Rausch, V., Hackl, M., Oppermann, J., Leschinger, T., Scaal, M., Mueller, L. P. and Wegmann, K. (2019). Peroneal nerve location at the fibular head: an anatomic study using 3D imaging. Arch. Orthop. Trauma Surg., 139 (7). S. 921 - 927. NEW YORK: SPRINGER. ISSN 1434-3916

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IntroductionInjuries 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.MethodsThe 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 ofthese 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.ResultsThe mean distance of the common peroneal nerve at the level of the tibial plateau to its posterior osseous limitation was 7.922.42mm, and 1.31 +/- 2.63mm to the lateral osseous limitation of the tibia. In a transversal plane, distance of the common peroneal nerve branching was 27.56 +/- 3.98mm relative to the level of the most proximal osseous extension of fibula and 11.77 +/- 6.1mm relative to the proximal extension of the tibial tuberosity. The deep peroneal nerve crossed the midline of the fibular shaft at a distance of 22.14mm +/- 4.35 distally to the most proximal extension of the fibula, the superficial peroneal nerve at a distance of 33.56mm +/- 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.

Item Type: Journal Article
CreatorsEmailORCIDORCID Put Code
URN: urn:nbn:de:hbz:38-136924
DOI: 10.1007/s00402-019-03141-7
Journal or Publication Title: Arch. Orthop. Trauma Surg.
Volume: 139
Number: 7
Page Range: S. 921 - 927
Date: 2019
Publisher: SPRINGER
Place of Publication: NEW YORK
ISSN: 1434-3916
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
PART 1; INJURIES; TIBIAMultiple languages
Orthopedics; SurgeryMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/13692


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