Peroneal nerve location at the fibular head: an anatomic study using 3D imaging

Area of Science:

• Orthopedic Surgery
• Anatomy
• Radiology

Background:

• Peroneal nerve injuries are a frequent complication during surgical treatment of proximal tibial or fibular fractures.
• Precise anatomical knowledge of the peroneal nerve is crucial for minimizing iatrogenic damage during surgery.

Purpose of the Study:

• To provide a detailed anatomical description of the peroneal nerve's position and branching patterns.
• To utilize 3D imaging for enhanced visualization and measurement of the peroneal nerve relative to bony landmarks.
• To aid surgeons in planning approaches to the fibular head and tibial plateau.

Main Methods:

• 18 formalin-embalmed lower leg specimens were dissected.
• The common, deep, and superficial peroneal nerves were marked with radiopaque threads.
• 3D X-ray scans were acquired, and digital measurements were taken from 3D reconstructions.

Main Results:

• Detailed measurements of the common peroneal nerve's distance to tibial plateau landmarks were recorded (e.g., 7.92 ± 2.42 mm to posterior limitation).
• Branching points of the common peroneal nerve were quantified relative to fibular and tibial landmarks (e.g., 27.56 ± 3.98 mm from fibular extension).
• Distances of the deep and superficial peroneal nerves from the fibular shaft midline were documented.

Conclusions:

• The course of the peroneal nerve exhibits significant individual variability.
• Careful surgical dissection is essential when operating on proximal posterolateral tibial or fibular fractures.
• While an area where the nerve is unlikely to be found was defined, specific 'safe zones' are not recommended due to anatomical variations.