The risk of iatrogenic injury to anterior tibial artery variations during tibial nail distal interlocking.

INTRODUCTION: Tibial intramedullary nailing remains a common tibial fracture fixation method. Tibial nailing indications continue to expand. Neurovascular complications from tibial nailing have been described; however, the proximity of distal tibial locking bolts to the anterior tibial artery (ATA) variants has not. MATERIALS AND METHODS: 52 cadaveric legs were dissected identifying three common ATA variants. Each ATA variant received an intraluminal wire to facilitate fluoroscopic identification. Three different intramedullary tibial nails were inserted in each of the three ATA variant specimens. With fluoroscopy, the proximity of the distal locking holes of each tibial nail to the intraluminal wire representing the ATA variant course was measured. RESULTS: Of the 40 measurements, the intraluminal wire was directly in the bolt insertional path in 8 of 40 (20%) and within 5 mm in 16 of 40 (40%). All specimens had the wire cross the locking bolt insertional path at least once in each of the nails. The ATA variant taking a more lateral course deep to the extensor digitorum longus and peroneus tertius to overlay the lateral malleolus had the highest occurrence of measurements less than 5 mm. CONCLUSIONS: The close proximity of tibial nail distal locking bolt holes to ATA variants presents a risk for iatrogenic vascular injury during insertion. The coronal locking bolts pose the greatest iatrogenic risk to the most laterally positioned ATA variant.

Safety of ankle trans-syndesmotic fixation.

BACKGROUND: Ankle syndesmosis fixation is often employed with the utilization of many variable methods and implants. Complications secondary to trans-syndesmotic fixation have been described, yet the proximity of a single trans-syndesmotic screw to the perforating branch of the peroneal artery (PBPA) has not. MATERIALS AND METHODS: Sixteen cadaveric legs received a single trans-syndesmotic screw using standard AO technique. The PBPA was identified and the following distances were measured using photographic images and morphometric software: the tip of lateral malleolus to the PBPA, the tibial plafond to the PBPA, tip of lateral malleolus to the screw, and the PBPA to the screw. Average distances were calculated and statistically compared. RESULTS: The location of the trans-syndesmotic screw inserted 2 cm proximal to the tibial plafond was on average less than 1.3 cm distal to the PBPA. In six out of the 16 specimens, the screw was less than 1 cm from the PBPA. In one specimen, the screw came within 0.22 cm of the PBPA. CONCLUSION/CLINICAL RELEVANCE: The placement of trans-syndesmotic fixation places the PBPA at risk. In order to avoid injury to the PBPA with trans-syndesmotic fixation, fixation should be avoided 2.3 to 4.1 cm proximal to the tibial plafond or 4.5 to 6.2 cm proximal to the tip of the lateral malleolus in females and 2.8 to 5.9 cm proximal to the tibial plafond or 5.1 to 7.2 cm proximal to the tip of the lateral malleolus in males.

Histopathologic changes related to fibrotic oviduct occlusion after genital tract infection of mice with Chlamydia muridarum.

OBJECTIVES: We sought to determine if intraluminal occluding fibrosis of the oviduct occurs after urogenital Chlamydia muridarum infection in mice. STUDY: Oviduct occlusion was assessed by infusing dye into the distal uterus and tracking the diffusion of the dye into the oviduct. We also conducted histologic assessment of the affected tissues using hematoxylin and eosin (H&E) and Masson trichrome stains. RESULTS: All previously infected susceptible mice had occluded oviducts compared with 17.5% of previously uninfected mice. Oviduct occlusion correlated with hydrosalpinx formation and infertility. Intraluminal oviduct fibrosis was observed in several sections of tissue displaying hydrosalpinx but not in tissues without hydrosalpinx. Fibrosis was localized to the oviduct isthmus and oviduct proper, proximal to the uterus. CONCLUSION: Intralumenal occluding fibrosis of the oviduct is a sequela of infection with C. muridarum in this model. These observations support the use of the murine model to study pathogenesis of chlamydial upper genital tract infection.