Anterior Tibial Artery Danger Zone During Anterolateral Plate Fixation of the Distal Tibia: A 3D CT Angiogram Modeling Study.

Abstract

The objective of this study was to define the danger zone at which the anterior tibial artery (ATA) is at risk during anterolateral plating of the distal tibia using a novel 3D CTA modeling technique. We identified 116 patients (232 lower extremities) with lower extremity CTAs performed between 04/2020 and 04/2022. Those with lower extremity trauma, evidence of a previously healed tibia fracture, or poor visualization of the ATA were excluded. The remaining 150 lower extremities (92 patients) were modeled with an anterolateral distal tibia plate using Sectra IDS7 software. The distance of the ATA from bony landmarks was measured perpendicular to the level at which the vessel intersected the plate. The ATA intersected the plate at a mean distance of 10.5 cm (95% CI 10.2 - 10.9) proximally, and distally at a mean distance of 4.6 cm (95% CI 4.4 - 4.9) from the central tibial plafond. The ATA intersected with the plate as far distal as hole number 1 and as proximal as hole 14 of the plate. The greatest injury risk was associated with plate holes 3-8. In this region the artery was at risk in 46-99 percent of specimens. The ATA is at risk when percutaneously placing screws in an anterolateral distal tibia plate. The artery can be as close as 4.4 cm and as far as 10.9 cm proximal to the tibial plafond when crossing the plate, correlating to a risk of injury to the ATA at plate holes 1 through 14. Level IV, computed tomography angiography study.