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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 3, 385-387.
doi: 10.1302/0301-620X.91B3.21673  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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The risk of iatrogenic injury to the deep peroneal nerve in minimally invasive osteosynthesis of the tibia with the less invasive stabilisation system

A CADAVER STUDY

W. Pichler, MD, Orthopaedic Surgeon1; W. Grechenig, MD, Professor1; N. P. Tesch, MD, Anatomist2; A. M. Weinberg, MD, Professor1; N. Heidari, MRCS, MSc, Specialist Registrar3; and H. Clement, MD, Orthopaedic Surgeon Department of Traumatology1

1 Department of Paediatric Surgery Medical University of Graz, Auenbruggerplatz 7a, A-8036 Graz, Austria.
2 Anatomic Institute Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria.
3 Royal London Rotation, Colchester General Hospital, Turner Road, Colchester, Essex CO4 5JL, UK.

Correspondence should be sent to Dr W. Pichler; e-mail: wolfgang.pichler{at}klinikum-graz.at

Percutaneous stabilisation of tibial fractures by locking plates has become an accepted form of osteosynthesis. A potential disadvantage of this technique is the risk of damage to the neurovascular bundles in the anterior and peroneal compartments. Our aim in this anatomical study was to examine the relationship of the deep peroneal nerve to a percutaneously-inserted Less Invasive Stabilisation System tibial plate in the lower limbs of 18 cadavers. Screws were inserted through stab incisions. The neurovascular bundle was dissected to reveal its relationship to the plate and screws.

In all cases, the deep peroneal nerve was in direct contact with the plate between the 11th and the 13th holes. In ten specimens the nerve crossed superficial to the plate, in six it was interposed between the plate and the bone and in the remaining two specimens it coursed at the edge of the plate.

Percutaneous insertion of plates with more than ten holes is not recommended because of the risk of injury to the neurovascular structures. When longer plates are required we suggest distal exposure so that the neurovascular bundle may be displayed and protected.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General