Fixation of a Distal Diaphyseal Tibia Fracture with Neurovascular Tissue Incarceration: Surgical Technique Using a Lesser Invasive Approach

Abstract

Soft tissue incarceration in a distal diaphyseal tibia fracture may predispose to adverse fracture healing. Incarcerated soft tissue may include nerves and/or vessels, with the potential for neurovascular complications. Meticulous neurovascular examination of the extremity is mandatory, and, when in doubt, Doppler ultrasound of the fracture area should be obtained, in addition to computed tomography angiography if neurovascular structures are involved. In order to address this situation, a surgical technique combining the advantages of minimally invasive plate osteosynthesis and limited fracture line exposition is described, exemplified with the case of a 65 y/o male who sustained a low-energy right closed distal diaphyseal tibio-peroneal fracture (AO/ OTA type 42-B2) with anterior tibial artery and deep peroneal nerve entrapment.