Deep Peroneal Nerve Injury following External Fixation of the Ankle: Case Report and Anatomic Study

Abstract

Background: We present a case of deep peroneal nerve injury after application of external fixator and conducted a cadaveric study of the relationship of the deep peroneal nerve to the lateral tibial cortex. Materials and Methods: A case of toe drop after application of the external fixator is reported. Twelve cadaveric lower legs were dissected to identify the course of the deep peroneal nerve. The tibia were divided into four Zones with equal length. The course of the nerve through each Zone of the tibia was studied Result: In Zone 1, the deep peroneal nerve went around the fibular neck and was found on the interosseous membrane at the distal portion of Zone 1. In Zone 2, the nerve still lay on the interosseous membrane in all specimens at the posterior edge of the lateral tibia. In Zone 3, the nerve moved away from the interosseous membrane and had direct contact with the tibia in nine specimens. In Zone 4, the nerve was on the anterior surface of the distal tibia. Conclusion: The deep peroneal nerve can be injured during the application of a unilateral frame ankle external fixator. The nerve is particularly at risk in Zone 2 and 3. Clinical Relevance: The study provided an anatomic basis for the safe application of a unilateral external fixator of the tibia. Level of Evidence: V, Expert Opinion