Management of Postoperative Common Peroneal Nerve Palsy After ORIF Proximal Tibia

Immediate Postoperative Assessment

The American Society of Anesthesiologists recommends conducting a simple postoperative assessment of lower extremity nerve function in the PACU and within 24 hours postoperatively to enable early recognition of CPN palsy 1, 2.
Document the presence or absence of ankle dorsiflexion, ankle eversion, and sensory deficits in the distribution of the common peroneal nerve, as recommended by the American Society of Anesthesiologists 1, 3.

The American Society of Anesthesiologists suggests using specific padding (foam or gel pads) to prevent direct pressure on the fibular head where the peroneal nerve is most vulnerable 1, 2, 4, 5.
Avoid contact with hard surfaces or supports that apply direct pressure on the fibular head or lateral tibia, as recommended by the American Society of Anesthesiologists 3, 6, 7.
Ensure padding is not excessively tight or restrictive, as inappropriate padding may paradoxically increase the risk of worsening neuropathy, according to the American Society of Anesthesiologists 1, 2, 4, 5.

The American Society of Anesthesiologists recommends documenting the following on the operative and anesthetic record: overall patient position, position of lower extremities, use of specific padding over the fibular head, and presence or absence of CPN function in the PACU 1, 3, 7.
This documentation facilitates continuous quality improvement and helps identify modifiable risk factors, as suggested by the American Society of Anesthesiologists 1, 3, 7.

Using excessively tight padding in an attempt to protect the nerve may worsen compression, according to the American Society of Anesthesiologists 1, 2, 4.
Failing to perform early postoperative assessment delays recognition and intervention, as recommended by the American Society of Anesthesiologists 1, 2.