Archives of Orthopaedic and Trauma Surgery

, Volume 131, Issue 10, pp 1409–1412 | Cite as

The risk of nerve injury with minimally invasive plate osteosynthesis of distal fibula fractures: an anatomic study

  • Thomas Neubauer
  • Nima HeidariEmail author
  • Annelie M. Weinberg
  • Wolfgang Grechenig
  • Norbert Peter Tesch
  • Wolfgang Pichler
  • Michael Wagner
Trauma Surgery



The aim of our study was to identify the structures which may be at risk of injury when using a minimally invasive technique for the osteosynthesis of the lateral malleolus and the influence of the size of the implant on the frequency of injury to these structures.


Forty plates were percutaneously inserted in 20 cadaveric legs. The region around the plate was then dissected to examine the relation of nerves and soft tissues to the plate.


The superficial peroneal nerve was in direct contact with the plate in 11 of the 20 cases (55%) of the 10 hole plates. We encountered only one case of the superficial peroneal nerve skirting the proximal edge of a 6 hole plate (p = 0.0164).


Consequently we recommend meticulous attention is paid to the dissection of soft tissues in both the proximal and distal incisions. The length of the plate may be checked with intraoperative imaging prior to its insertion, and the site of both proximal and distal incisions may be marked on the skin. After careful dissection down to the bone, preserving nerves and tendons, the periosteal elevator should be introduced both from the proximal as well as the distal incisions to prepare the extra-periosteal tunnel for the insertion of the plate, in order to avoid the entanglement of the superficial peroneal nerve with the metal work, particularly in plates of longer than six holes.


Minimal invasive plating fibula Complications Malleolar fractures 


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Thomas Neubauer
    • 1
  • Nima Heidari
    • 2
    • 3
    Email author
  • Annelie M. Weinberg
    • 3
  • Wolfgang Grechenig
    • 2
  • Norbert Peter Tesch
    • 4
  • Wolfgang Pichler
    • 2
  • Michael Wagner
    • 1
  1. 1.Department of TraumatologyWilhelminenspital der Stadt WienViennaAustria
  2. 2.Department of TraumatologyMedical University of GrazGrazAustria
  3. 3.Department of Paediatric and Adolescent SurgeryMedical University of GrazGrazAustria
  4. 4.Medical University of Graz, Anatomic InstituteGrazAustria

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