Cíl studie: Koniotomie zaujímá pevné místo v algoritmu zajištění dýchacích cest, nicméně klinická frekvence indikací ke koniotomii je velmi nízká, čímž je možnost jejího praktického nácviku v reálné praxi výrazně omezena. Cílem práce bylo posouzení přínosu nácviku koniotomie na kadaverech. Typ studie: Prospektivní observační studie anonymním dotazníkem. Název a sídlo pracoviště: FN Hradec Králové. Soubor a metody: Účastníky studie tvořili lékaři, kteří absolvovali nácvik koniotomie na kadaverech.Každý lékař byl požádán před provedenímnácviku o anonymní vyplnění dotazníku. Před nácvikem byly sledovány: věk, pohlaví, délka praxe v oboru, atestace v oboru, zkušenost s koniotomií, zkušenost s tracheotomií,stupeň „ochoty a připravenosti“ provést v indikovaném případě koniotomii (stupeň 4 = bez obtíží, kdykoliv je indikace; stupeň 3 = s menšími zábranami, ale vím jak na to; stupeň 2 = s velkými zábranami, s maximální nejistotou; stupeň 1 = zřejmě bych koniotomii samostatně neprovedl, netroufl bych si). Po nácviku byly sledovány: stupeň „ochoty a připravenosti“ provedení koniotomie, hodnocení užitečnosti a přínosu nácviku. Statistické zpracování SigmaStat Statistical Software (Wilcoxon Signed Rank Test, Spearman Rank Correlation, p<0,05). Výsledky: Soubor tvořilo 22 lékařů (7 mužů, 15 žen). Bez předchozí praktické zkušenosti s koniotomií bylo 20 lékařů. Praktické zkušenosti s provedením tracheotomie udávalo 8 lékařů. Stupeň „ochoty a připravenosti“ před nácvikem: stupeň 4 udávali 3 lékaři; stupeň 3 uvedlo 13 lékařů; stupeň 2 uvedlo 6 lékařů_ stupeň 1 neuvedl žádný.Po nácviku stupeň 4 udávalo 8 lékařů; stupeň 3 udávalo 14 lékařů; stupeň 2 nebo 1 neuvedl žádný z lékařů, dosažení vyššího stupně dosahovalo statistické významnosti (p=0,003). Nácvik koniotomie považovalo za užitečný všech 22 lékařů. Stupeň připravenosti ke koniotomii před nácvikem koreloval s předchozí zkušeností s tracheotomií (r = 0,47, p = 0,02) a dosaženou atestací (r = 0,62, p = 0,002). Závěr: Nácvik koniotomie by měl představovat nedílnou součást postgraduální přípravy lékařů oboru. Využití kadaverů v nácviku koniotomie zvyšuje stupeň připravenosti k provedení výkonu. Předchozí zkušenost s tracheostomií, vyšší atestace a mužské pohlaví jsou spojeny s vyšším stupněm připravenosti ke koniotomii ještě před provedením nácviku.
Objective: Cricothyroidotomy plays on important role in emergency pathway of the difficult airway algorithm, however emergent cricothyroidotomy is performed infrequently and can be difficult because of the lack of training and skill retention. The aim of the study was to assess cricothyroidotomy training on cadavers in anaesthesiologists. Design: prospective observational questionnaire based study. Settings: Tertiary Care Hospital, Hradec Králové. Material and methods: All participants performed cricothyroidotomy training procedure on cadavers under the guidance of the physician skilled in cricothyroidotomy. Each participant had to perform one attempt of cricothyroidotomy without assistance. All participants were asked to fill in the questionnaire before training – age, sex, certification degree, length of clinical practice, previous experience with cricothyroidotomy and tracheotomy, degree of willingness (DOW) to perform cricothyroidotomy in real life was according to assessed the four point scale: 4 = definitely yes anytime if necessary, 3 = slightly hesitating but yes, 2 = hesitating with great degree of uncertainty, 1 = probably would not perform even if indicated. After training, DOW to perform cricothyroidotomy and training utility were evaluated. Statistical analysis was performed using SigmaStat Statistical Software (Wilcoxon Signed Rank Test, Spearman Rank Correlation, p<0.05). Results: Twenty-two anesthesiologists (7 men, 15 women) completed the study by filling in the questionnaire. Two participants (ptc.) had previous experience of performing cricothyroidotomy, 8 of tracheotomy. Degree of willingness to perform cricothyroidotomy before training: 4 (3 ptc.), 3 (13 ptc.), 2 (6 ptc.), 1 (0). There was a significant (p=0.003) increase of DOW after training: 4 (8 ptc.), 3 (14 ptc.), 2 (0), 1 (0). Positive correlation between previous experience with tracheotomy, resp. degree of certification and pre-training DOW to perform cricothyroidotomy was found (r=0.47, P=0.02, resp. r=0.62, P=0.002). All participants of the study considered the training effective. Conclusion: Cricothyroidotomy training should be a part of emergency airway management practice. Performance of cricothyroidotomy on cadavers may be possible effective way to increase DOW to perform this procedure in a real-life situation. Previous experience with tracheotomy, higher degree of certification, male sex are related to higher pre-training degree of DOW.
