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Anderson et al: Permanent Iatrogenic Fibular Nerve Injury following Tibial Plateau Levelling Osteotomy
Veterinary and Comparative Orthopedics and Traumatology 3, 2024

🔍 Key Findings Summary

  • 3 dogs developed permanent fibular nerve dysfunction following TPLO
  • Common findings:
    • Drill hole or screw in caudal tibial cortex just distal to osteotomy
    • Caudal malpositioning of TPLO plate (esp. right limb of case 3)
    • Post-op signs: cranial tibial atrophy, knuckling, exaggerated gait, no hock flexion
  • One case had confirmed deep/superficial fibular neuropathy via electrodiagnostics
  • Recommended prevention: avoid overly caudal drill paths; careful gait assessment at follow-up is key

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← Articles

Anderson et al: Permanent Iatrogenic Fibular Nerve Injury following Tibial Plateau Levelling Osteotomy
Veterinary and Comparative Orthopedics and Traumatology 3, 2024

🔍 Key Findings Summary

  • 3 dogs developed permanent fibular nerve dysfunction following TPLO
  • Common findings:
    • Drill hole or screw in caudal tibial cortex just distal to osteotomy
    • Caudal malpositioning of TPLO plate (esp. right limb of case 3)
    • Post-op signs: cranial tibial atrophy, knuckling, exaggerated gait, no hock flexion
  • One case had confirmed deep/superficial fibular neuropathy via electrodiagnostics
  • Recommended prevention: avoid overly caudal drill paths; careful gait assessment at follow-up is key

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Multiple Choice Questions on this study

In Anderson 2024 et al., how was the caudal malpositioning of the TPLO plate hypothesized to contribute to nerve injury?

A. Required longer implants that contacted nerve
B. Reduced screw purchase near fibular nerve
C. Directed drill trajectory toward fibular nerve
D. Compressed fibular nerve during osteotomy
E. Blocked neurovascular entry at fibular head

Answer: Directed drill trajectory toward fibular nerve

Explanation: Drilling caudally positioned plates risks striking the fibular nerve directly:contentReference[oaicite:3]{index=3}
In Anderson 2024 et al., which clinical sign was consistently observed in all affected dogs?

A. Absence of patellar reflex
B. Knuckling and lack of hock flexion
C. Pelvic limb hypertonia
D. Contralateral limb lameness
E. Generalized proprioceptive loss

Answer: Knuckling and lack of hock flexion

Explanation: All dogs exhibited absent hock flexion and paw knuckling due to fibular nerve dysfunction:contentReference[oaicite:1]{index=1}
In Anderson 2024 et al., what recommendation did authors give to help detect this complication early?

A. Use of intraoperative fluoroscopy
B. Post-op EMG screening on all TPLOs
C. Pre-op nerve mapping of tibial caudal aspect
D. Routine post-op gait assessments
E. Immediate MRI for unexplained lameness

Answer: Routine post-op gait assessments

Explanation: Only routine in-person gait assessments identified this nerve injury, not owner observation:contentReference[oaicite:4]{index=4}
In Anderson 2024 et al., what radiographic feature was common among all cases of fibular nerve injury post-TPLO?

A. Loosening of distal screw
B. Osteolysis near osteotomy
C. Drill hole or screw at caudal tibial cortex
D. Plate spanning the stifle joint
E. Fractured fibular head

Answer: Drill hole or screw at caudal tibial cortex

Explanation: In all 3 cases, either a radiolucent drill hole or a screw was present at the caudal cortex distal to the TPLO osteotomy:contentReference[oaicite:0]{index=0}
In Anderson 2024 et al., what did the electrodiagnostic testing in Case 3 confirm?

A. Isolated tibial nerve paresis
B. Normal conduction in sciatic and fibular nerves
C. Fibular nerve neuropathy only on left
D. Cranial tibial myopathy
E. Right deep and superficial fibular neuropathy

Answer: Right deep and superficial fibular neuropathy

Explanation: Electromyography and nerve conduction confirmed bilateral fibular neuropathy in the right limb only:contentReference[oaicite:2]{index=2}

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