidity,hemilithotomy position,peroneal palsy
                Surgery
                drop foot, contralateral leg, morbidity, hemilithotomy position, peroneal palsy

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