Anatomical and clinical study of the common fibular nerve. Part 1: Anatomical study

Abstract

The aims of this research were: (1) to minimize injury to the common fibular nerve by a detailed anatomical study of the nerve and its branches and (2) clinically to establish a protocol for preoperative and postoperative assessment of patients undergoing surgery on the proximal third of the leg. Thus the incidence of fibular nerve palsy would definitely be negligible. The first part of the research consisted of an anatomical study of the common fibular nerve and its branches, paying particular attention to the motor nerve branches innervating different muscles of the leg. Dissections were done on 20 unselected lower limbs of cadavers, of unknown gender, age and dominant side, to study the anatomy of the common fibular nerve and its branches and the neighboring structures, such as the tibia, the fibula and the muscles of the leg. It was found that 76.7% of all motor nerve branches were located in the proximal third of the leg, 19.5% in the middle third and 3.8% in the distal third. The free courses of the motor nerve branches were 48.5% in the proximal third, 44.4% in the middle third and 7.1% in the distal third. Within a distance of 6 cm from the fibular head we found 51.1% of the motor nerve branches and from 6 to 11 cm there were only 25.5%. Hence there were danger zones of high and low risk for injury to the common fibular nerve and its branches. Results obtained are evaluated and discussed with regard to safer surgical approaches and insertion of Steinmann pins in the proximal third of the leg.