Isolated Left Extensor Hallucis Longus Palsy Secondary to Deep Peroneal Nerve Injury in a 15-Year-Old Boy: A Case...

Nerve palsies are potential consequences of fractures that can result in temporary loss of muscular function. Nerve palsies have not been extensively described in the context of tibial tubercle fractures in the pediatric population. Although the symptoms accompanying nerve palsies concern patients, evidence suggests that non-operative management often results in full functional recovery over time. Our case contributes to the available literature to demonstrate this point, even when neurologic deficits seem abnormally prolonged.

We describe a case of isolated left extensor hallucis longus (EHL) palsy in a 15-year-old African American male patient, who initially presented to our institution's emergency department with a left knee injury. While playing basketball, he sustained a left proximal fibular shaft fracture with a displaced tibial tubercle. Open reduction and internal fixation is the name of the procedure and is considered singular; however, he developed an EHL palsy that persisted for 3 months postoperatively. Nerve conduction studies found substantial left peroneal neuropathy. The patient received physical therapy throughout this time. With nothing other than non-operative management, he recovered full function 7 months after the initial injury with no further complications.

We are aware of only 3 other published reports of isolated EHL palsy, each with unique causes. Our report may be one of the first documented cases of a tibial tubercle fracture with peroneal nerve palsy resulting in an isolated EHL deficit. It is important for clinicians and patients to be aware that even prolonged nerve and muscular deficits can be expected to resolve with non-operative management.