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Minimally invasive cerclage at the tibia using a modified Goetze technique: An anatomical study
Stefan Förch1, Leonard Lisitano1, Franziska von der Helm1
1Trauma Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86159 Augsburg, Germany.
Orthopaedics & Traumatology, Surgery & Research : OTSR
|March 17, 2023
Summary
Minimally invasive cerclages can be safely inserted in the tibia without damaging nerves or vessels. This anatomical study confirms the feasibility of the technique, highlighting potential risks in specific tibial regions.
Area of Science:
- Orthopedic surgery
- Anatomical studies
Background:
- Minimally invasive cerclage techniques for tibial fractures are not widely used.
- Recent clinical data suggest no increased complication rates with a new operative technique.
Purpose of the Study:
- To anatomically evaluate the safety of a minimally invasive cerclage technique at various tibial levels.
- To determine if relevant nerves, vessels, or tendons are encased during insertion.
Main Methods:
- Ten human cadaveric lower legs were used.
- Minimally invasive cerclages were inserted at four distinct tibial levels (proximal to distal).
- Cadavers were dissected at cerclage sites to identify and measure distances to encased anatomical structures.
Main Results:
- No relevant anatomical structures were encased by cerclages in any specimen.
- Proximal tibia: Posterior tibial artery and vein were closest (4.0–5.5mm).
- Distal tibia: Anterior tibial artery and vein, deep fibular nerve, and posterior tibialis tendon were closest (0.8–2.2mm).
Conclusions:
- Minimally invasive tibial cerclage insertion is anatomically feasible with correct technique.
- Careful attention is required to avoid the posterior tibial neurovascular bundle proximally and anterior tibial structures distally.
