Peroneal nerve injury as a complication of pediatric tibial osteotomies: a review of 255 osteotomies.

A retrospective study of 255 consecutive tibial osteotomies performed for correction of frontal, sagittal, and rotational deformities in children is presented. Eleven (4.3%) peroneal neurapraxias were identified; seven were motor and sensory (2.7%), and four were sensory only (1.6%). In all cases, traction on the peroneal nerve, either by intraoperative retraction, or by anatomic displacement of the osteotomy fragments, was felt to produce the neurapraxia. There were no vascular injuries or compartment syndromes. Increased patient age, estimated blood loss and tourniquet time, difficulty in exposure, and male sex were associated with an increased risk of peroneal neurapraxia. Rotational osteotomies were of little risk for peroneal nerve injury, whereas angulatory osteotomies, particularly proximal procedures, were more prone to complication. Prophylactic anterior compartment release and fibular osteotomy are recommended to avoid anterior compartment syndrome after tibial osteotomy. In cases of persistent peroneal nerve palsy due to suspected anatomic traction and displacement, exploration of the peroneal nerve is warranted.