• Jin Hwa Jeong, Moon Chong Chang, and Seung Ah Lee.
• Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center.
• Medicine (Baltimore). 2019 Jul 1; 98 (27): e16253.

RationalePeroneal nerve injury is one of the major complications that may occur after closing wedge high tibial osteotomy (CWHTO). In contrast, the reduced risk of the peroneal nerve injury has been considered as one of the advantages of opening wedge HTO (OWHTO).Patient ConcernsA 61-year-old male who underwent OWHTO showed a dropped big toe immediately after surgery.DiagnosisInjury of deep peroneal nerve was confirmed by electrodiagnostic study. It was probably caused by a posterolaterally protruded screw.InterventionsThe protruded screw was replaced with a shorter one 3 weeks after OWHTO.OutcomesThe motor weakness and sensory reduction were completely recovered at 9 months after surgery.LessonsOWHTO has been known to be safe from peroneal nerve injury. However, considering the anatomical course of deep peroneal nerve, great care should be taken to avoid damage to the deep peroneal nerve while drilling holes and inserting distal screws toward the posterolateral aspect of the proximal tibia.

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