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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(06): e939-e943
DOI: 10.1055/s-0042-1757961
Artigo Original
Ortopedia Pediátrica

Risk of Neurovascular Injury during Screw Fixation of Tibial Tubercle Fractures in Pediatric and Adolescent Patients[*]

Article in several languages: português | English
Paula Biolatto 
1   Cirurgião Ortopédico, Departamento de Ortopedia Pediátrica, Sanatório Allende, Córdoba, Argentina
,
Alpesh Kothari 
2   Cirurgião Ortopédico, Departamento de Ortopedia Pediátrica, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7HE, Reino Unido
,
Javier Masquijo 
1   Cirurgião Ortopédico, Departamento de Ortopedia Pediátrica, Sanatório Allende, Córdoba, Argentina
› Author Affiliations Financial Support The authors declare that they have received no financial support from public, commercial, or non-profit sources.
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Abstract

Objective To review knee magnetic resonance imaging (MRI) scans for the analysis of the location of neurovascular structures (NVSs), and to define the risk of bicortical fixation.

Methods Distances between the posterior cortex and the popliteal NVSs were measured on the MRI scans of 45 adolescents (50 knees) at 3 levels (C1: center of the proximal tibial epiphysis; C2: 10 mm distal to the physis; and C3: 20 mm distal to the physis). The NVSs located between 5 mm and 10 mm from the incision were considered in a zone of moderate risk for damage, while those less than 5 mm from the incision were considered in a zone of high risk for damage, and those more than 10 mm from the incision were considered to be in a zone of low risk for damage. The independent Student t-test was used for the comparison of the NVS distance 0with gender, skeletal maturity, and the tibial tubercle-trochlear groove (TT-TG) distance. Values of p < 0.05 were regarded as statistically significant.

Results The path of the C1 screw posed an increased risk of damage to the popliteal artery and vein compared with other screw paths (p < 0.001). The popliteal artery has a high risk of damage at the level of C1 (4.2 ± 2.2mm), and a moderate risk at C2 (9.6 ± 2.4mm), and the popliteal vein has a moderate risk at C1 (6.0 ± 2.7 mm), and a low risk at C2 and C3 (10.8 ± 3.1mm, and 12.05 ± 3.1mm respectively). The C3 position presented the lowest risk of damage to these structures (p < 0.001). The distance between the posterior tibial cortex and the posterior tibial nerve was < 15 mm at the 3 levels analyzed (C1: 11.0 ± 3.7 mm; C2: 13.1 ± 3.8 mm; and C3: 13 ± 3.9 mm).

Conclusions The present study clarifies that the popliteal vessels are at risk of injury during tibial tubercle screw fixation, particularly when drilling the proximal tibial epiphysis. Monocortical drilling and screw fixation are recommended for the surgical treatment of tibial tubercle fractures.

Level of Evidence III Diagnostic study.

Keywords

child - fracture fixation, internal - tibial fractures - popliteal artery injury

Authors' Contributions

Each author contributed individually and significantly to the development of the present article: Biolatto P: measurements, manuscript preparation. Kothari A: study design, statistical analysis, manuscript review. Masquijo JJ: study design, measurements, manuscript preparation.


* Study developed at the Department of Pediatric Orthopedics, Sanatorio Allende, Córdoba, Argentina.




Publication History

Received: 04 June 2022

Accepted: 12 September 2022

Article published online:
31 July 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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