Anatomy of the superficial peroneal nerve: Can we predict nerve location and minimize iatrogenic lesion?

Relvas-Silva, Miguel; Pinho, André; Lopes, Joanne; Lixa, João; Leite, Maria João; Sousa, Alexandra; Veludo, Vitorino; Madeira, Dulce; Pereira, Pedro

doi:10.1016/j.morpho.2020.09.004

Cited by 8 publications

(8 citation statements)

References 23 publications

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“…The frequency of these variations is similar to that reported by other authors as 23% [ 10 ], although some studies have found only 8.3% [ 1 ]. For this reason, in agreement with other authors [ 2 , 20 ], we believe that the use of ultrasound should be mandatory when performing a fasciotomy to avoid any iatrogenic damage to the superficial fibular nerve.…”

Section: Discussionsupporting

confidence: 90%

“…Our results are similar to those of other articles that have measured the distance between the exit of the superficial fibular nerve from the crural fascia and of the lateral malleolus apex. For example, one study reported a distance of 10.33 cm for intraseptal cases and 11.28 cm for extraseptal cases [ 26 ], while another study reported 11.36 cm ± 4.39 cm [ 20 ]. However, as in those studies, we observed a great variability in the number of nerve divisions [ 28 ] and their trajectory [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…For example, one study reported a distance of 10.33 cm for intraseptal cases and 11.28 cm for extraseptal cases [ 26 ], while another study reported 11.36 cm ± 4.39 cm [ 20 ]. However, as in those studies, we observed a great variability in the number of nerve divisions [ 28 ] and their trajectory [ 20 ]. The frequency of these variations is similar to that reported by other authors as 23% [ 10 ], although some studies have found only 8.3% [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

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Compartments of the crural fascia: clinically relevant ultrasound, anatomical and histological findings

Ortiz-Miguel,

Miguel-Pérez,

Blasi

et al. 2023

Surg Radiol Anat

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Purpose Compartment syndrome is a surgical emergency that can occur in any part of the body and can cause cell necrosis when maintained over time. The resulting defects can affect the nerves, muscle cells, bone tissue, and other connective tissues inside the compartment, and fasciotomy has to be performed. The anatomical and histological characteristics of the leg make acute, chronic, and exertional compartment syndrome more likely in this limb. For these reasons, knowledge of the ultrasound, anatomical, and histological features of the crural fascia can help in the treatment of leg compartment syndrome. Methods Twenty-one cryopreserved lower limbs from adult cadavers and from one 29-week-old fetus were obtained from the dissection room. They were examined by ultrasound and a subsequent anatomical dissection and microscopy to study the crural fascia and its relationship with the different muscles. Anthropometric measurements were taken of the distances from the head of the fibula and lateral malleolus to the origin of the tibialis anterior muscle in the crural fascia, the exit of the superficial fibular nerve, and the fascia covering the deep posterior muscles of the leg. Results The crural fascia has very important clinical relationships, which can be identified by ultrasound, as the origin of the tibialis anterior muscle at 16.25 cm from the head of the fibula and the exit of the superficial fibular nerve that crosses this fascia at 21.25 cm from the head of the fibula. Furthermore, the presence of a septum that fixes the deep posterior muscles of the leg and the vessels and nerve can be seen by ultrasound and can explain the possible development of a posterior compartmental syndrome of the leg. Awareness of these features will help to keep these structures safe during the surgical treatment of compartment syndrome. Conclusion The ultrasound study allows identification of anatomical structures in the leg and, thus, avoids damage to them during surgery for compartmental syndromes.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Compartments of the crural fascia: clinically relevant ultrasound, anatomical and histological findings

Ortiz-Miguel,

Miguel-Pérez,

Blasi

et al. 2023

Surg Radiol Anat

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“…As routine in our Unit, appropriate dissection techniques were performed by using proper dissection tools in order to achieve the objectives of the study [12][13][14]. The specimens were placed in a supine position and the medial side of the distal part of the leg, ankle and foot were carefully dissected in order not to disturb the normal anatomy of the medial region of the ankle [15].…”

Section: Methodsmentioning

confidence: 99%

An anatomical approach to the tarsal tunnel syndrome: what can ankle's medial side anatomy reveal to us?

