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Deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess the risk of injury to the neurovascular bundle on the interosseous membrane of the leg during drilling for distal screw insertion in open-wedge high tibial osteotomy (OWHTO), and to investigate the possible influence of the method of plate placement on the risk.

Methods

This retrospective study involved, 55 patients (32 with a TomoFix plate, 23 with a TriS plate) who underwent postoperative CT scanning of the knee following OWHTO between 2009 and 2018. The angle and position of the locking plate, and the direction of screw insertion relative to the interosseous membrane were analysed.

Results

All distal screws had a risk of neurovascular injury. In particular, 25 screws at the #4 hole (45%) had an extended insertion trajectory that intersected with the interosseous membrane. The angle of the proximal part of the TomoFix plate was a significant risk factor. In contrast, methods of TriS plate placement showed no statistically significant differences.

Conclusions

Extended insertion trajectories of distal screws were likely to intersect with the interosseous membrane with the neurovascular bundle potentially on its surface; thus, drilling for bicortical fixation posed a risk of neurovascular injury. The risk increased as the TomoFix plate was placed more medially, suggesting that bicortical drilling must be performed with the utmost attention when the plate is placed at the medial position. Given the particularly high risk at the #3 and #4 screw holes, monocortical fixation of a few distal screws is recommended as long as good stability is ensured.

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References

  1. Amis AA (2013) Biomechanics of high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 21:197–205

    Article  Google Scholar 

  2. Boyce DA, Prewitt C (2018) Great toe drop following knee ligament reconstruction: a case report. Physiother Theory Pract 13:1–7

    Google Scholar 

  3. Dietrich P, Henning M (2013) The preclinical sheep model of high tibial osteotomy relating basic science to the clinics: standards, techniques and pitfalls. Knee Surg Sports Traumatol Arthrosc 21:228–236

    Article  Google Scholar 

  4. Duivenvoorden T, van Diggele P, Reijman M et al (2017) Adverse events and survival after closing- and opening-wedge high tibial osteotomy: a comparative study of 412 patients. Knee Surg Sports Traumatol Arthrosc 25:895–901

    Article  CAS  Google Scholar 

  5. Ekhtiari S, Haldane CE, de Sa D, Simunovic N, Musahl V, Ayeni OR (2016) Return to work and sport following high tibial osteotomy:a systematic review. J Bone Joint Surg Am 98:1568–1577

    Article  Google Scholar 

  6. Emmanuel PE, Edgar MTE (2008) Isolated extensor hallucis longus paralysis after knee arthroscopy: a case report. Foot Ankle Online J 1(10):2

    Google Scholar 

  7. Fleorkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21:170–180

    Article  Google Scholar 

  8. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin N Am 10:585–608

    CAS  Google Scholar 

  9. Georgoulis AD, Makris CA, Papageorgiou CD, Moebius UG, Xenakis T, Soucacos PN (1999) Nerve and vessel injuries during high tibial osteotomy combined with distal fibular osteotomy: a clinically relevant anatomic study. Knee Surg Sports Traumatol Arthrosc 7:15–19

    Article  CAS  Google Scholar 

  10. Hey HW, Tan TC, Lahiri A et al (2011) Deep peroneal nerve entrapment by a spiral fibular fracture. J Bone Joint Surg Am 93:e113(1–5)

    Google Scholar 

  11. Ihle C, Ahrend M, Grunwald L, Ateschrang A, Stockle U, Schroter S (2017) No change in patellar height following open wedge high tibial osteotomy using a novel femur-referenced measurement method. Knee 24(5):1118–1128

    Article  CAS  Google Scholar 

  12. Kihm CA, Camasta CA (2017) Review of drop hallux: assessment and surgical repair. J Foot Ankle Surg 56(1):103–107

    Article  Google Scholar 

  13. Kudoh H, Sakai T, Horiguchi M (1999) The consistent presence of the human accessory deep peroneal nerve. J Anat 194:101–108

    Article  Google Scholar 

  14. Lui TH, Chan LK (2011) Deep peroneal nerve injury following external fixation of the ankle: case report and anatomic study. Foot Ankle Int 32(5):550–555

    Article  Google Scholar 

  15. Madry H, Goebel L, Hoffmann A et al (2017) Surgical anatomy of medial open-wedge high tibial osteotomy: crucial steps and pitfalls. Knee Surg Sports Traumatol Arthrosc 225(12):3661–3669

    Article  Google Scholar 

  16. Martin R, Birmingham TB, Willits K, Litchfield R, Lebel ME, Giffin JR (2014) Adverse event rates and classifications in medial opening wedge high tibial osteotomy. Am J Sports Med 42(5):1118–1126

    Article  Google Scholar 

  17. Ogawa H, Matsumoto K, Akiyama H (2017) The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy. Bone Joint J 99-B:887–893

    Article  CAS  Google Scholar 

  18. Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR (2016) High tibial osteotomy: a systematic review and current concept. Arch Bone Joint Surg 4(3):204–212

    PubMed  Google Scholar 

  19. Seo SS, Kim OK, Seo JH, Kim DH, Kim YG, Lee IS (2016) Complications and short-term outcomes of medial opening wedge high tibial osteotomy using a locking plate for medial osteoarthritis of the knee. Knee Surg Relat Res 28(4):289–296

    Article  Google Scholar 

  20. Shin YS, Kim KH, Sim HB, Yoon JR (2016) Comparison between two angular stable locking plates for medial opening-wedge high tibial osteotomy: decisive wedge locking plate versus TomoFix. J Orthop Sci 21(6):791–797

    Article  Google Scholar 

  21. Staubli AE, Simoni CD, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury 34:55–62

    Article  Google Scholar 

  22. Suriyuth J, Viwatpinyo K, Phornphutkul C, Mahakkanukrauh P (2015) Anatomical relationship between the deep peroneal nerve and the anterolateral surface of the tibia in Thai cadavers. J Med Assoc Thai 98:207–211

    PubMed  Google Scholar 

  23. Takeuchi R, Ishikawa H, Kumagai K et al (2012) Fractures around the lateral cortical hinge after a medial opening-wedge high tibial osteotomy: a new classification for lateral hinge fracture. Arthroscopy 28:85–94

    Article  Google Scholar 

  24. Takeuchi R, Hwa JW, Ishikawa H et al (2017) Primary stability of different plate positions and the role of bone substitute in open wedge high tibial osteotomy. Knee 24(6):1299–1306

    Article  Google Scholar 

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Funding

This study did not received any funding.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Junya Itou, Masafumi Itoh, Chiyomi Maruki, Takahiro Tajimi, Takaaki So, Umito Kuwashima & Ken Okazaki

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  1. Junya Itou
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  2. Masafumi Itoh
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  3. Chiyomi Maruki
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  4. Takahiro Tajimi
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  5. Takaaki So
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  6. Umito Kuwashima
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  7. Ken Okazaki
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Corresponding author

Correspondence to Ken Okazaki.

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Authors declares that they have no conflicts of interest.

Ethical approval

The study was approved by the ethics committee of Tokyo Women’s Medical University (Approval No. 4713).

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Itou, J., Itoh, M., Maruki, C. et al. Deep peroneal nerve has a potential risk of injury during open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 28, 1372–1379 (2020). https://doi.org/10.1007/s00167-019-05445-y

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  • DOI: https://doi.org/10.1007/s00167-019-05445-y

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