Acta Chir Orthop Traumatol Cech. 2015; 82(5):337-340 | DOI: 10.55095/achot2015/056

Minimal Invasive Dorsal Plate Osteosynthesis of the Tibia - Are Nerves and Vessels at Risk? An Anatomical StudyOriginal papers

S. GRECHENIG1,*, M. DREU2, H. CLEMENT3, M. PLECKO3, W. PICHLER1, A. GÄNSSLEN4, W. KRUTSCH1
1 Medical University of Regensburg, Department of Traumatology, Regensburg, Germany
2 Medical University of Graz, Anatomic Institute, Graz, Austria
3 Unfallkrankenhaus Graz, Graz, Austria
4 Department of Trauma, Orthopaedics and Hand Surgery, Klinikum Wolfsburg, Wolfsburg, Germany

PURPOSE OF THE STUDY:
Purpose of this anatomic study was to develop a new and safe technique of minimal invasive dorsal plate osteosynthesis for tibia shaft fractures.

MATERIAL AND METHODS:
Sixteen paired adult lower limbs of eight different cadaveric specimens were examined. Anatomical prebending for each plate was done. Plates were inserted percutaneously, following plate fixation the neurovascular bundle was dissected out. The distance between the neurovascular bundle (posterior tibial nerve, posterior tibial artery) and the plate was measured at two different positions. The distance to the origin of the flexor digitorum longus muscle and the arch of the soleus muscle was measured.

RESULTS:
The mean distance between the neurovascular bundle and the plate amounted 1.4 cm (±0,2 cm; 1.0-1.7 cm) at hole number six and 1.1 cm (±0.4 cm; 0.6-2.0 cm) at hole number ten. The nerve was never directly in contact with the plate. The flexor digitorum longus muscle had its origin along the plate and was between the plate and the neurovascular bundle in all cases.

CONCLUSIONS:
Dorsal percutaneous plate insertion is a safe and easy method for osteosyntesis of tiba shaft fractures. Especially in case of poor skin and soft tissue conditions this technique offers a good alternative.

Keywords: tibia fracture, dorsal approach, posterior tibial nerve, posterior tibial artery, percutaneous plating

Published: October 1, 2015  Show citation

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GRECHENIG S, DREU M, CLEMENT H, PLECKO M, PICHLER W, GÄNSSLEN A, KRUTSCH W. Minimal Invasive Dorsal Plate Osteosynthesis of the Tibia - Are Nerves and Vessels at Risk? An Anatomical Study. Acta Chir Orthop Traumatol Cech. 2015;82(5):337-340. doi: 10.55095/achot2015/056. PubMed PMID: 26516950.
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    References

    1. ADKISON, D. P., BOSSE, M. J., GACCIONE, D. R., GABRIEL, K. R.: Anatomical variations in the course of the superficial peroneal nerve. J. Bone Jt Surg., 73-A: 112-114, 1991. Go to original source...
    2. COLE, P. A., ZLOWODZKI, M., KREGOR, P. J.: Less Invasive Stabilization System (LISS) for fractures of the proximal tibia; indications, surgical technique and preliminary results of the UMC Clinical Trial. Injury, 34 (Supp 1): 16-29, 2003. Go to original source... Go to PubMed...
    3. COLE, P. A., ZLOWODZKI, M., KREGOR, P. J.: Treatment of proximal tibia fractures using the less invasive stablization system: Surgical experience und early clinical results in 77 fractures. J. Orthop. Trauma, 18: 528-535, 2004. Go to original source... Go to PubMed...
    4. HASENBOEHLER, E., RIKLI, D., BABST, R.: Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury, 38: 365-370, 2007. Go to original source... Go to PubMed...
    5. HOPPENFELD, S., DE BOER, P.: Surgical exposures in orthopaedics; The anatomic approach. 4th revised edition. Philadelphia, Lippincott Williams & Wilkins 2009.
    6. JARVIS, H. C., CANNADA, L. K.: Acute tibialis posterior tendon rupture associated with a distal tibial fracture. Orthopedics, 35: e595-597, 2012. Go to original source... Go to PubMed...
    7. KNUSSMANN, R., ANTHROPOLOGIE: Handbuch der vergleichenden Biologie des Menschen. Lehrbuch der Anthropologie. Bd.1, Teil 1, 4. Auflage, Stuttgart, New York, Gustav Fischer Verlag 1988.
    8. LOBENHOFFER, P., GERICH, T., BERTRAM, T., LATTERMANN, C., POHLEMANN, T., TSCHEME, H.: [Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures]. Unfallchirurg, 100: 957-967, 1997. Go to original source... Go to PubMed...
    9. MASQUELET, A. C., McCULLOUGH, C. J., TUBIANA, R., FYFE, I. S., KLENERMAN, L.: An atlas of surgical exposures of the lower extremity. London, Taylor & Francis 1993.
    10. PHISITKUL, P. H., McKINLEY, T., NEPOLA, J. V., MARSH, J. L.: Complications of locking plate fixation in complex proximal tibia injuries. J. Orthop.Trauma, 21: 83-91, 2007. Go to original source... Go to PubMed...
    11. PICHLER, W., CLEMENT, H., BOLDIN, C., GRECHENIG, W., TESCH, N. P.: Primary transection of the superficial peroneal nerve resulting from a distal fibula fracture. J. Orthop. Trauma, 21: 212-214, 2007. Go to original source... Go to PubMed...
    12. PICHLER, W., GRECHENIG, W., TESCH, N. P., WEINBERG, A. M., HEIDARI, N., CLEMENT, H.: The risk of iatrogenic injury to the deep peroneal nerve in minimally invasive osteosynthesis of the tibia with the less invasive stabilisation system: a cadaver study. J. Bone Jt Surg., 91-B: 385-387, 2009. Go to original source... Go to PubMed...
    13. REDFERN, D. J., SYED, S. U., DAVIES, S. J.: Fractures of the distal tibia: minimally invasive plate osteosynthesis. Injury, 35: 615-620, 2004. Go to original source... Go to PubMed...
    14. RICCI, W. M., RUDZKI, J. R., BORRELLI, J. Jr.: Treatment of complex proximal tibia fractures with the less invasive skeletal stabilization system. J. Orthop. Trauma, 18: 521-527, 2004. Go to original source... Go to PubMed...
    15. STANDRING, S., ELLIS, H., HEALY, J., JOHNSON, D., WILLIAMS, A.: Gray's anatomy. 39th edition. The anatomical basis of clinical practice, New York, Elsevier 2005.
    16. STANNARD, J. P., WILSON, T. C., VOLGAS, D. A.: The less invasive stabilzation system in the treatment of complex fractures of the tibial plateau: short-term results. J. Orthop. Trauma, 18: 552-558, 2004. Go to original source... Go to PubMed...
    17. TESCH, N. P., GRECHENIG, W., HEIDARI, N., PICHLER, W., GRECHENIG, S., WEINBERG, A. M.: Morphology of the tibialis anterior muscle and its implications in minimally invasive plate osteosynthesis of tibial fractures. Orthopedics, 10: 157-159, 2010. Go to original source... Go to PubMed...
    18. THIEL, W.: The preservation of the whole corpse with natural color. Ann. Anat., 174: 185-195., 1992. Go to original source... Go to PubMed...
    19. TONG, O. G., BAVONRATANAVECH, S.: Minimally invasive plate osteosynthesis (MIPO). AO Manual of fracture management, Stuttgart - New York, Georg Thieme 2007. Go to original source...

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