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Peroneal nerve location at the fibular head: an anatomic study using 3D imaging.
Arch Orthop Trauma Surg. 2019 Jul; 139(7):921-926.AO

Abstract

INTRODUCTION

Injuries to the peroneal nerve are a common complication in operative treatment of proximal tibial or fibular fractures. To minimize the risk of iatrogenic injury to the nerve, detailed knowledge of the anatomy of the peroneal nerve is essential. Aim of this study was to present a detailed description of the position and branching of the peroneal nerve based on 3D-images to assist preparation for surgical approaches to the fibular head and the tibial plateau.

METHODS

The common peroneal nerve, the deep and the superficial peroneal nerve were marked with a radiopaque thread in 18 formalin-embalmed specimens. Three-dimensional X-ray scans were then acquired from the knee and the proximal lower leg in full extension of the knee. In 3D-reconstructions of these scans, distances of the common peroneal nerve and its branches to clearly defined osseous landmarks were measured digitally. Furthermore, the height of the branching of the common peroneal nerve was measured in relation to the landmarks.

RESULTS

The mean distance of the common peroneal nerve at the level of the tibial plateau to its posterior osseous limitation was 7.92 ± 2.42 mm, and 1.31 ± 2.63 mm to the lateral osseous limitation of the tibia. In a transversal plane, distance of the common peroneal nerve branching was 27.56 ± 3.98 mm relative to the level of the most proximal osseous extension of fibula and 11.77 ± 6.1 mm relative to the proximal extension of the tibial tuberosity. The deep peroneal nerve crossed the midline of the fibular shaft at a distance of 22.14 mm ± 4.35 distally to the most proximal extension of the fibula, the superficial peroneal nerve at a distance of 33.56 mm ± 6.68.

CONCLUSION

As the course of the peroneal nerve is highly variable in between individuals, surgical dissection for operative treatment of proximal posterolateral tibial or fibular fractures has to be done carefully. We defined an area were the peroneal nerve and its branches are unlikely to be found. However, specific safe zones should not be utilized due to the individual anatomic variation.

Authors+Show Affiliations

Center for Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital, Kerpener Str. 62, 50937, Cologne, Germany. rauschv@gmail.com.Center for Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital, Kerpener Str. 62, 50937, Cologne, Germany.Center for Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital, Kerpener Str. 62, 50937, Cologne, Germany.Center for Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital, Kerpener Str. 62, 50937, Cologne, Germany.Department of Anatomy II, Medical Faculty, University of Cologne, Cologne, Germany.Center for Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital, Kerpener Str. 62, 50937, Cologne, Germany.Center for Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital, Kerpener Str. 62, 50937, Cologne, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30737594

Citation

Rausch, V, et al. "Peroneal Nerve Location at the Fibular Head: an Anatomic Study Using 3D Imaging." Archives of Orthopaedic and Trauma Surgery, vol. 139, no. 7, 2019, pp. 921-926.
Rausch V, Hackl M, Oppermann J, et al. Peroneal nerve location at the fibular head: an anatomic study using 3D imaging. Arch Orthop Trauma Surg. 2019;139(7):921-926.
Rausch, V., Hackl, M., Oppermann, J., Leschinger, T., Scaal, M., Müller, L. P., & Wegmann, K. (2019). Peroneal nerve location at the fibular head: an anatomic study using 3D imaging. Archives of Orthopaedic and Trauma Surgery, 139(7), 921-926. https://doi.org/10.1007/s00402-019-03141-7
Rausch V, et al. Peroneal Nerve Location at the Fibular Head: an Anatomic Study Using 3D Imaging. Arch Orthop Trauma Surg. 2019;139(7):921-926. PubMed PMID: 30737594.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peroneal nerve location at the fibular head: an anatomic study using 3D imaging. AU - Rausch,V, AU - Hackl,M, AU - Oppermann,J, AU - Leschinger,T, AU - Scaal,M, AU - Müller,L P, AU - Wegmann,K, Y1 - 2019/02/08/ PY - 2018/06/25/received PY - 2019/2/10/pubmed PY - 2019/10/28/medline PY - 2019/2/10/entrez KW - 3D imaging KW - Anatomy KW - Fibular head KW - Nerve injury KW - Peroneal nerve KW - Tibia fracture SP - 921 EP - 926 JF - Archives of orthopaedic and trauma surgery JO - Arch Orthop Trauma Surg VL - 139 IS - 7 N2 - INTRODUCTION: Injuries to the peroneal nerve are a common complication in operative treatment of proximal tibial or fibular fractures. To minimize the risk of iatrogenic injury to the nerve, detailed knowledge of the anatomy of the peroneal nerve is essential. Aim of this study was to present a detailed description of the position and branching of the peroneal nerve based on 3D-images to assist preparation for surgical approaches to the fibular head and the tibial plateau. METHODS: The common peroneal nerve, the deep and the superficial peroneal nerve were marked with a radiopaque thread in 18 formalin-embalmed specimens. Three-dimensional X-ray scans were then acquired from the knee and the proximal lower leg in full extension of the knee. In 3D-reconstructions of these scans, distances of the common peroneal nerve and its branches to clearly defined osseous landmarks were measured digitally. Furthermore, the height of the branching of the common peroneal nerve was measured in relation to the landmarks. RESULTS: The mean distance of the common peroneal nerve at the level of the tibial plateau to its posterior osseous limitation was 7.92 ± 2.42 mm, and 1.31 ± 2.63 mm to the lateral osseous limitation of the tibia. In a transversal plane, distance of the common peroneal nerve branching was 27.56 ± 3.98 mm relative to the level of the most proximal osseous extension of fibula and 11.77 ± 6.1 mm relative to the proximal extension of the tibial tuberosity. The deep peroneal nerve crossed the midline of the fibular shaft at a distance of 22.14 mm ± 4.35 distally to the most proximal extension of the fibula, the superficial peroneal nerve at a distance of 33.56 mm ± 6.68. CONCLUSION: As the course of the peroneal nerve is highly variable in between individuals, surgical dissection for operative treatment of proximal posterolateral tibial or fibular fractures has to be done carefully. We defined an area were the peroneal nerve and its branches are unlikely to be found. However, specific safe zones should not be utilized due to the individual anatomic variation. SN - 1434-3916 UR - https://www.unboundmedicine.com/medline/citation/30737594/Peroneal_nerve_location_at_the_fibular_head:_an_anatomic_study_using_3D_imaging_ L2 - https://dx.doi.org/10.1007/s00402-019-03141-7 DB - PRIME DP - Unbound Medicine ER -