Assessing Risk to Articular Cartilage and the Calcaneofibular Ligament During Fibular Nailing: A Cadaveric Study

Area of Science:

• Orthopaedic surgery
• Biomechanics
• Anatomy

Background:

• Traditional ankle fracture fixation risks include wound complications and hardware issues.
• Intramedullary (IM) fibular nailing offers a minimally invasive alternative.
• Limited data exists on IM fibular nailing's impact on the calcaneofibular ligament (CFL) and distal fibula cartilage.

Purpose of the Study:

• To assess the risk and extent of anatomical structure damage during IM fibular nailing.
• To evaluate proximity of the IM nail to critical soft tissues and cartilage.

Main Methods:

• Ten cadaveric lower extremities underwent IM fibular nail fixation.
• Distances from the nail to the CFL, ATFL, sural nerve (SN), superficial peroneal nerve (SPN), peroneus longus, peroneus brevis (PB), and articular cartilage were measured.
• Risks were categorized as high (0-5 mm), moderate (5.1-10 mm), or low (>10 mm).

Main Results:

• The CFL, ATFL, and PB were identified as high-risk structures.
• CFL damage occurred in 30% of specimens (14-64% width).
• Average distances to CFL (1.20 mm), ATFL (3.43 mm), PB (3.19 mm), and cartilage (3.45 mm) were in the high-risk range; however, no significant cartilage, ATFL, SN, or SPN damage was observed.

Conclusions:

• IM fibular nailing is a safe and reliable option for ankle fractures.
• Surgeons must be aware of potential iatrogenic damage to the CFL and peroneal tendons.
• While cartilage was spared, its proximity necessitates careful surgical technique.