Review Question - QID 3647

The above clinical scenario describes a post-op superficial peroneal nerve (SPN) deficit following ORIF of a tibial fracture using both external fixation and minimally invasive plate osteosynthesis (MIPO). The less invasive stabilization system (LISS) plate by Synthes is a system which utlizes the MIPO technique. This minimally invasive technique can increase the risk of damage to the SPN without careful identification of the nerve distally due to its close proximity to LISS plate holes 11-13.

Deangelis et al studied the anatomy of the superficial peroneal nerve in relation to fixation of tibia fractures with the LISS plate using cadaveric dissections. They found that the superficial peroneal nerve is at significant risk during percutaneous screw placement in holes 11 through 13 of the 13-hole proximal tibia LISS plates. They recommended using an incision and careful dissection down to the plate in this region of distal locking screws to minimize the risk of damage to the nerve.

Roberts et al also studied neurovascular anatomy of the leg in relation to screw placement, but did it in relation to locking screws used in intramedullary nailing. They concluded that intramedullary nail locking screws placed from a lateral-to-medial direction minimized the risk of injuries to the SPN and tibial neurovascular bundle. A disadvantage of lateral-to-medial locking screw placement was less resistance to nail bending forces.