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Percutaneous Fibular Nail for Ankle Fractures: An Anatomic Mapping Study
Matheus Levy A T de Souza1,2,3, Frederick Michels2,4, Hugo Bertani Dressler1
1Mater Dei Healthcare Network, Belo Horizonte, Minas Gerais, Brazil.
Foot & Ankle Orthopaedics
|June 4, 2026
Summary
Intramedullary fibular nailing effectively reduces ankle fractures with minimal wound complications. However, the superficial peroneal nerve is at risk during the procedure, necessitating careful technique to avoid injury.
Area of Science:
- Orthopedic surgery
- Anatomy
- Biomechanics
Background:
- Intramedullary fibular nailing is increasingly used for ankle fractures, especially in high-risk patients.
- Concerns exist regarding the safety and reduction quality of this minimally invasive technique.
- Anatomical assessment of potential risks to adjacent structures is crucial.
Purpose of the Study:
- Evaluate risks to adjacent structures during percutaneous retrograde locked intramedullary fibular nail implantation.
- Assess fracture reduction quality using radiographic analysis.
- Identify critical anatomical zones and potential iatrogenic injury risks.
Main Methods:
- Ten cadaveric lower extremities with simulated Weber B/C ankle fractures were used.
- Fractures were fixed using intramedullary nailing.
- Reduction quality was assessed fluoroscopically; specimens were dissected to evaluate adjacent structures and measure distances.
Main Results:
- Adequate fracture reduction was achieved in all specimens.
- No peroneal tendon injuries were observed.
- The superficial peroneal nerve (SPN) posed the highest risk, with mean distances of 4.52mm (anterior portal) and 14.17mm (lateral portal); SPN contacted the anterior portal in 3 specimens without observed injury.
Conclusions:
- Intramedullary nailing is effective for ankle fracture reduction with minimal soft-tissue complications.
- The superficial peroneal nerve is at greatest anatomic risk, particularly with anterior portal placement.
- Strict adherence to percutaneous techniques is vital to minimize iatrogenic injury.
