Proximal tibio-fibular joint is routinely stabilised\nduring leg lengthening, peri-articular fractures and\ndeformity corrections of tibia. Potential injury to the\ncommon peroneal nerve at the level of the fibula head/neck\njunction during wire insertion is a recognised complication.\nPrevious studies have mapped the course of the common\nperoneal nerve and its branches at the level of the fibular\nhead, and guidelines are published regarding placement of\nproximal tibial wires. This study aims to relate the course\nof the common peroneal nerve to the placement of a lateral\ninsertion fibula head transfixion wire. Standard 1.8-mm\nIlizarov ââ?¬Ë?oliveââ?¬â?¢ wires were inserted in the fibula head of 10\nun-embalmed cadaveric knees. Wires were inserted percutaneously\nto the fibula head using surface anatomy\nlandmarks and palpation technique. The course of the\ncommon peroneal nerve was then dissected. Distances\nfrom wire entry point to the course of the common peroneal\nnerve were measured post-wire insertion. The mean distance\nof the common peroneal nerve from the anterior\naspect of the broadest point of the fibular head was\n24.5 mm (range 14.2ââ?¬â??37.7 mm). Common peroneal nerve\nwas seen to cross the neck of fibula at a mean distance of\n34.8 mm from the tip of fibula (range 21.5ââ?¬â??44.3 mm).\nWire placement was found to be on average, 52 % of the\nmaximal AP diameter of the fibula head and 64 % of the\ndistance from tip of fibula to the point of nerve crossing\nfibula neck. When inserting a fibula head transfixion wire,\ncare must be taken not to place wire entry point too distal\nor posterior on the fibula head. Observing a safe zone in the\nanterior half of the proximal 20 mm of the fibula head\nwould avoid injury to the nerve. In cases where palpation\nof fibula is difficult due to patient habitus, we recommend\nconsideration of the use of fluoroscopic guidance during\nwire transfixion of the proximal tibio-fibular articulation to\navoid wire insertion too distally and subsequent potential\nnerve injury.
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