title: Nerve and tendon injury with percutaneous fibular pinning: a cadaveric study.
abstract: OBJECTIVE
  The purposes of this study were to measure the average distance from a percutaneous pin in each quadrant of the distal fibula to the sural nerve and nearest peroneal tendon, and define the safe zone for percutaneous pin placement as would be used during surgery.
  
  
  METHODS
  Ten fresh-frozen cadavers underwent percutaneous pin fixation into four quadrants of the distal fibula. The sural nerve and peroneal tendon were identified as they coursed around the lateral ankle. Distances from the K-wire in each quadrant to the anatomic structure of interest were measured.
  
  
  RESULTS
  Average distances (mm) from the K-wire to the sural nerve in the anterolateral, anteromedial, posterolateral, and posteromedial quadrants were 19.1±8.9 (range, 5.1-35.5), 12.8±8.2 (range, 0.3-27.8), 12.6±6.8 (range, 3.0-27.8), and 5.9±5.5 (range, 0.1-19.9), respectively. Average distances from the K-wire to the nearest peroneal tendon in the anterolateral, anteromedial, posterolateral, and posteromedial quadrants were 15.7±4.4 (range, 9.5-23.1), 11.9±5.2 (range, 3.2-21.7), 6.3±3.9 (range, 0.1-14.4), and 1.0±1.6 (range, 0-5.6), respectively.
  
  
  CONCLUSIONS
  Percutaneous pinning of distal fibula fractures is a successful treatment option with minimal complications. Our anatomical study found the safe zone of percutaneous pin placement to be in the anterolateral quadrant. The sural nerve can be as close as 5.1mm and the peroneal tendons as near as 15.7mm. In contrast, the posteromedial quadrant was associated with the greatest risk of injury to both the sural nerve and peroneal tendons.
authors.affiliation: Temple University School of Medicine, Department of Orthopaedic Surgery and Sports Medicine, 3401 North Broad Street, Zone B, 6th floor, Philadelphia, PA 19140, United States.
authors.forename: Justin
authors.initials: J
authors.lastname: Iorio
authors.affiliation: Temple University School of Medicine, Department of Orthopaedic Surgery and Sports Medicine, 3401 North Broad Street, Zone B, 6th floor, Philadelphia, PA 19140, United States.
authors.forename: Katharine
authors.initials: K
authors.lastname: Criner
authors.affiliation: Temple University School of Medicine, Department of Orthopaedic Surgery and Sports Medicine, 3401 North Broad Street, Zone B, 6th floor, Philadelphia, PA 19140, United States. Electronic address: saqib.rehman@tuhs.temple.edu.
authors.forename: Saqib
authors.initials: S
authors.lastname: Rehman
authors.affiliation: Temple University School of Medicine, Department of Orthopaedic Surgery and Sports Medicine, 3401 North Broad Street, Zone B, 6th floor, Philadelphia, PA 19140, United States.
authors.forename: Casey
authors.initials: C
authors.lastname: Meizinger
authors.affiliation: Temple University School of Medicine, Department of Orthopaedic Surgery and Sports Medicine, 3401 North Broad Street, Zone B, 6th floor, Philadelphia, PA 19140, United States.
authors.forename: Christopher
authors.initials: C
authors.lastname: Haydel
mesh_terms: D000843:Ankle Joint / Q000033:anatomy & histology / Q000601:surgery*; D001858:Bone Nails; D001864:Bone Wires; D002102:Cadaver; D005360:Fibula / Q000033:anatomy & histology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D013497:Sural Nerve / Q000033:anatomy & histology*; D013708:Tendon Injuries / Q000517:prevention & control*
keywords: Cadaver; Fibula fracture; Intramedullary pinning; Nerve injury; Safe zones; Tendon injury