Incidence of Iatrogenic Damage During Ilizarov Fixation of the Tibia.
Research type
Research Study
Full title
Incidence and Clinical Importance of Iatrogenic Damage to the Deep Peroneal Nerve and Anterior Tibial Artery during Ilizarov Fine Wire External Fixation of the Distal Tibia.
IRAS ID
217590
Contact name
Paul Harwood
Contact email
Sponsor organisation
Leeds Teaching Hospitals NHS Trust
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
A treatment for complex fractures of the distal tibia is the Ilizarov method. Wires are inserted through the bone proximally and distally to a fracture. These wires are connected to rings, which are in turn connected via rods, stabilising the fracture. Insertion of these wires carries an inherent risk of injuring important structures such as nerves and blood vessels. Standard routes of insertion have been designed in an attempt to minimise this risk based on anatomic descriptions. In certain areas however these standard safe wire "corridors" are less clearly defined due to variable anatomy between individuals, one such area is in the distal (bottom part) of the tibia. During our previous research using cadaveric specimens, we evaluated the safety of standard wire insertion corridors In this area. The study suggested the incidence rate of damage to the anterior tibial artery and the deep peroneal nerve is potentially higher than previous literature suggested, at 25%. This is potentially due to limitations of cadaveric research or that these complications are going un-noticed in clinical practice. Such injuries may be of consequence to patients in later life and therefore it is important to define clearly;
There are two potential reasons for increased incidence.
1) The true incidence of damage to the deep peroneal nerve (DPN) and anterior tibial artery (ATA) during surgical fixation of the distal tibia.
2) To determine if wires in particular areas increase this risk as was apparent in the cadaveric study.
3) To try and understand why iatrogenic damage does not always result in clinical symptoms.REC name
London - Westminster Research Ethics Committee
REC reference
17/LO/0137
Date of REC Opinion
6 Mar 2017
REC opinion
Further Information Favourable Opinion