PURPOSE OF THE STUDY To improve the important torsional, bending and compressive stability in femoral neck fixation, locking plates have been the latest contribution. However, increased strength by restricted fracture motion may come at expense of an altered load distribution and failure patterns. Within locking plate technology, the important intermediate fracture compression may principally be achieved by multiple sliding screws passing through a sideplate fixed to the femur or connected to an interlocking plate not fixed to the femur laterally, sliding "en bloc" with the plate. While biomechanical studies may deliver the short-time patient safety requirements in implant development, no adequate failure evaluation has been performed with interlocking devices ex vivo in this setting. In the present biomechanical study, we analysed if a novel femoral neck interlocking plate with pins could improve fixation performance by changing the parameters involved in the failure mechanism in terms of fixation strength, fracture motion, load distribution and failure pattern. MATERIAL AND METHODS Sixteen pairs of human femurs with stable subcapital osteotomies were fixated by 2 pins or 3 pins interlocked in a plate using a paired design. Femurs were loaded non-destructively to 10° torsion around the neck axis, 200 N anteroposterior bending and 500 N vertical compression in 7° adduction with 1 Hz in 20 000 cycles, and were subsequently subjected to destructive compression to evaluate failure patterns. Bending stiffness, compressive stiffness and displacement from compressive testing reflected fracture motion. Torque and compression to failure replicated known failure mechanisms and defined strength. To evaluate load distribution, associations between biomechanical parameters and measured local bone mineral measurements by quantitative CT were analysed. RESULTS Interlocked pins increased mean strength 73% in torsion and 39% in compression (p = 0.038). Strength was related to all 4 regional mineral masses from the femoral head to subtrochanterically with interlocking (r = 0.64-0.83, p = 0.034), while only to mineral masses in the femoral head in compression and to the head, neck and trochanterically in torsion with individual pins (r = 0.67-0.78, p = 0.024). No difference was detected in fracture motion or failure pattern. DISCUSSION Within the last decade, angular stable implants have expanded our therapeutic arsenal of femoral neck fractures. Increased stability at the expense of altered devastating failure patterns was not retrieved in our study. The broadened understanding of the effect of interlocking pins by an isolated plate as in the current study involved the feature to gain fixation strength. By permitting fracture compression, and through a significant change of correlations between mechanical parameters and local bone mineral factors, a lateral redistribution of load with interlocked pins from the fragile bone medially to the more solid lateral bone was demonstrated. Regarding the long-term patient safety of interlocked pins and healing complications of non-union and segmental collapse of the femoral head, a definite conclusion may be premature. However, the improved biomechanics of an interlocking plate must be considered a favourable development of the pin concept. CONCLUSIONS Interlocked pins may improve fixation performance by a better load distribution, not by restricting fracture motion with corresponding altered failure patterns. This is encouraging and a challenge to complete further studies of the interlocking plate technology in the struggle to find the optimal treatment of the femoral neck fracture. Key words: femoral neck fracture, biomechanics, cadaver bone, bone mineral, internal fixation, locking plate, interlocked pins.
