Permanent Iatrogenic Fibular Nerve Injury following Tibial Plateau Levelling Osteotomy.

Caudal plate positioning during TPLO increases fibular nerve injury risk; careful drilling technique essential.

This case series describes three dogs that developed permanent fibular nerve injury as a complication following tibial plateau levelling osteotomy (TPLO), a common surgical procedure for treating cranial cruciate ligament disease. The fibular nerve injury resulted in cranial tibial muscle atrophy, absent hock flexion, and mild lameness. One case was confirmed with electrodiagnostic testing. A significant finding was that all three cases had drill tracts in an identical location on the caudal aspect of the tibia, immediately distal to the osteotomy site. The authors concluded that more caudally positioned plates increase the risk of fibular nerve injury during medial-to-lateral tibial drilling. The study emphasizes the importance of careful intraoperative positioning and technique during TPLO, specifically regarding plate placement and drilling trajectory. Additionally, thorough gait assessment during routine post-operative follow-up visits is essential for early identification of this potentially permanent complication, allowing for timely intervention or client counseling regarding functional outcomes.

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