Neurovascular complications following tibial osteotomy in children. A case report

Anterior tibial sensory and motor losses following tibial osteotomy in children may result from any of 3 distinguishable etiologies. Peroneal nerve traction does not result in abnormalities of the dorsalis pedis pulse, pain on passive muscle stretch or a tense anterior tibial compartment. An anterior compartmental syndrome may or may not produce an abnormal pulse, but passive muscle stretch is painful and the compartment is tense and tender. Significant occusion of the anterior tibial artery produces diminution of the pulse and painful muscle stretch in the absence of a tense compartment. Certain pre-, intra- and postoperative measures can minimize the chance of these complications and facilitate their detection and treatment. These include: prophylactic fasciotomy, external pin fixation and frequent, thorough examination. If one of these complications arises, dressing should be loosened and the leg returned immediately to its preoperative position. Subsequent therapy is based on continued observation and the specific diagnosis.