- MeSH
- Biomechanical Phenomena MeSH
- Bone Plates MeSH
- Bone Nails MeSH
- Bone Screws * MeSH
- Femur Neck * surgery MeSH
- Humans MeSH
- Cadaver MeSH
- Fracture Fixation, Internal MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
CÍL: Cílem této studie bylo zhodnotit rizika spojená s léčbou nestabilních zlomenin distálního radia Mi - kronailem. Na kadaverech bylo hodnoceno riziko penetrace distálních zamykatelných šroubů do ra - diokarpálního skloubení nebo jejích umístění pro - ximálně od subchondrální kosti a riziko jejích pro - niknutí do dorzální nebo volární plochy distálního radia. MATERIÁL A METODIKA: Mikronail byl aplikován 40 kadaverózních distálních radií. Kortikální okno pro vstup Mikronailu bylo umístěno v třech různých lo - kalitách: v I. extenzorovém kompartmentu, mezi I. a II. extenzorovým kompartmentem a ve II. exten - zorovém kompartmentu. Kortikální okno bylo pro - vedeno také na třech různých vzdálenostech od hrotu processus styloideus radii (0,5, 1,0 a 1,5 cm). Šrouby byly umístěny v různých úhlech rotace Mik - ronailu. VÝSLEDKY: Optimální poloha pro kožní incizi je 0,5 cm proximálně od hrotu processus styloideus radii, na dorzální třetině výšky distálního radia, v délce 2,0 cm proximálním směrem. Kortikální okno pro vložení Mikronail ™ je 1,0 cm proximál - ně od hrotu processus styloideus radii mezi I. a II. extenzorovým kompartmentem s jeho zaváděním v 0° rotaci v transverzální rovině. V této poloze jsou rizika jeho použití nejmenší. ZÁVĚR: Léčba zlomenin distálního radia nitrodře - ňovou fixací Mikronailem je miniinvazivním chirur - gickým řešení. Použitím správné operační techniky a správný výběr pacientů vede k úspěšným výsled - kům s minimální kloubní nebo kortikální penetra - cí šroubů a s minimálním rizikem poškození či po - dráždění měkkých tkání.
OBJECTIVE: The purpose of the study was to esti - mate the range of risks related to the treatment of unstable fractures of distal radius with Micronail™. In this study were evaluated, on cadavers, the inci - dence of penetration of distal locking screws into the radiocarpal joint or their displacement proxi - mally from subchondral bone; and the incidence of their penetration into the dorsal or volar surface of radius. MATERIAL AND METHODS: The Micronail was pla - ced in 40 cadaver distal radii. Cortical window for Micronail insertion was made in different locations: in I. extensor compartment, between I. and II. exten - sor compartments and in II. extensor compartment. Cortical window was made also in three different distances from the tip of radial styloid (0.5, 1.0 and 1.5 cm). The screws were placed at different angles of rotation of Micronail. RESULTS: Optimal position for skin incision is about 0.5 cm proximal from the tip of radial styloid, on dorsal third of altitude of the distal radius, and ex - tends for 2.0 cm proximally. The cortical window for Micronail™ insertion is about 1.0 cm proximal from the tip of radial styloid between I. and II. extensor compartments in 0° tilt in transversal plane. In this position, the risks of this treatment are the least. CONCLUSION: Treatment of distal radius fracture by intramedullary fixation with Micronail™ is a miniin - vasive surgical option. Applying the correct surgi - cal technique and proper patient selection lead to successful outcomes with minimum articular or cor - tical penetration and minimum risks of soft tissue injury or irritation.
