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CC BY 4.0 · Surg J (N Y) 2021; 07(03): e154-e157
DOI: 10.1055/s-0041-1731423
Case Report

Traumatic Rupture and Herniation of the Peroneus Tertius Muscle Leading to Compartment Syndrome and Entrapment of the Superficial Peroneal Nerve: A Case Report

Eetu N. Suominen
1   Department of Clinical Medicine, University of Turku, Turku, Finland
,
Henrik Sandelin
2   Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
3   Department of Orthopaedics, Liverpool Hospital, Sydney, New South Wales, Australia
,
Jani Puhakka
2   Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
,
Jussi Repo‡   *
4   Department of Surgery, Tampere University Hospital, Tampere, Finland
,
Mikko Ovaska‡   *
5   Sports Clinic and Hospital, Pihlajalinna Dextra, Helsinki, Finland
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Abstract

We present a patient with compartment syndrome and entrapment of the superficial peroneal nerve due to a direct hit to the lateral part of the right lower extremity. The diagnosis of evolving compartment syndrome was made without delay and the patient was quickly taken to the operating theater. Intraoperatively, the entrapment of the superficial peroneal nerve caused by rupture and herniation of the peroneus tertius muscle was surprisingly observed at the site, where the nerve pierces the anterior compartment. The nerve was successfully released in conjunction with fasciotomies of the anterior and lateral compartments. Meticulous diagnosis of compartment syndrome is critical to prevent ischemic injury to muscles and nerves. Recognition of anatomy and anatomical variations is important to prevent iatrogenic injury in unusual circumstances.

Keywords

peroneus tertius - superficial peroneal nerve - compartment syndrome - nerve - entrapment - herniation - anatomical variation - fasciotomy

Note

Investigation performed at the Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.


* Authors contributed equally to this study.




Publication History

Received: 09 September 2020

Accepted: 25 March 2021

Article published online:
19 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Yammine K, Erić M. The fibularis (peroneus) tertius muscle in humans: a meta-analysis of anatomical studies with clinical and evolutionary implications. BioMed Res Int 2017; 2017: 6021707
    CrossrefPubMedGoogle Scholar
  • 2 Pacha D, Carrera A, Llusa M, Permanyer E, Molona O, Morro R. Clinical anatomy of the superficial peroneal nerve in the distal leg. Eur J Anat 2020; 7 (S1): 15-20
    PubMedGoogle Scholar
  • 3 Styf J. Entrapment of the superficial peroneal nerve. Diagnosis and results of decompression. J Bone Joint Surg Br 1989; 71 (01) 131-135
    CrossrefPubMedGoogle Scholar
  • 4 Styf J, Morberg P. The superficial peroneal tunnel syndrome. Results of treatment by decompression. J Bone Joint Surg Br 1997; 79 (05) 801-803
    CrossrefPubMedGoogle Scholar
  • 5 Rorabeck CH. The treatment of compartment syndromes of the leg. J Bone Joint Surg Br 1984; 66 (01) 93-97
    CrossrefPubMedGoogle Scholar
  • 6 Raheja S, Choudhry R, Singh P, Tuli A, Kumar H. Morphological description of combined variation of distal attachments of fibulares in a foot. Surg Radiol Anat 2005; 27 (02) 158-160
    CrossrefPubMedGoogle Scholar
  • 7 Joshi SD, Joshi SS, Athavale SA. Morphology of peroneus tertius muscle. Clin Anat 2006; 19 (07) 611-614
    CrossrefPubMedGoogle Scholar
  • 8 Jana R, Roy TS. Variant insertion of the fibularis tertius muscle is an evidence of the progressive evolutionary adaptation for the bipedal gait. Clin Pract 2011; 1 (04) e81
    CrossrefPubMedGoogle Scholar
  • 9 Mehta V, Gupta V, Nayyar A. et al. Accessory muscle belly of peroneus tertius in the leg--a rare anatomical variation with clinical relevance--utility in reconstructions. Morphologie 2011; 95 (308) 23-25
    CrossrefPubMedGoogle Scholar
  • 10 Yildiz S, Yalcin B. An unique variation of the peroneus tertius muscle. Surg Radiol Anat 2012; 34 (07) 661-663
    CrossrefPubMedGoogle Scholar
  • 11 Sirasanagnadla SR, Bhat KM, Nayak SB, Shetty P, Thangarajan R. A rare case of variant morphology of peroneus tertius muscle. J Clin Diagn Res 2014; 8 (10) AD01-AD02
    PubMedGoogle Scholar
  • 12 Inaparthy P, Ravikumar K. Intratendinous ganglion of peroneus tertius: a case report. Foot Ankle Surg 2006; 12 (04) 221-222
    CrossrefPubMedGoogle Scholar
  • 13 Derrick E, Flores M, Scherer K, Bancroft L. Peroneus tertius tendon tear: a rare cause of lateral ankle pain. Cureus 2016; 8 (04) e577
    PubMedGoogle Scholar
  • 14 Iceman K, Magnus MK, Thompson MJ, Abicht BP. Peroneus tertius syndrome: A rare cause of anterolateral ankle and rearfoot pain. J Foot Ankle Surg 2020; 59 (01) 131-135
    CrossrefPubMedGoogle Scholar
  • 15 Sammarco GJ, Henning C. Peroneus tertius muscle as a cause of snapping and ankle pain: a case report. Am J Sports Med 2007; 35 (08) 1377-1379
    CrossrefPubMedGoogle Scholar
  • 16 Asp R, Marsland D, Elliot R. The superficial peroneal nerve: a review of its anatomy and surgical relevance. OA Anat 2014; 2 (01) 6
    PubMedGoogle Scholar
  • 17 Ducic I, Dellon AL, Graw KS. The clinical importance of variations in the surgical anatomy of the superficial peroneal nerve in the mid-third of the lateral leg. Ann Plast Surg 2006; 56 (06) 635-638
    CrossrefPubMedGoogle Scholar
  • 18 Styf J. Diagnosis of exercise-induced pain in the anterior aspect of the lower leg. Am J Sports Med 1988; 16 (02) 165-169
    CrossrefPubMedGoogle Scholar
  • 19 Mino DE, Hughes Jr EC. Bony entrapment of the superficial peroneal nerve. Clin Orthop Relat Res 1984; (185) 203-206
    PubMedGoogle Scholar
  • 20 Daghino W, Pasquali M, Faletti C. Superficial peroneal nerve entrapment in a young athlete: the diagnostic contribution of magnetic resonance imaging. J Foot Ankle Surg 1997; 36 (03) 170-172
    CrossrefPubMedGoogle Scholar
  • 21 Sabapathy SR, Langer V, Bhatnagar A. Intraneural lipoma associated with a branch of the superficial peroneal nerve. J Foot Ankle Surg 2008; 47 (06) 576-578
    CrossrefPubMedGoogle Scholar