Anatomy of the superficial peroneal nerve in relation to fixation of tibia fractures with the less invasive stabilization system.
OBJECTIVE
To examine the danger to the superficial peroneal nerve during percutaneous screw placement in the distal holes of the 13-hole proximal tibia Less Invasive Stabilization System plate in a cadaver.


METHODS
Anatomic study.


METHODS
Medical school anatomy laboratory.


METHODS
Fourteen adult cadaveric lower extremities were used. A 13-hole proximal tibia Less Invasive Stabilization System plate was placed as described by the manufacturer. Dissection of the superficial peroneal nerve was performed following localization of screw holes 7 through 13 using insertion sleeves, centering sleeves, and 2.0-mm Kirschner wires passed through the insertion guide.


RESULTS
The average distance from the superficial peroneal nerve to the center of holes 11, 12, and 13 was 10.0 mm (range 0-21, standard deviation 5.6), 6.8 mm (range 0-16, standard deviation 4.3), and 2.7 mm (0-11, standard deviation 3.7), respectively. In 12 of 14 legs (86%), the superficial peroneal nerve was 5.0 mm or less from the center of hole 13. The nerve was touching the guide wire at hole 11 in 1 specimen (7%), at hole 12 in 2 specimens (14%), and at hole 13 in 6 specimens (43%). In 1 specimen (7%), the guide wire pierced the superficial peroneal nerve at hole 13.


CONCLUSIONS
These findings suggest that the superficial peroneal nerve is at significant risk during percutaneous screw placement in holes 11 through 13 of the 13-hole proximal tibia Less Invasive Stabilization System plate. Use of a larger incision and careful dissection down to the plate in this region may minimize the risk of damage to the nerve.
Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA 01095, USA.
Joseph P
JP
Deangelis
Nicola A
NA
Deangelis
Richard
R
Anderson
D001863:Bone Screws; D005592:Fracture Fixation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010543:Peroneal Nerve / Q000033:anatomy & histology* / Q000293:injuries; D013978:Tibial Fractures / Q000601:surgery*