title: Risk of vascular injury at the proximal tibia for medial narrow locking plate fixation: an anatomical study using CT angiogram.
abstract: OBJECTIVE
  To evaluate possibility of screw-related vascular injury at proximal tibia while using medial narrow tibial locking plate.
  
  
  METHODS
  Cross-sectional images of CTangiographs (33 samples) at levels corresponding with the screw holes of a narrow locking plate were used to evaluate the risk of vascular injury relating to screw insertion. This was performed by measuring the distance and angle between the screw trajectory in each hole and the columns of arteries at the proximal tibia.
  
  
  RESULTS
  There is a higher risk of injury to the anterior tibial artery than to the posterior tibial artery in cases of perfect placement of a medial locking plate for osteosynthesis of the tibial shaft fracture. In instance of plate tilting, thus causing a deviation ofscrew trajectory of up to 20 degrees from the perpendicular axis of the middle 1/3 of medial tibial surface, the posterior tibial artery is also at risk of being injured.
  
  
  CONCLUSIONS
  Vascular injury relating to locking screw insertion from the medial aspect of the tibia is still a risk. To prevent vascular injury, the plate should be positioned in the middle 1/3 and parallel to the medial tibial surface. Attachment of the instrument beyond the far cortex of the tibia stillpresents a risk of injuring the tibial artery.
authors.forename: Likit
authors.initials: L
authors.lastname: Rugpolmuang
authors.forename: Tanit
authors.initials: T
authors.lastname: Taweebanjongsin
authors.forename: Kongkhet
authors.initials: K
authors.lastname: Riansuwan
mesh_terms: D000328:Adult; D001860:Bone Plates / Q000009:adverse effects*; D001863:Bone Screws / Q000009:adverse effects*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D013977:Tibia / Q000601:surgery; D016909:Tibial Arteries / Q000000981:diagnostic imaging* / Q000293:injuries*; D013978:Tibial Fractures / Q000601:surgery*; D014057:Tomography, X-Ray Computed