title: The risk of nerve injury with minimally invasive plate osteosynthesis of distal fibula fractures: an anatomic study.
abstract: OBJECTIVE
  The aim of our study was to identify the structures which may be at risk of injury when using a minimally invasive technique for the osteosynthesis of the lateral malleolus and the influence of the size of the implant on the frequency of injury to these structures.
  
  
  METHODS
  Forty plates were percutaneously inserted in 20 cadaveric legs. The region around the plate was then dissected to examine the relation of nerves and soft tissues to the plate.
  
  
  RESULTS
  The superficial peroneal nerve was in direct contact with the plate in 11 of the 20 cases (55%) of the 10 hole plates. We encountered only one case of the superficial peroneal nerve skirting the proximal edge of a 6 hole plate (p = 0.0164).
  
  
  CONCLUSIONS
  Consequently we recommend meticulous attention is paid to the dissection of soft tissues in both the proximal and distal incisions. The length of the plate may be checked with intraoperative imaging prior to its insertion, and the site of both proximal and distal incisions may be marked on the skin. After careful dissection down to the bone, preserving nerves and tendons, the periosteal elevator should be introduced both from the proximal as well as the distal incisions to prepare the extra-periosteal tunnel for the insertion of the plate, in order to avoid the entanglement of the superficial peroneal nerve with the metal work, particularly in plates of longer than six holes.
authors.affiliation: Department of Traumatology, Wilhelminenspital der Stadt Wien, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Neubauer
authors.forename: Nima
authors.initials: N
authors.lastname: Heidari
authors.forename: Annelie M
authors.initials: AM
authors.lastname: Weinberg
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Grechenig
authors.forename: Norbert Peter
authors.initials: NP
authors.lastname: Tesch
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Pichler
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D002102:Cadaver; D005260:Female; D005360:Fibula / Q000293:injuries* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010543:Peroneal Nerve / Q000293:injuries*; D012307:Risk Factors