Deep peroneal nerve injury during plate fixation for medial open‐wedge high tibial osteotomy: A case report and cadaveric study

Abstract

This report presents a case of deep peroneal nerve palsy caused by an injury during drilling for distal locking screws of a T-shaped locking plate used for osteosynthesis of medial open-wedge high tibial osteotomy. A cadaveric simulation study reproduced the risk of injury during the surgery. K E Y W O R D Sneurovascular injury, open-wedge high tibial osteotomy, osteoarthritis, surgical complications

Tibial shaft fracture after medial open‐wedge distal tibial tuberosity osteotomy: A case report

“…Meanwhile, deep peroneal nerve injury has been described as a complication of OWHTO with a locking plate. 12 , 13 To avoid this risk, mono‐cortical fixation of several of the distal screws is recommended. Finite element analysis of mono‐cortical fixation for three distal screws (2, 3, and 4) of the locking plate showed no impairment of biomechanical stability as compared with bi‐cortical fixation for all four distal screws in OWHTO.…”

Monocortical fixation for locking plate distal screws does not impair mechanical properties in open-wedge high tibial osteotomy

“…The primary reason for choosing monocortical fixation for the distal screws was to avoid potential deep peroneal nerve injury [ 4 ]. The deep peroneal nerve is a branch of the common peroneal nerve and innervates mainly the tibialis anterior and the extensor hallucis longus [ 12 ].…”

“…In many previous studies, monocortical fixation of three of the four screws was considered popular with the use of the long locking plate during OWHTO [ 4 , 15 ]. In contrast, bicortical fixation for all distal screws was seen in recent reports from Asia [ 2 , 16 ].…”

“…Inclusion criteria were (1) two of the four distal screws fixed in a monocortical fashion, and (2) full-length weightbearing radiographs obtained at both 1 month and 1 year after surgery. In contrast to the FEA method used in the present study, two of the four distal screws were fixed in a monocortical fashion because of the need to reduce the risk of neurovascular injury [ 4 – 6 ]. There was a limitation in the FEA itself as well as a risk of hinge fracture [ 11 ], and fixation of two distal screws was adopted as a compromise.…”

“…Recently, it was reported that the neurovascular bundle containing the deep peroneal nerve on the interosseous membrane of the leg is at potential risk of injury during drilling for distal screws on the locking plate [ 4 – 6 ]. The extended trajectories of the distal screws of the locking plates likely pass close to the neurovascular bundle located next to the lateral wall of the tibia, and neurovascular bundle injury can occur during drilling for bicortical fixation.…”