Updated: 10/28/2014

Approach to the Fibula

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Introduction
  • Provides exposure to
    • entire fibula
  • Indications include
    • ORIF of fibula fractures
    • resection of fibula
    • excision of fibula bone lesions
Internervous plane
  • Between
    • peroneal muscles (superficial peroneal nerve)
    • muscles of the posterior compartment (tibial nerve)
Approach
  • Position
    • may be done supine with bump under affected limb or in lateral position
  • Incision
    • Make linear longitudinal incision along the posterior border of the fibula (length depends on desired exposure)
    • may extend proximally to a point 5cm proximal to the fibular head
      • proximally follow in line with the biceps femoris tendon
  • Superficial dissection
    • begin proximally and incise the fascia taking great care not to damage the common peroneal nerve
    • identify the posterior border of the biceps femoris tendon and its insertion into the head of the fibula
    • about 10-12 cm above the tip of the lateral malleolus, the superficial peroneal nerve pierces the fascia
    • identify and isolate the common peroneal nerve as it courses behind the biceps femoris tendon
    • mobilize the common peroneal nerve by cutting the fibers of the peroneus longus
  • Deep dissection
    • develop plane between peroneal muscles and soleus down to bone
    • make a longitudinal incision in the periosteum of the fibula
    • strip the muscles that originate on the fibula to expose your desired segment of fibula
  • Extensile measure
    • distal - may be extended distally to become continuous with
      • Approach to the lateral malleolus
      • Ollier's lateral approach to the tarsus
      • Kocher lateral approach to the ankle and tarsus
      • Lateral approach to the calcaneus
Dangers
  • Common peroneal nerve
    • avoid injury by isolating proximally
  • Superficial peroneal nerve
    • susceptible to injury at junction of middle and distal third of leg 
    • if injured will cause numbness on the dorsum of the foot
 

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