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My wife had a fall a month ago and fracture her left pubic

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ramus. It has been healing...
My wife had a fall a month ago and fracture her left pubic ramus. It has been healing very nice but ever since the fall she is having pain on her left leg either above the knee or under. The pain kind of jumping between the upper leg and the lower leg. Also she has a drop foot on her left leg ever she has the fall. Any advice?
Submitted: 1 year ago.Category: Neurology
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Answered in 7 minutes by:
4/10/2016
Neurologist: Dr. Frank, Board Certified Physician replied 1 year ago
Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9,000
Experience: Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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Hello. Welcome to JA. It sounds like she damaged her sciatic nerve up high, and how that happened in a pubic ramus fracture I am not sure. Did she fall on her buttocks, or sustain trauma to that area. That would give her the foot drop, or if she was injured in the lateral knee area. It sounds like the pain is from the sciatic or from the saphenous nerve (a sensory nerve that runs under the pubic ramus) which would give her pain jumping on the anterior surface (more medial or inner) of her thigh. She needs an EMG or nerve test done by a neurologist to find out which nerve(S) are damaged, and to what extent (focal demyelination, axonal, segmental with conduction block, etc) as that would help to figure out the prognosis and if certain meds like IVIG might help. For the drop foot, she needs rehabilitation to see her, get her an FAO (foot ankle orthotic) which fits in her shoe. Also maybe a common peroneal nerve stimulator to stimulate and help regain nerve function. It depends on where on the peroneal nerve, the injury occurred.

So she needs a neurologist, an orthopedist, a physical therapist. Get back to me to discuss this further and I will reply. If you wish me to call you I can, but JA charges extra. Let me know if you want that service. Dr Frank

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Customer reply replied 1 year ago
Is the pain in the leg and the drop foot are connected?
Could the drop foot will heal or it could be a permanent damage?
Her pain level has drop since the fall happened, she was in a rehab for few weeks and is now at home using. A walker. She could stand up on her own for few minutes but can't walk on her own without the walker.
We have a PT worked with her at the rehab and Kaiser PT will come to see her twice a week.
Any comments.
Neurologist: Dr. Frank, Board Certified Physician replied 1 year ago

I would say if the pubic ramus fracture is on the same side as the foot drop, yes, it much have been injured inside the pelvis area as it descends down into the leg. Foot drop is difficult to get a total recovery, it depends on the age of the patient, blood supply to the leg and the common peroneal nerve. If the nerve had just a demyelinating injury or if the EMG shows loss of axons to suggest more permanent injury. There are studies that using the stimulator early promotes recovery as well. Ask the PT if they have stimulators for foot drop that you can lease rather than purchase. She should use it all through the day, even in her rehab session. Sounds like she is starting to recover, this will be a longer rehab, but if she is steadily improving, that is a good thing. Dr Frank

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Neurologist: Dr. Frank, Board Certified Physician replied 1 year ago

I hope I was able to answer your questions. Please get back to me anytime if you need more information and I will reply. If satisfied, please remember to rate this service by clicking on the rating stars, as that is how I am compensated for this work thanks Dr frank

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Customer reply replied 1 year ago
There are two issues that we are concern about is how long before the pain the the leg will be gone. And more important is will she be able to walk on her own (without the walker?
Neurologist: Dr. Frank, Board Certified Physician replied 1 year ago

If her weakness is only the foot dorsiflexors (foot drop) and not the proximal hip flexors from the ramus fracture (If I could examine her, or if you have a Neurology consult or a physiatry consult that would help here, you can upload them using that paperclip icon, or any information you have) then she should eventually be able to walk with a cane, and an FAO in her shoe, after her pelvic fractures heal. But if there are combined hip and the foot drop, it will be hard to ambulate without that walker. How long before the pain will be gone is dependent on the severity of the fractures, the periosteal (covering layer to the bone) damage to the pelvis and her pain threshold. Hard to give you a number as in weeks, but hopefully by 8 weeks her pain should be much reduced. There are conditions like RSD/CRPS II where you can have prolonged pain from trauma that is hard to treat without special methods. Again, I cannot say from here if she has that problem, but you could ask her pain management or orthopedist. Dr Frank

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Neurologist: Dr. Frank, Board Certified Physician replied 1 year ago

Hello. I hope I was able to send you the information you need or can use. Please get back to me anytime and I will reply. If satisfied with this answer, please remember to rate this service by clicking on the rating stars, as that is how I am compensated for this work. I will also put out the phone option box which allows me to call you. JA charges extra for this service, but we can discuss her problem at length over the phone. Just put your number in the box, and a time to call if not now. Thanks *****

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