Lopes,

Rodrigues‐Pinho,

Neves

et al. 2023

Journal of Foot and Ankle Research

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Background The heel is a complex anatomical region and is very often the source of pain complaints. The medial heel contains a number of structures, capable of compressing the main nerves of the region and knowing its anatomical topography is mandatory. The purpose of this work is to evaluate if tibial nerve (TN) and its main branches relate to the main anatomical landmarks of the ankle’s medial side and if so, do they have a regular path after emerging from TN. Methods The distal part of the legs, ankles and feet of 12 Thiel embalmed cadavers were dissected. The pattern of the branches of the TN was registered and the measurements were performed according to the Dellon–McKinnon malleolar-calcaneal line (DML) and the Heimkes Triangle (HT). Results The TN divided proximal to DML in 87.5%, on top of the DML in 12,5% and distal in none of the feet. The Baxter’s nerve (BN) originated proximally in 50%, on top of the DML in 12,5% and distally in 37.5% of the cases. There was a strong and significant correlation between the length of DML and the distance from the center of the medial malleolus (MM) to the lateral plantar nerve (LPN), medial plantar (MPN) nerve, BN and Medial Calcaneal Nerve (MCN) (ρ: 0.910, 0.866, 0.970 and 0.762 respectively, p < 0.001). Conclusions In our sample the TN divides distal to DML in none of the cases. We also report a strong association between ankle size and the distribution of the MPN, LPN, BN and MCN. We hypothesize that location of these branches on the medial side of the ankle could be more predictable if we take into consideration the distance between the MM and the medial process of the calcaneal tuberosity.

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“…There are reports for iatrogenic injury of SPN in literature, or of its branches during multiple operative procedures around the ankle and foot as ankle arthroscopy, selective anaesthetic block, fasciotomies, external fixation devices, lateral approach for osteosynthesis for lateral malleolar fracture, ankle arthrodesis or arthroplasty [5,6,7,8] . The main cause of iatrogenic injury of SPN is topographic anatomic variation which is reported from different authors and presented in their anatomic studies according to route and branches distribution [4,9,10,11] . Barret et al (2006) postulated that clinical implication of this anatomic variation of SPN or its branches is important in surgeons who operate in lateral compartment of the leg to avoid iatrogenic nerve injuries [10] .…”

Section: Introductionmentioning

confidence: 99%

Is Anatomic Variation of Superficial Peroneal Nerve Having Medical Implication in Internal Fixation of Lateral Malleolus Fractures? A Case Report

Kastanis

Kapsetakis

et al. 2022

ijirms

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Superficial peroneal nerve (SPN) is one of the terminal branches of the common peroneal nerve which innervates muscles of the lateral compartment of the leg. It is reported in literature in cadaveric studies, that there is anatomic variation of the SPN according to course and distribution and how important this finding is in many surgical interventions around leg, ankle, and foot, with scope to avoid iatrogenic damage of the respective nerve. The aim of this study is to present a woman of 67 years old who presented in emergency department after a fall with a bimalleolar fracture of the left ankle and paresthesia distribution of superficial peroneal nerve (dorsal surface of the foot, and 3rd to 5th toes) and based on this case to analyze if this anatomic variation of SPN has an essential role in lateral approach for internal fixation of lateral malleolar fractures.

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Anatomy of the superficial peroneal nerve: Can we predict nerve location and minimize iatrogenic lesion?

Cited by 8 publications

References 23 publications

Compartments of the crural fascia: clinically relevant ultrasound, anatomical and histological findings

Compartments of the crural fascia: clinically relevant ultrasound, anatomical and histological findings

An anatomical approach to the tarsal tunnel syndrome: what can ankle's medial side anatomy reveal to us?

Is Anatomic Variation of Superficial Peroneal Nerve Having Medical Implication in Internal Fixation of Lateral Malleolus Fractures? A Case Report

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