title: The risk of neurovascular injury in minimally invasive plate osteosynthesis (MIPO) when using a distal tibia anterolateral plate: a cadaver study.
abstract: OBJECTIVE
  Percutaneous plating of the distal tibia via a limited incision is an accepted technique of osteosynthesis for extra-articular and simple intra-articular distal tibia fractures. The aim of this study was to analyze structures that are at risk during this approach.
  
  
  METHODS
  Thirteen unpaired adult lower limbs were used for this study. Thirteen, 15-hole LCP anterolateral distal tibial plates were percutaneously inserted according to the recommended technique. Dissection was performed to examine the relation of the superficial and deep peroneal nerves and anterior tibial artery relative to the plate.
  
  
  RESULTS
  The superficial peroneal nerve was found to cross the vertical limb of the LCP plate at a mean distance of 63 mm (screw hole five) but with a wide range of 21 to 105 mm. The neurovascular bundle (deep peroneal nerve and anterior tibial artery) crossed the plate at a mean of 76 mm (screw hole six) but also with a wide range of 38 to 138 mm. The zone of danger of the neurovascular structures ranges from 21 to 138 mm from the tibial plafond. In one specimen, a significant branch of the deep peroneal nerve was found to be entrapped under the plate.
  
  
  CONCLUSIONS
  Caution is advised when using anterolateral minimally invasive technique for plate insertion and screw placement in the distal tibia due to great variability in the neurovascular structures that course distally in the lower leg and cross the ankle.
authors.affiliation: Guy's and St Thomas' nHS Foundation Trust, Department of Trauma and Orthopaedics, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Lidder
authors.forename: S
authors.initials: S
authors.lastname: Masterson
authors.forename: C
authors.initials: C
authors.lastname: Grechenig
authors.forename: H
authors.initials: H
authors.lastname: Clement
authors.forename: A
authors.initials: A
authors.lastname: Gänsslen
authors.forename: S
authors.initials: S
authors.lastname: Grechenig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D002102:Cadaver; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010543:Peroneal Nerve / Q000033:anatomy & histology / Q000293:injuries*; D012307:Risk Factors; D013977:Tibia / Q000033:anatomy & histology / Q000601:surgery*; D016909:Tibial Arteries / Q000033:anatomy & histology / Q000293:injuries*; D013978:Tibial Fractures / Q000601:surgery*