Iatrogenic Fibula Head Avulsion Fracture in Fixed Valgus Arthritic Knee During Total Knee Arthroplasty

Total knee replacement in valgus knees is more challenging than in varus knees, which needs meticulous handling and decision-making from the surgical approach to the rehabilitation protocol. In this case, we report an iatrogenic fibula head fracture during total knee replacement for a valgus knee with no concomitant common peroneal nerve palsy. This is the first report of this kind in the literature.

We report a case of a 67-year-old male with fixed valgus and flexion deformity of the right knee, who underwent total knee arthroplasty by lateral para-patellar approach and sustained an iatrogenic fibula head fracture without common peroneal nerve palsy. The probable cause could be excess pressure exerted by the assistant holding the Hohmann retractor on the posterior aspect of the tibia and/or during the maneuvers to expose the posterolateral part of the tibia through the lateral para-patellar approach. He had no neurovascular defects postoperatively and has followed the regular rehabilitation protocol with good functional recovery and showing signs of radiological union in progress of the fracture at 2-month follow-up.

Gentle handling of rigid multiplanar deformity valgus arthritic knees is mandatory to prevent complications. A fibula head fracture could be one of the methods of lateral contracture release in rigid valgus knees.