title: Impact of posterior tibial nail malpositioning on iatrogenic injuries by distal medio-lateral interlocking screws. A cadaveric study on plastinated specimens.
abstract: In intramedullary tibial nailing, multi-planar locking makes stabilization of proximal and distal metaphyseal fractures possible. A known complication in intramedullary nailing of the tibia is iatrogenic injury to neuro-vascular structures caused by the insertion of locking screws. As shown in previous studies, the distal positioning of the nail is important, as it determines the course of the locking bolts. The goal of the present study was to display the consequences of posterior nail malpositioning with respect to the safety of the distal medio-lateral locking screws and the available options. Human cadaveric legs were plastinated according to the sequential plastination technique after intramedullary nailing of the tibia and were then cut transversely. The tibial nails were placed centrally or posteriorly. Macroscopic analysis showed a distinct drawback of posterior nail positioning, with diminished options for the placement of the locking screws and thereby a risk of damaging the anterior and posterior neuro-vascular bundles by distal medio-lateral locking screws.
authors: Department for Orthopaedics and Traumatology, University of Clogne, Cologne, Germany. kilian.wegmann@uk-koeln.de
authors: Kilian
authors: K
authors: Wegmann
authors: Klaus Josef
authors: KJ
authors: Burkhart
authors: Jörg
authors: J
authors: Buhl
authors: Thomas
authors: T
authors: Gausepohl
authors: Jürgen
authors: J
authors: Koebke
authors: Lars Peter
authors: LP
authors: Müller
mesh_terms: D001858:Bone Nails; D001863:Bone Screws; D002102:Cadaver; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D006801:Humans; D007866:Leg / Q000294:innervation