A gross anatomic study of distal tibia and fibula for single-incision approach

OBJECTIVE This study aimed to investigate the feasibility of single incision for plating for the treatment of distal tibia and fibula fractures by a gross anatomic study. METHODS The anatomical structures of the anterolateral lower legs were identified. The lower leg length was measured from the top of fibular head to the tip of lateral malleolus. The distances between the extensor digitorum longus and anterior border of distal thirds of the tibia as well as the fibula were also measured. Additionally, their mutual relationships to the surrounding anatomical structures were described. RESULTS The distances from the proximal, middle, and distal thirds of the tibia to the extensor digitorum longus were 2.96 ± 0.46, 1.85 ± 0.25, and 2.15 ± 0.30 cm, respectively; the distances from the proximal, middle, and distal thirds of the fibula to the extensor digitorum longus were 1.82 ± 0.28, 2.09 ± 0.31, and 2.30 ± 0.27 cm, respectively. The results indicated that the safe gap from the distal tibia to extensor digitorum longus (EDL) was 1.6-3.4 cm and from the EDL to fibula was 1.5-2.6 cm. In addition, the average number of vascular pedicle in tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus longus, and peroneus brevis was 2-3. Injuries generated by retracting medially and laterally in vascular pedicle could hardly affect the distal muscles. CONCLUSIONS Therefore, we suggest that it is feasible to plate fractures of both the distal tibia and fibula through one anterolateral incision.