The distal approach for anterolateral plate fixation of the tibia: an anatomic study

To determine what anatomic structures are at risk when placing plates from distal to proximal along the anterolateral border of the tibia.

Cadaveric dissection study.

The Zimmer Institute, Warsaw, Indiana.

A laboratory investigation was performed using 10 matched limbs (5 right and 5 left) of 5 fresh, frozen, nonpreserved cadaveric specimens. Dissections were carried out to identify the relationships between the plate/screw contructs and (1) the superficial peroneal nerve (SPN) and the pedicle containing the deep peroneal nerve and the anterior tibial vessels (DPN/ATV).

The SPN was always visualized in the subcutaneous tissues of the distal incision. The DPN/ATV courses along the posterior half of the tibial shaft proximally and crosses the distal third of the plate as it transitions to an anterior position The pedicle crosses and covers the tibia in a consistent region 40 to 110 mm proximal to the ankle joint.

The distal anterolateral approach can be used to place plates along the anterolateral border of the tibia. The SPN is always seen in the distal incision and is not at risk. The structures at risk are the deep peroneal nerve and the anterior tibial vessels as they course from a posterior position proximally to a more anterior position distally.