- MeSH
- Radius Fractures surgery MeSH
- Risk Assessment statistics & numerical data MeSH
- Fracture Fixation, Intramedullary * methods statistics & numerical data adverse effects MeSH
- Bone Nails MeSH
- Humans MeSH
- Minimally Invasive Surgical Procedures methods MeSH
- Cadaver MeSH
- Check Tag
- Humans MeSH
- Publication type
- Evaluation Study MeSH
PURPOSE OF THE STUDY: The study was designed to investigate whether anatomical variations of the anterior and posterior divisions of the internal iliac artery and their branches are associated with different risks of bleeding resulting from injury to the posterior pelvic segment. MATERIAL AND METHODS: The study was carried out on 19 cadavers. The dissected area included the internal iliac artery from the common iliac artery bifurcation to the origins of the superior gluteal artery, the inferior gluteal artery and the internal pudendal artery. Using an electronic slide rule, distances between the bifurcation and the origin of each branch from either the anterior or the posterior division were measured. The diameter of each vessel was also determined. Findings of the study were compared with variations described in the literature. The degree of risk for bleeding related to different anatomical variations of the internal iliac artery and its branches was evaluated based on the proximity to the bone. RESULTS: There are six anatomical variations of internal iliac artery branches. Four of them were found: type A1 was recorded in 10 specimens, type A2 in six, type B1 in two and type C in one specimen. Types B2 and D were not seen. DISCUSSION: The type B2 and C anatomical variations were considered to carry higher risks of bleeding due to injury to the posterior pelvic segment. These variations are characterized by vessels larger in diameter and a longer course of the posterior division along the posterior part of the greater sciatic notch (area often involved in unstable pelvic ring fractures). On the other hand, the type C variation showed a longer internal iliac artery separated from the bone with a thick layer of soft tissue, which suggested lower risk than was attributed to the dominant type A1 variation. It was not possible to evaluate type B2 variation because it is very rare and was not found in study material. In type A2 and B1 variations, the branches were separated from bony structures similarly to the dominant type A1 variation. CONCLUSIONS: The cadaver study designed to assess the risk of bleeding associated with different morphological variations of the branching pattern of the internal iliac artery did not identify any anatomical arrangement that might carry a higher risk of injury to the vessels by free bone fragments of the posterior segment in unstable pelvic fractures. It can be concluded that less common branching patterns of the internal iliac artery are not associated with higher risk of bleeding than the dominant type A1 variation.
- MeSH
- Iliac Artery anatomy & histology injuries MeSH
- Fractures, Bone complications MeSH
- Risk Assessment methods MeSH
- Hemorrhage etiology MeSH
- Humans MeSH
- Cadaver MeSH
- Pelvic Bones injuries MeSH
- Check Tag
- Humans MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
AIMS: To assess the results of a biomechanical test of cadaveric specimens, comparing 2 methods of fixation of modified Lapidus arthrodesis in combination with arthrodesis of the first metatarsophalangeal joint. METHODS: A total of 12 cadaveric specimens were used in the test. Arthrodesis of the first MTP joint was in all patients fixed with a Variable Angle LCP 1st MTP Fusion Plate 2.4/2.7. Two methods of fixation of the Lapidus arthrodesis were compared, i.e. fixation with two screws in the PS (plate-screw) version versus fixation with X-Locking Plate 2.4/2.7 in the PP (plate-plate) version. Measurements were obtained with the use of a testing machine ZWICK Z 020-TND with an optical device Mercury RT for measuring deformities. Each specimen was subjected to 3 loading options, a. displacement 5 mm, the support is placed under the proximal phalanx, b. displacement 5 mm, the support is placed under the first metatarsal head and c. load to failure, the support is placed under the first metatarsal head. RESULTS: In all specimens the PS construct showed a statistically considerably higher stiffness than the PP construct. In all specimens treated with the PP construct the load to failure was lower than in the PS construct. For loading mode a., at a significance level of 0.05 (P<0.05), the P-value was 0.036, for mode b. the P-value was 0.007 and for loading mode c. the P-value was 0.006. In addition, age-related decrease in stiffness of the specimen was proved at a significance level of 5% (P=0.004). CONCLUSION: In all the three loading modes, the PS (plate-screw) construct showed a statistically higher stiffness than the PP (plate-plate) construct.
