Protective mechanisms of the common fibular nerve in and around the fibular tunnel: a new concept.
The most frequent site at which the common fibular nerve is affected by compression, trauma, traction, masses, and surgery is within and around the fibular tunnel. The aim of this study was to determine whether there were protective mechanisms at this site that guard against compression of the nerve. Twenty-six lower limbs of 13 preserved adult cadavers (11 males and two females) were used. Proximal to the entrance of the tunnel, three anatomical configurations seemed to afford the required protection for the nerve: reinforcement of the deep fascia; tethering of the common fibular nerve to both the tendon of the biceps femoris and the reinforced fascia; and the particular arrangement of the deep fascia, fibular head, and soleus and gastrocnemius muscles. At the entrance of the tunnel, contraction of the first segment of fibularis longus muscle could afford the required protection. In the tunnel, contraction of the second and third segments of fibularis longus muscle could guard against compression of the nerve. The tough fascia on the surface of fibularis longus muscle and the fascial band within it, which have long been accused of compression of the nerve, may actually be elements of the protective mechanisms. We conclude that there are innate, anatomical protective mechanisms which should be taken into consideration when decompressing the common fibular nerve. To preserve these mechanisms whenever possible, the technique should be planned and varied according to the underlying etiology.
El Gharbawy
Ramadan M
RM
Centers for Surgical Anatomy and Technique, Emory University School of Medicine, Atlanta, Georgia 30322, USA. relghar@emory.edu
Skandalakis
Lee J
LJ
Skandalakis
John E
JE
D000328:Adult; D005205:Fascia / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D007866:Leg / Q000294:innervation; D008297:Male; D009408:Nerve Compression Syndromes / Q000517:prevention & control*; D010543:Peroneal Nerve / Q000033:anatomy & histology*