Risk of Vascular Injury at the Proximal Tibia for Medial Narrow Locking Plate Fixation: An Anatomical Study Using CT Angiogram
Likit Rugpolmuang MD*, Tanit Taweebanjongsin MD*, Kongkhet Riansuwan MD*
Affiliation : * Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To evaluate possibility of screw-related vascular injury at proximal tibia while using medial narrow tibial locking
plate.
Material and Method: Cross-sectional images of CT angiographs (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 of screw 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.
Conclusion : 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 still presents a risk of injuring the tibial artery.
Keywords : Vascular injury, Tibia, Fracture, Locking plate, Anatomy
