Minimally invasive plating of the distal tibia: do we really sacrifice saphenous vein and nerve? A cadaver study.
OBJECTIVE
To investigate the risk of saphenous nerve (SN) and great saphenous vein (GSV) injury during percutaneous screw placement of the 3.5/4.5 LCP Distal Tibial Metaphyseal Plate and the 3.5-mm LCP Medial Distal Tibia Plate with tab in distal tibias of cadaver extremities.


METHODS
Thirty-one unpaired (1 fresh and 30 formalin fixed) adult cadaveric lower extremity specimens were dissected. Using the principles of minimally invasive plating, a 3.5/4.5 LCP Distal Tibial Metaphyseal Plate was implanted in 16 extremities and a 3.5-mm LCP Medial Distal Tibia Plate with tab in the remaining 15 extremities. Injuries to or any evidences of direct contact with the SN or GSV were recorded. Additionally, the shortest distances of each hole to the main branches of these anatomic structures were measured.


RESULTS
The risk of injury to the SN and GSV was higher in holes 4, 5, and 6 when using the 3.5/4.5 LCP Distal Tibial Metaphyseal Plate and in holes 3, 5, and 8 when using the 3.5-mm LCP Medial Distal Tibia Plate.


CONCLUSIONS
The SN and GSV are at high risk for injury during percutaneous screw placement of the 3.5/4.5 LCP Distal Tibial Metaphyseal Plate and the 3.5-mm LCP Medial Distal Tibia Plate at the distal tibia. Careful dissection in the stab incisions down the plate, atraumatic placement of the drill sleeves, and protection of the soft tissues during screw insertion might decrease the risk of injury to the SN and GSV.
Ozsoy
Mehmet Hakan
MH
1st Clinic of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey. hakanozsoy@rocketmail.com
Tuccar
Eray
E
Demiryurek
Deniz
D
Bayramoglu
Alp
A
Hayran
Mutlu
M
Cavusoglu
Ali Turgay
AT
Dincel
Veysel Ercan
VE
Sakaogullari
Abdurrahman
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates / Q000009:adverse effects*; D001863:Bone Screws / Q000009:adverse effects; D002102:Cadaver; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D059348:Peripheral Nerve Injuries; D010525:Peripheral Nerves / Q000033:anatomy & histology*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012501:Saphenous Vein / Q000033:anatomy & histology* / Q000293:injuries; D013977:Tibia / Q000098:blood supply / Q000294:innervation; D013978:Tibial Fractures / Q000601:surgery*; D055815:Young Adult