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Anatomic Considerations Regarding the Placement of a Retrograde Intramedullary Fibular Screw
Suman Medda1, Amy P Trammell1, Robert D Teasdall1
1Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
Journal of Surgical Orthopaedic Advances
|June 28, 2021
Summary
Identifying the best entry point for retrograde fibular screws is crucial. The ideal placement avoids damaging surrounding ligaments and prevents impingement on the talus, ensuring surgical safety.
Area of Science:
- Orthopaedic Surgery
- Anatomy
- Biomechanical Engineering
Background:
- Retrograde intramedullary fibular cortical screws are used in fracture fixation.
- Accurate screw placement is essential to prevent neurovascular and soft tissue injury.
- Optimal screw trajectory requires detailed anatomical knowledge.
Purpose of the Study:
- Determine the ideal starting point for retrograde fibular cortical screws.
- Evaluate potential damage to surrounding soft tissues during screw insertion.
- Establish anatomical landmarks for safe screw placement.
Main Methods:
- Four fresh frozen cadavers were used for the study.
- A standardized protocol for fluoroscopic-guided screw placement was followed.
- Measurements were taken from the screw head to adjacent soft tissue structures.
Main Results:
- No peroneal tendon damage occurred with the foot in an inverted and plantarflexed position.
- The anterior talofibular ligament (ATFL) was closest anteriorly (3-4 mm).
- The calcaneofibular ligament (CFL) was closest posteriorly (2-3 mm).
- Two screws impinged on the lateral talar process, violating the malleolar fossa.
Conclusions:
- The ideal starting site is the midline on lateral radiographs and 3.0 mm lateral to the malleolar fossa on AP radiographs.
- This placement strategy avoids injury to the ATFL and CFL.
- It also prevents impingement on the lateral process of the talus.
