Approach to the Fibula

  • The approach to the fibula employs a classic extensile exposure and offers access to all parts of the fibula.

  • The approach to the fibula includes the following:
    1. Partial resection of the fibula during tibial osteotomy or as part of the treatment of tibial nonunion.
    2. Resection of the fibula for decompression of all four compartments of the leg.
    3. Tumors Resection.
    4. Osteomyelitis Resection.
    5. Open reduction and internal fixation of fractures of the fibula
    6. Removal of bone graft, cortico-cancellous strut grafts.

  • May be done in supine position with bump under affected limb or in lateral position.

  • Landmarks:
    1. Head of the fibula.
    2. The lower fourth of the fibula.
  • Incision:
    • Make linear longitudinal incision along the posterior border of the fibula (length depends on desired exposure)
    • May be extended proximally to a point 5 cm proximal to the fibular head.

  • The internervous plane for the approach to the fibula lies between:
    • Peroneal muscles: innervated by superficial peroneal nerve.
    • Muscles of the posterior compartment: innervated by tibial nerve.

  • 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.
  • The superficial peroneal nerve pierces the fascia about 10-12 cm above the tip of the lateral malleolus.
  • 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.

  • 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.

  • The approach to the fibula can be extended distally:
    • Extend the skin incision distally by curving it over the lateral side of the tarsus.
    • To gain access to the sinus tarsi and the talocalcaneal, talonavicular, and calcaneocuboid joints, reflect the underlying extensor digitorum brevis muscle.
    • This extension is used frequently for lateral operations on the leg and foot.

  • The structures at risk during the approach to the fibula include:
    1. Common peroneal nerve:
      • Avoid injury by isolating proximally.
    2. 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.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
approach to the fibula approach to the fibula approach to the fibula approach to the fibula approach to the fibula approach to the fibula
Images Source:
  • Surgical Exposures in Orthopaedics 4th Edition Book.

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