Vascular injury involving proximal medial-to-lateral oblique locking screw insertion in tibial intramedullary nailing.

Orthopaedic surgeons have reported increased neurologic complications with the employment of next-generation tibial nail fixation with variable proximal and distal locking options. However, vascular injury due to oblique screw placement has not been documented. We describe a case in which a medial-to-lateral oblique locking screw led to significant vascular injury. The judicious use of these screws and their relative contribution to fracture stability should be carefully considered for individual cases. Additionally, drill penetration through the far tibial cortex may not be obvious and utilizing oscillation or reverse drilling techniques may be of benefit. Lastly, the forward thrust of the popliteal artery with the use of a positioning bump in the popliteal fossa may place the vascular structure at increased risk of injury. Employing means to avoid these injuries and minimize risks in pertinent patients is of utmost importance.