title: Minimal Invasive Dorsal Plate Osteosynthesis of the Tibia--Are Nerves and Vessels at Risk? An Anatomical Study.
abstract: OBJECTIVE
  Purpose of this anatomic study was to develop a new and safe technique of minimal invasive dorsal plate osteosynthesis for tibia shaft fractures.
  
  
  METHODS
  Sixteen paired adult lower limbs of eight different cadaveric specimens were examined. Anatomical prebending for each plate was done. Plates were inserted percutaneously, following plate fixation the neurovascular bundle was dissected out. The distance between the neurovascular bundle (posterior tibial nerve, posterior tibial artery) and the plate was measured at two different positions. The distance to the origin of the flexor digitorum longus muscle and the arch of the soleus muscle was measured.
  
  
  RESULTS
  The mean distance between the neurovascular bundle and the plate amounted 1.4 cm (±0,2 cm; 1.0-1.7 cm) at hole number six and 1.1 cm (±0.4 cm; 0.6-2.0 cm) at hole number ten. The nerve was never directly in contact with the plate. The flexor digitorum longus muscle had its origin along the plate and was between the plate and the neurovascular bundle in all cases.
  
  
  CONCLUSIONS
  Dorsal percutaneous plate insertion is a safe and easy method for osteosyntesis of tiba shaft fractures. Especially in case of poor skin and soft tissue conditions this technique offers a good alternative.
authors.affiliation: Medical University of Regensburg, Department of Traumatology, Regensburg,Germany.
authors.forename: S
authors.initials: S
authors.lastname: Grechenig
authors.forename: M
authors.initials: M
authors.lastname: Dreu
authors.forename: H
authors.initials: H
authors.lastname: Clement
authors.forename: M
authors.initials: M
authors.lastname: Plecko
authors.forename: W
authors.initials: W
authors.lastname: Pichler
authors.forename: A
authors.initials: A
authors.lastname: Gänsslen
authors.forename: W
authors.initials: W
authors.lastname: Krutsch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D002102:Cadaver; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000473:pathology; D013977:Tibia / Q000033:anatomy & histology; D016909:Tibial Arteries / Q000033:anatomy & histology* / Q000293:injuries; D013978:Tibial Fractures / Q000601:surgery*; D013979:Tibial Nerve / Q000033:anatomy & histology* / Q000293:injuries