Deep peroneal nerve palsy after opening wedge high tibial osteotomy: A case report

Peroneal nerve injury is one of the major complications that may occur after closing wedge high tibial osteotomy (CWHTO). In contrast, the reduced risk of the peroneal nerve injury has been considered as one of the advantages of opening wedge HTO (OWHTO). A 61-year-old male who underwent OWHTO showed a dropped big toe immediately after surgery. Injury of deep peroneal nerve was confirmed by electrodiagnostic study. It was probably caused by a posterolaterally protruded screw. The protruded screw was replaced with a shorter one 3 weeks after OWHTO. The motor weakness and sensory reduction were completely recovered at 9 months after surgery. OWHTO has been known to be safe from peroneal nerve injury. However, considering the anatomical course of deep peroneal nerve, great care should be taken to avoid damage to the deep peroneal nerve while drilling holes and inserting distal screws toward the posterolateral aspect of the proximal tibia.