Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2014; 81(5):313-316 | DOI: 10.55095/achot2014/042

The Risk of Neurovascular Injury in Minimally Invasive Plate Osteosynthesis (MIPO) when Using a Distal Tibia Anterolateral Plate: A Cadaver StudyOriginal papers

S. Lidder^1,*, S. Masterson², C. Grechenig³, H. Clement⁴, A. Gänsslen⁵, S. Grechenig⁶

¹ Guy's and St Thomas' NHS Foundation Trust, Department of Trauma and Orthopaedics, London, UK

² Queens Hospital, Department of Trauma and Orthopaedics, Romford, UK

³ Medical University of Graz, Graz, Austria

⁴ AUVA Trauma Hospital Graz, Graz, Austria

⁵ Department of Trauma, Orthopaedics and Hand Surgery, Klinikum Wolfsburg, Wolfsburg, Germany

⁶ University Hospital Regensburg, Department of Traumatology, Regensburg, Germany

PURPOSE OF THE STUDY:
Percutaneous plating of the distal tibia via a limited incision is an accepted technique of osteosynthesis for extra-articular and simple intra-articular distal tibia fractures. The aim of this study was to analyze structures that are at risk during this approach.
Material and Methods
Thirteen unpaired adult lower limbs were used for this study. Thirteen, 15-hole LCP anterolateral distal tibial plates were percutaneously inserted according to the recommended technique. Dissection was performed to examine the relation of the superficial and deep peroneal nerves and anterior tibial artery relative to the plate.

RESULTS:
The superficial peroneal nerve was found to cross the vertical limb of the LCP plate at a mean distance of 63 mm (screw hole five) but with a wide range of 21 to 105 mm. The neurovascular bundle (deep peroneal nerve and anterior tibial artery) crossed the plate at a mean of 76 mm (screw hole six) but also with a wide range of 38 to 138 mm. The zone of danger of the neurovascular structures ranges from 21 to 138 mm from the tibial plafond. In one specimen, a significant branch of the deep peroneal nerve was found to be entrapped under the plate.

CONCLUSION:
Caution is advised when using anterolateral minimally invasive technique for plate insertion and screw placement in the distal tibia due to great variability in the neurovascular structures that course distally in the lower leg and cross the ankle.

Keywords: distal tibia, percutaneous plating, neurovascular injury

Published: October 1, 2014  Show citation