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 close the deep peroneal nerve — one of the main nerves of the lower leg — runs to a long titanium plate (the Less Invasive Stabilisation System, or LISS plate) when it is slid down the shin bone through a small skin incision to fix a fracture. We examined 18 cadaver legs.
Rationale
Minimally-invasive plating of the tibia has clear advantages: smaller scars, less disruption to the soft tissue around the fracture, and faster healing. The trade-off is that the surgeon cannot see directly what the plate is touching as it slides into place. We wanted to know whether the deep peroneal nerve — which controls the muscles that lift the foot — was at risk.
Results
In every single one of the 18 specimens, the deep peroneal nerve was in direct contact with the plate between the 11th and 13th holes. In some cases the nerve was actually trapped between the plate and the bone. The conclusion was unambiguous: percutaneous plates with more than 10 holes pose a real risk to the nerve.
Implications
For patients having a tibial LISS plate inserted, the safest practice is to use shorter plates where possible, or, when a longer plate is genuinely needed, to make a small additional incision distally so that the nerve can be visualised and protected before the plate is finally seated.
Source: Pichler W, Grechenig W, Tesch NP, Weinberg AM, Heidari N, Clement H. The risk of iatrogenic injury to the deep peroneal nerve in minimally invasive osteosynthesis of the tibia with the less invasive stabilisation system: A cadaver study. Journal of Bone and Joint Surgery - Series B 2009;91(3):385-7. doi:10.1302/0301-620X.91B3.21673
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