1545 - Deep Peroneal Neuritis secondary to ORIF Hardware Impingement Treated with Serial Nerve Hydrodissection

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CW

Cameron Williams, DO

Resident Physician
Texas Rehabilitation Hospital of Fort Worth
Fort Worth, Texas, United States

Co-Author(s)

DC

Daniel Clearfield, DO, MS, FAOASM

Founder and Medical Director
Motion is Medicine Sports Medicine
North Richland Hills, Texas, United States

Submitter(s)

CW

Cameron Williams, DO

Texas Rehabilitation Hospital of Fort Worth
Fort Worth, Texas, United States

Case Diagnosis: Deep peroneal nerve entrapment secondary to adhesions from protruding trimalleolar ankle fracture open reduction internal fixation (ORIF) hardware, managed with serial ultrasound-guided nerve hydrodissections (HD).

Case Description: A 50-year-old female presented six months post right trimalleolar ankle fracture s/p ORIF with persistent right ankle pain, plantar foot paresthesias, and sharp, stabbing pain between the first and second toes. Ultrasound revealed deep peroneal nerve entrapment at a loosened, slightly protruding screw from the prior ORIF. She underwent ultrasound-guided HD with a 22G needle, using D5W, lidocaine, and dexamethasone. At two-week follow-up, she reported 30–40% improvement with resolution of stabbing pain, and a second HD was performed using an 18G needle due to dense scar tissue. Two weeks later, she reported 90% improvement with minimal residual discomfort, but further protrusion of the screw was noted on ultrasound, prompting referral to foot and ankle surgery for hardware evaluation.

Discussions: Deep peroneal nerve entrapment is a known cause of persistent neuropathic pain following ankle ORIF, typically related to hardware positioning and scar formation. Ultrasound-guided HD offers a minimally invasive method for perineural scar release, improving nerve gliding and reducing inflammation, and can significantly improve neuropathic symptoms. Literature review revealed no current reports directly linking HD to hardware loosening; however, theoretical concerns exist regarding mechanical forces during HD in the presence of unstable hardware.

Conclusions: This case demonstrates the effectiveness of ultrasound-guided hydrodissection in managing post-surgical deep peroneal nerve entrapment following ankle ORIF, while emphasizing the importance of consistent ultrasound re-evaluation. Caution should be exercised when performing HD near hardware, particularly when screw loosening is suspected or known.