Proximal tibial transfixion for skeletal traction. An anatomic study of neurovascular structures

Pin placement in the proximal tibia is commonly performed by passing the pins percutaneously, without visualization of the underlying neurovascular and anatomic structures. Neurovascular injuries are uncommon. Complications are avoidable through a thorough familiarity with the location of the neurovascular structures. Six cadaveric legs were dissected and the three-dimensional anatomy of the peroneal nerve in the proximal one-third of the leg defined, with the use of profile radiography. The nerve is situated predominantly posterior to the tibia. The pin should be passed through the middle of the tibia (in cross section) strictly in the coronal plane to avoid neural damage. Skeletal traction or external fixation pins may, therefore, safely be placed in the proximal tibia.