A 17-year-old boy, three weeks into a tibial lengthening with an Ilizarov frame, develops weakness of ankle dorsiflexion and numbness in the first dorsal web space. The most appropriate next step is:
- A Stop or slow distraction and surgically decompress the common peroneal nerve at the fibular neck ✓
- B Continue distraction unchanged and add intensive ankle physiotherapy
- C Convert the ring fixator to a monolateral external fixator
- D Obtain an MRI of the lumbosacral spine
Correct answer: A. Stop or slow distraction and surgically decompress the common peroneal nerve at the fibular neck
Explanation
Foot drop with sensory loss in the first web space indicates common peroneal nerve palsy, the classic neurological complication of tibial lengthening, caused by traction or compression of the nerve around the fibular neck where the fibular osteotomy is performed. The response is to halt or slow distraction and decompress the nerve; waiting risks permanent deficit. Lumbar pathology is irrelevant here since the findings fit a focal peroneal lesion precisely.
Reference: Campbell's Operative Orthopaedics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.