This is a plain-English translation of the academic paper above, prepared for patients, referring clinicians, and other non-specialist readers. It preserves the structure of the original paper while removing technical jargon. For the full clinical paper, follow the PubMed or DOI links.
Background
How variable the tibialis anterior muscle — the muscle that runs down the front of the shin and lifts the foot — is in shape and length, and what that variation means for surgeons sliding a plate up the front of the shin bone through small skin incisions to fix a fracture.
Rationale
Minimally invasive plating of the tibia means sliding a long plate under the skin and muscle, with only small incisions at each end. The plate has to pass under or alongside the tibialis anterior muscle and its tendon, and the deep peroneal nerve and anterior tibial artery run nearby. If the surgeon assumes a typical anatomy that does not match the patient in front of them, the plate or screws can damage these structures.
Results
In 40 cadaveric legs, we found very large variation in where the muscle ended and where it became tendon. The lower edge of the muscle belly ranged from about 6 cm to over 20 cm above the inner ankle bone. There was no relationship between the length of the shin bone and the shape of the muscle — you cannot predict the muscle’s anatomy from the patient’s leg length.
Implications
For patients having a tibia plate inserted using a minimally invasive technique, the surgeon should not rely on a “textbook” assumption about where the tendon begins. The safest practice is to make a small open incision at the lower end of the plate so that the nerve and artery can be seen and protected before the final screws go in.
Source: Tesch NP, Grechenig W, Heidari N, Pichler W, Grechenig S, Weinberg AM. Morphology of the tibialis anterior muscle and its implications in minimally invasive plate osteosynthesis of tibial fractures. Orthopedics 2010;33(3). doi:10.3928/01477447-20100129-08
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