Iatrogenic common peroneal nerve palsy after proximal tibia / plateau surgery: systematic review and meta-analysis

Iatrogenic common peroneal nerve palsy (PNP) is an uncommon but important complication after fixation of proximal tibial and tibial plateau fractures. This review estimates pooled incidence and explores approach-related risk. Four databases (PubMed, Embase, Scopus, Cochrane) were searched to August 2025. Clinical cohorts reporting postoperative PNP or explicitly stating no neurovascular complications were included. Proportions were pooled using random-effects meta-analysis on the logit scale. Subgroups were analyzed by approach/fixation technique. 19 studies (n=814) comprising 21 iatrogenic PNP events were eligible. The pooled incidence was 4.14% (95% CI 2.24–7.53%; I 2 =42.1%). Distraction-assisted ORIF showed the greatest variability. Posterior/posterolateral approaches reported mostly zero events when the nerve was exposed and protected. Anterolateral constructs showed very low risk. Iatrogenic PNP after tibial plateau fixation is infrequent overall but varies by technique. Minimizing distraction, identifying and protecting the nerve during posterolateral exposures, and mini-open distal screw insertion may reduce risk.