An iatropathic tibial nerve injury in a patient following total ankle replacement

Abstract

Ankle arthroplasty is an infrequent procedure, and there is a risk of injury to nearby neurovascular structures from direct injury and from traction. The risk of nerve injury is difficult to quantify due to low-procedure numbers, non-mandatory nerve injury reporting to the National Joint Registry in the UK and delayed recognition of nerve injury despite the British Orthopaedic Association Standards for Trauma 5 guidelines on the management of peripheral nerve injury. Neuropathic pain following a major joint procedure with disordered sensation, motor paralysis and alterations in autonomic function in the distal skin are suggestive of nerve injury. A Tinel's sign at the site of suspected injury is diagnostic and the nerve should be promptly explored by a surgeon familiar with the operative assessment and reconstruction options for nerve injury. Processed nerve allograft is a useful adjunct in the reconstruction algorithm in cases of non-critical nerve disruption and central sensitisation to avoid the harvest of an intact sensory autologous nerve and risking further exacerbation of neuropathic pain at another site. The case presented discusses an iatropathic tibial nerve injury in a 48-year-old man who underwent reconstruction using nerve allograft.