Nerve and tendon injury with percutaneous fibular pinning: A cadaveric study

Iorio, Justin; Criner, Katharine; Rehman, Saqib; Meizinger, Casey; Haydel, Christopher

doi:10.1016/j.injury.2014.08.025

Cited by 5 publications

(3 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous cadaveric studies have demonstrated the close proximity of the peroneal tendons and sural nerve which pass within millimetres of the posterior medial boarder of the fibula, however the risk remains underappreciated. 8 Our investigation supports these findings and draws attention to other 'at risk' structures such as the incisura and flexor hallucis longus.…”

Section: Discussionsupporting

confidence: 82%

“…Trauma to these structures can necessitate reoperation in up to 43% of patients. 8,9 The identification and use of safe corridors for implant insertion form the basis of good orthopaedic practice and, to date, no previous studies have attempted to define a safe zone for lag screw insertion for this common procedure. 10 Our study aimed to address this deficiency using a combination of postoperative radiographic and magnetic resonance images (MRI) to define typical fibula lag screw position and map a common reference point and subsequent safe trajectory for lag screw fixation in the unstable supination external rotation/Danis-Weber B type injuries.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A practical ‘safe zone’ technique for lag screw fixation of the fibula

Kaye

Marlow

Williams

et al. 2018

annals

View full text Add to dashboard Cite

Introduction During ankle fracture fixation, iatrogenic trauma to retro fibula structures can result in morbidity and reoperation. We describe a safe zone for lag screw insertion. Materials and methods This study was completed in three sections. We identified the average entry and exit points for the lag screw using 45 Weber B ankle fractures identified from our trauma database. We then analysed 26 sequentially presented ankle magnetic resonance images, concentrating on axial sections at 4, 8, 12 and 16 mm above the ankle joint. Finally, we used 63 sequentially performed magnetic resonance scans to confirm the safe zone from these consistent structures. Results The typical lag screw exit point was 14.2 mm above the ankle joint (95% confidence Interval 11.3-17.1 mm). A safe zone trajectory occurred between 31 and 45 degrees taken from the anterior aspect of the flat fibular surface at this level. The obvious palpable landmark to direct screw trajectory and avoid 'at risk' structures was found to be the medial edge of the Achilles tendon. Our final dataset confirmed in 63 scans, the medial aspect of the Achilles tendon to be a consistent safe zone with a minimum distance of at risk structures of 4 mm. Conclusion This simple method of directing the fibula lag screw towards the palpable medial edge of the Achilles tendon is practical, easy to teach and directs the screw on a safe trajectory away from the most commonly injured structures around the back of the fibula.

show abstract