Anterior tibial artery and deep peroneal nerve entrapment in spiral distal third tibia fracture

The rate of injury to arterial structures following long bone injuries is low. The rate in tibial diaphyseal fractures is similarly low. This rate increases with open fractures, likely reflective of the higher energy nature of open fractures. The possibility of iatrogenic injury to neurovascular structures during fracture fixation is more concerning. Consequently, the clinician must be aware of the location of neurovascular structures and the possible distortion of the normal anatomy when treating fractures. The anterior tibial artery is in proximity to the distal tibia. Typically, the neurovascular bundle lies directly on the anterolateral tibia between the tibialis anterior and the extensor hallucis longus in the distal third of the tibia. After fracture, this normal relationship may be disrupted.