The deep peroneal nerve is risk during an anterolateral approach to the distal tibia and ankle for open reduction and internal fixation of pilon fractures.
The anterolateral approach to the distal tibia is a commonly used approach for ORIF of distal tibia and ankle fractures. This surgical dissection crosses the anterior compartment of the leg, endangering the deep peroneal nerve (DPN).
Herscovici et al describe the Bohler incision which is an expansile anterolateral approach to the foot and ankle. They describe its utility in exposure of the anterior surface of the distal tibia, the anterior talar dome, talar neck, talonavicular, subtalar, and calcaneocuboid joints.
Wolinsky et al performed an anatomical study on the anterolateral approach to the distal tibia. They found that the superficial peroneal nerve (SPN) is always seen in the distal incision and should be safe if adequately protected. The structures at risk with this approach are the DPN and the anterior tibial vessels as they course from a posterior position proximally to a more anterior position distally.
1- The superficial personeal nerve is also at risk during this incision, but is in the lateral compartment of the leg.
3- The sural nerve is not at risk..
4- The saphenous nerve is not at risk.
5- The posterior tibial nerve is not at risk.
Herscovici D Jr, Sanders RW, Infante A, DiPasquale T. Bohler incision: an extensile anterolateral approach to the foot and ankle. J Orthop Trauma. 2000 Aug;14(6):429-32.
PMID:11001418 (Link to Abstract)
Wolinsky P, Lee M. The distal approach for anterolateral plate fixation of the tibia: an anatomic study. J Orthop Trauma. 2008 Jul;22(6):404-7.
PMID:18594305 (Link to Abstract)