Anatomy and pattern of tibial periosteal circulation: implications for tibial plating : a cadaveric study

The significance of periosteal vessels in the healing of tibial shaft fractures is well-established. However, the gross anatomical patterns and differential distribution of these vessels on the medial versus lateral surface of the tibial shaft have not been thoroughly described. This study aimed to illustrate the comparative anatomy of periosteal circulation on the medial versus lateral surface of the tibial shaft, where tibial plates are commonly applied.

Ten adult fresh cadavers underwent aortic injection with coloured silicone to investigate the vascular system of the lower limbs, including the tibial extraosseous circulation. Following material fixation, the medial and lateral tibial surfaces were dissected extraperiosteally from the knee to the ankle joint to visualize the gross anatomy of periosteal vessels running along the medial and lateral surfaces of the tibial shaft.

In all specimens, periosteal vessels on the lateral tibial consisted of six to eight main trunks in 17 out of 20 specimens. These vessels were evenly distributed, horizontally oriented, and exhibited variable side branching. Most of these vessels crossed the anterior tibial crest, terminating on the medial side. The extensor muscles on the lateral tibial surface made negligible contributions to the periosteal circulation. The medial tibial surface received its periosteal blood supply partly from the terminal branches of the traversing vessels from the lateral surface and partly from branches of the posterior tibial artery. These vessels were shorter, smaller, sparsely scattered, randomly distributed, and exhibited greater variability in number and size compared to their lateral counterparts.

Periosteal circulation to the anterior two-thirds of the tibial shaft is mainly delivered through the lateral tibial surface. When periosteal circulation is a concern, lateral plating may be more disruptive compared to medial plating.