Nerve Traction Injury After Subacute Revision External Fixation of a Tibial Plateau Fracture

Nerve traction injuries are common clinical entities that can be confused with nerve palsies secondary to alternate etiologies. Common mechanisms of nerve injury include direct laceration, crush injury, compression injury, elevated compartment pressures, or traction injury. Traction injuries commonly occur after trauma or aberrant patient positioning; however, traction injury following external fixation for lower extremity injury is rare. This case report describes a 42-year-old man who initially sustained a Schatzker VI tibial plateau fracture that required revision of external fixation for pin-site infection as soft tissues recovered from the initial trauma. Postoperatively, the patient experienced a nerve traction injury from lengthening after revision external fixation. Acute loss of common peroneal motor and sensory function was identified 1 hour postoperatively in the post-anesthesia care unit; this reversed on the immediate release of distraction from the external fixation construct. The patient's clinical course and the basic science principles underlying nerve traction injuries are discussed. Although traction injuries are rare after external fixation, orthopedic clinicians must understand them because early recognition can optimize outcomes. Knowledge of the biomechanical properties of peripheral nerves and their mechanisms of injury in such clinical settings may be useful for recognizing patients at risk for nerve traction injuries. [Orthopedics. 2018; 41(3):e434-e437.].