Peripheral Nerve Injury Following Tibial Osteotomy in Children. Is There a Role for Routine Prophylactic Common Peroneal Nerve Decompression?

Aims: To evaluate the long-term clinical outcomes and risk factors for nerve injury in children undergoing tibial osteotomy for lengthening and/or deformity correction at a tertiary pediatric center, focusing on common peroneal and tibial nerve injuries.

Methods: This retrospective study included all children under 18 years of age who underwent tibial osteotomy over a 7-year period, excluding those with neuromuscular conditions. The primary outcome was peripheral nerve injury, while secondary outcomes included early unplanned return to theatre and deformity parameters.

Results: A total of 173 tibial osteotomies were performed on 135 children, 80 of which were for tibial lengthening. Peripheral nerve injuries occurred in 11 cases (6.3%), with 81% showing complete (45%) or partial recovery (36%). Among patients undergoing tibial lengthening, the prevalence of nerve injury was 3.5%. Significant risk factors for nerve injury included multiple osteotomies (P=0.02, RR: 1.30) and acute correction of valgus deformities (P=0.01, RR: 1.35).

Conclusion: The overall prevalence of nerve injury was 6.3% for all osteotomies and 3.5% in those undergoing tibial lengthening, with an 81% recovery rate. The rate of early unplanned return to the theatre was low at 3.4%. Prophylactic decompression of the common peroneal nerve should be considered for double-level osteotomies and acute correction of valgus deformity but is not routinely required during standard tibial lengthening. The potential risk of nerve injury should be discussed with the families as part of shared decision-making.

Level of evidence: Level IV.