PROXIMAL TIBIAL FINE WIRE PLACEMENT IN RELATION TO COMMON PERONEAL NERVE: CADAVERIC ANALYSIS

Background: Potential injury to the common peroneal nerve at the level of the fibula head/neck junction during fine wire insertion in stabilization of proximal fibula, is a recognised complication. This study aims to relate the course of the common peroneal nerve to fibula head transfixion wire. Methods: Standard 1.8mm Ilizarov wires were inserted percutaneously in the fibula head of cadaveric knees. The course of the common peroneal nerve was dissected calculating wire to nerve distance. Results: The common peroneal nerve was seen to cross the neck of fibula at a mean distance of 34.8mm from the tip of fibula (range 21.5–44.3mm). Wire placement was found to be on average, 52% of the maximal AP diameter of the fibula head and 64% of the distance from tip of fibula to the point of nerve crossing fibula neck. Conclusion: When inserting a fibula head transfixion wire, care must be taken not to place wire entry point too distal or posterior on the fibula head. Observing a safe zone in the anterior half of the proximal 20mm of the fibula head would avoid injury to the nerve. In cases where palpation of fibula is difficult, we recommend wire insertion under fluoroscopic guidance.