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.

AUVA Trauma Hospital Graz Graz Austria

Department of Trauma Orthopaedics and Hand Surgery Klinikům Wolfsburg Wolfsburg Germany

Guy's and St Thomas' nHS Foundation Trust Department of Trauma and Orthopaedics London UK

Medical University of Graz Graz Austria

Queens Hospital Department of Trauma and Orthopaedics Romford UK

University Hospital Regensburg Department of Traumatology Regensburg Germany

Riziko poranění neurovaskulárních struktur při miniinvazívní dlahové osteosyntéze (MIPO) s použitím distálnítibiální anterolaterální dlahy. Studie na kadaverech

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