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LATERAL APPROACH TO THE FIBULA

USES

This approach is used for harvesting the fibula for a bone graft. It can also be used if extended far enough proximally and distally to release the anterior, lateral, and posterior compartments, although this approach is not the best way to release the deep posterior compartment.

ADVANTAGES

This approach, which is largely subcutaneous, is straightforward and easy. It can be extended as far proximally and distally as necessary for adequate exposure.

DISADVANTAGES

The major disadvantage is that the fibula is actually posterior to the tibia, and the fibula gets in the way of accessing the deep muscles posteriorly.

STRUCTURES AT RISK

There are perforating blood vessels that run from posterior to anterior around the fibula. They need to be identified and cauterized or ligated before transection.

If you drift too far anteriorly and are dissecting into the muscle belly, the peroneal nerve to the musculature is at risk. If you are too far posterior, you will either be going through the peroneal musculature or into the gastrocnemius.

TECHNIQUE

A straight incision is made over the fibula laterally. It is carried as far proximally and distally as necessary for exposure. Once you are deep to the subcutaneous tissue, the fibula is palpated, and the muscles are separated anteriorly and posteriorly.

If this approach is being used for a compartment syndrome, then the anterior and lateral compartments are easily identified and decompressed. They are just anterior and posterior to the fibula. The most secure way to release the posterior compartments is to resect the fibula. If you choose not to do that, then the peroneal musculature is separated from the fibula and retracted posteriorly. This will then allow you to enter the deep posterior compartment. The posterior tibial nerve and artery will be running along the back of the tibia, and indiscriminate dissection should not be done once you are medial to the peroneal muscles.

Related posts:

Volar Approach to the Basal Joint of the Thumb (for Bennett’s Fracture) Paronychium Approach Anterior Approach Deltopectoral Approach Posterior Approach Anterior Approach to the Cervical Spine

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