The Risk of Injury to the Anterior Tibial Artery in the Posterolateral Approach to the Tibia Plateau: A Cadaver Study

Background: Posterolateral tibial plateau shear fractures often require buttress plating, which can be performed through a posterolateral approach. The purpose of this study was to provide accurate data about the inferior limit of dissection. Methods: Forty unpaired cadaver adult lower limbs were used. The anterior tibial artery was identified because it coursed through the interosseous membrane. The perpendicular distance from the lateral joint line and fibula head to this landmark was measured. Results: The anterior tibial artery coursed through the interosseous membrane at 46.3 +/- 6 9.0 mm (range 27-62 mm) distal to the lateral tibial plateau and 35.7 +/- 6 9.0 mm (range 17-50 mm) distal to the fibula head. Conclusions: Displaced posterolateral tibial plateau fractures require anatomic reduction and stabilization with a buttress plate. This can be achieved by gaining access to the posterolateral tibial cortex. The distal limit of this dissection can be as little as 27 mm distal to the lateral tibial plateau. Dissection in this region should be carried out with caution.