- MeSH
- Arthrodesis * methods MeSH
- Biomechanical Phenomena MeSH
- Bone Plates MeSH
- Humans MeSH
- Metatarsophalangeal Joint * surgery MeSH
- Cadaver MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Transplantace ledvin ze zemřelých dárců je rutinní léčbou selhání ledvin. Akutní selhání štěpu nebo časná rejekce po transplantaci je zřejmě způsobena mnoha faktory, mezi které patří i vlastnosti dárce kadaverózního orgánu. V studii se zaměřujeme zejména na kadaverózní dárce orgánů a možný vliv jejich terapie na prognózu štěpu. V předkládané studii bylo vyšetřeno 33 dárců kadaverózní ledviny, 15 dárců se smrtí mozku netraumatické etiologie (D1) a dárci se smrtí mozku v důsledku kraniocerebrálního poranění bez podávaných krevních transfuzí (n = 10, D2) nebo s prováděnými krevními převody (n = 8, D3). S vědomím významného omezení, které je dáno počtem dárců v jednotlivých skupinách, je možné konstatovat vyšší počet akutních rejekcí štěpu rezistentních na kortikoidy od netraumatických dárců orgánů a od dárců s prováděnými převody krve.
Kidney transplantation from brain dead donors has become a routine treatment for renal failure. Acute graft failure or early rejection after transplantation is multifactorial process; the characteristics of cadaveric donor is one of the features. Our study evaluated brain dead donors and possible effect of their therapy on the graft survival prognosis. In our study we evaluated thirty-three brain dead donors of cadaveric kidney. Fifteen donors had a brain death following non-traumatic injury (D1), ten patients suffered brain death after craniocerebral injury and were not transfused (D2), eight brain dead patients after craniocerebral injury were transfused (D3). Considering limitations of the study based on the small number of donors in the groups, we can conclude that there is a higher rate of acute graft rejections resistant to corticosteroids harvested from non-traumatic brain dead donors and from donors being transfused.
- MeSH
- Anemia complications MeSH
- Cytokines immunology blood MeSH
- Tissue Donors physiology MeSH
- Adult MeSH
- Immune System cytology immunology physiopathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Blood Component Transfusion adverse effects MeSH
- Graft Rejection physiology drug effects MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Comparative Study MeSH
PURPOSE OF THE STUDY: The aim of the study was to assess the average length of a proximal and a distal incision, to verify the location of the axillary nerve and to identify risk factors for nerve injury during minimally invasive plate osteosynthesis. MATERIAL AND METHODS: During cadaver study a total of 24 implantations using the Philos angular stable plate were performed from the minimally invasive anterolateral approach. A five-hole plate inserted with the aid of new Philos aiming device was used in all cases. The plate was fixed with four screws proximally and with three screws to the diaphysis. After implantation either of the incisions were joined and the axillary nerve was exposed on the lateral side of the arm. RESULTS: The nerve was not found to be injured during plate implantation in any of the cases. The average length of the proximal incision was 56 ± 2.8 mm (52-64 mm) and that of the distal incision was 32 ± 2.5 mm (28-35 mm). The middle free part covering the axillary nerve was on average 45 ± 4.3 mm (38-54) long. The average width of the nerve was 1.9 ± 0.35 mm (1.4-2.8 mm). The average distance of the axillary nerve was 39 ± 2.9 mm (37-44 mm) from the superior facet of the greater tubercle and 53 ± 3.9 mm (48-60) from the lower edge of the acromial process. In 80% of the cases the nerve was located in the area determined for the screws going to the medial calcar region; in 20% it was over a hole for the screw directed towards the centre of humeral head. Nerve location above the first six most proximally placed screws was not recorded in any of the cases. DISCUSSION: The minimally invasive anterolateral approach is an alternative technique for osteosynthesis of proximal humerus fractures using angular stable plates. Advantages reported by a number of authors include lower incidence of avascular necrosis of the humeral head, an easier way of reduction and a better view of the rotator cuff. On the other hand, this approach is associated with a higher risk of damage to the axillary nerve. Distance of axillary nerve from acromion is very variable. It may be located in the range of 30 to 85 mm from the acromial edge. CONCLUSION: The anterolateral approach is, when respecting the anatomical position of the axillary nerve, a safe alternative to the conventional deltoideopectoral approach.
