The Study Of The Danger Zone For Locking Screw Placement Of Distal Tibia Fractures By Anteromedial Approach Using Locking Plate

Introduction The approach of tibial distal medial plate fixation is a commonly used in orthopedic surgery,and the complication of the anterior tibial artery iatrogenic injury in this procedure could happen.The purpose of this study was to determine the risk of anatomical structure in the treatment of tibial fractures with the tibial distal medial plate.Methods The project was performed on 10 adult fresh specimens of the lower extremity.Each lower leg was fixed with 14-hole locking plate.Clearing interference zone that the anterior tibial artery was influenced by the application of plate and screws fixation.The distances between the anterior tibial artery and each screw were measured.The locking screws that damaged or contacted directly to the anterior tibial artery were recorded and the resultant data were tabulated.Results The average of tibia length was 38.6cm.The danger zone for the anterior tibial artery averaged of the tibia length from the medial malleolus was(15.4±3.3)cm,expressed in percentage was 31.3% to 48.4%(99% CI: 36.6,42.4).And the study demonstrated that the anterior tibial artery may be at risk for injury from the tibial distal medial plate fixation.Conclusion When the locking plate is placed at the tibial distal anteromedial by MIPPO,there is a cross in the direction between the screws and the anterior tibial artery.So the anterior tibial artery would be damaged if the plates and screws are fixed in crossing place.From this anatomy study,the danger zone could be determined as a percentage of tibial length.It can be used to guide the placement of plate and screws in clinical surgery for avoiding iatrogenic injury of the anterior tibial artery during operation.