title: Minimally invasive plating of the distal tibia: do we really sacrifice saphenous vein and nerve? A cadaver study.
abstract: 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.
authors.affiliation: 1st Clinic of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey. hakanozsoy@rocketmail.com
authors.forename: Mehmet Hakan
authors.initials: MH
authors.lastname: Ozsoy
authors.forename: Eray
authors.initials: E
authors.lastname: Tuccar
authors.forename: Deniz
authors.initials: D
authors.lastname: Demiryurek
authors.forename: Alp
authors.initials: A
authors.lastname: Bayramoglu
authors.forename: Mutlu
authors.initials: M
authors.lastname: Hayran
authors.forename: Ali Turgay
authors.initials: AT
authors.lastname: Cavusoglu
authors.forename: Veysel Ercan
authors.initials: VE
authors.lastname: Dincel
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Sakaogullari
mesh_terms: 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