- MeSH
- Axilla innervation MeSH
- Humeral Fractures * diagnosis surgery MeSH
- Outcome Assessment, Health Care MeSH
- Humerus pathology physiopathology MeSH
- Bone Plates MeSH
- Humans MeSH
- Minimally Invasive Surgical Procedures adverse effects instrumentation methods MeSH
- Intraoperative Complications prevention & control MeSH
- Peripheral Nerve Injuries * etiology prevention & control MeSH
- Fracture Fixation, Internal * adverse effects instrumentation methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
Úvod: Již ve starší literatuře se objevují zmínky o tom, že musculus subscapularis může mít variabilní uspořádání v místě svého dolního okraje. Cílem této prospektivní studie bylo detailně prozkoumat strukturu a uspořádání této dolní části musculus subscapularis. Metoda a materiál: Provedli jsme anatomickou pitvu obou ramenních kloubů na 25 kadaverozních preparátech, 11 mužských a 14 ženských, jako přístup jsme použili Henryho deltoideopektorální přístup. V případě, že byl nalezen akcesorní sval pod spodním okrajem musculus subscapularis, zkoumali jsme detailně začátek tohoto svalu na lopatce, místo úponu svalu na humeru, délku a šíři svalu a jeho vztah k musculus subscapularis. Výsledky: Ve skupině 50 vyšetřených ramen byl nalezen akcesorní sval ve 42 případech. Jestliže byl sval nalezen na jedné straně, byl vždy nalezen i na druhostranném ramenním kloubu téhož kadáveru. Z celkového počtu 22 mužských ramen byl nalezen akcesorní sval v 18 případech (81,8 %), u ženských ramen (N = 28) byl akcesorní sval nalezen ve 24 případech (85,7 %). Průměrná šíře začátku svalu byla 1,7 cm, průměrná šíře jeho úponu byla 1,2 cm. Průměrná délka svalu byla 7,2 cm. Diskuze: Otázkou je, zdali je možné, aby byl v lidském ramenním kloubu přítomen sval, který by nebyl doposud popsán a detailně prozkoumán. Již v literatuře z 19. a 20. století se vyskytují zmínky o akcesorních svalových vláknech, více či méně závislých na musculus subscapularis. Závěr: Vzhledem k začátku akcesorního svalu na lopatce blízko začátku musculus subscapularis a vzhledem k úponu tohoto svalu blízko úponu musculus subscapularis na humeru může být akcesorní sval považován za samostatný sval, který by mohl plnit funkci antagonisty musculus supraspinatus.
Introduction: It has been mentioned in the earlier literature, that the subscapularis muscle usually has variations in the arrangement of its lower margin. The aim of this prospective study was to investigate the structure and arrangement of this lower part of the subscapularis muscle. Methods and Materials: We dissected both shoulders of 25 cadavers, 11 males and 14 females, using Henry´s deltopectoral approach. If the accessory muscle underneath the lower margin of the subscapularis muscle was found, we studied its origin on the scapula, insertion to the humerus, the length and width of the muscle and its relationship to the subscapularis muscle. Results: In the investigated group of 50 shoulders, the accessory muscle was present in 42 of them. In those bodies with the accessory muscle it was always found bilaterally. In all male shoulders (N = 22), the accessory muscle was found in 18 cases (81,8 %), in all female shoulders (N = 28) in 24 cases (85,7 %). The average muscle origin width was 1,7 cm, the average muscle insertion width was 1,2 cm. The average muscle length was 7,2 cm. Discussion: The question is, if it is really possible there is in the human shoulder the muscle, that has not been described and studied in detail until now. In the literature from 19th and 20th century the presence of accessory muscle fibres is already mentioned, more or less dependent on the subscapularis muscle. Conclusion: Due to its origin on the scapula near the origin of the subscapularis muscle and insertion near the subscapularis muscle on the humerus, the accessory muscle should be considered as the separate muscle possibly functioning as the opponent of the supraspinatus muscle.
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.
- MeSH
- Tibial Arteries anatomy & histology injuries MeSH
- Tibial Fractures surgery MeSH
- Bone Plates * MeSH
- Middle Aged MeSH
- Humans MeSH
- Minimally Invasive Surgical Procedures adverse effects methods MeSH
- Cadaver MeSH
- Peroneal Nerve anatomy & histology injuries MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Tibia anatomy & histology surgery MeSH
- Fracture Fixation, Internal adverse effects methods MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
