Common peroneal neuroma in continuity with complete foot drop secondary to a bullet fragment injury

Abstract

Background. Common peroneal nerve (CPN) injuries are generally common but they are uncommon due to gunshot injuries and are associated with poor motor outcomes. Managing neuroma-in-continuity is still challenging because there are currently no accepted standards for deciding on the most effective course of treatment or estimating the time needed for repair. Treatment options for a neuroma-in-continuity include neurolysis, neuroma resection with interposition, end-to-side nerve grafting, and bypass grafting. Case presentation. A 40-year-old man presented with findings of complete right foot drop due to an 8-month-old firearm injury to his right distal thigh. Following baseline investigations, imaging, and anaesthesia fitness, he underwent surgical exploration under general anaesthesia. A neuroma-in-continuity was found in the CPN, resected, and an end-to-end nerve repair was performed. Along with the neuroma-in-continuity, a bullet fragment was also removed. The neurological status remained unchanged postoperatively. Conclusion. Regardless of the cause of the lesion, patients should be urged to seek surgical therapy if there is no spontaneous recovery within four months after the CPN injury. Sharp injuries and knee dislocations have a better chance of recovery than crush injuries and gunshot wounds.