Anatomic considerations for retrograde fibular medullary screw insertion: a cadaveric study
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ORIGINAL ARTICLE
Anatomic considerations for retrograde fibular medullary screw insertion: a cadaveric study Zachary L. Telgheder1 · Matthew P. Sullivan1 Received: 26 May 2020 / Accepted: 22 August 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Objectives A retrograde fibular medullary screw may be utilized in certain fractures about the ankle. The purpose of this study is to investigate the anatomic considerations of a retrograde medullary screw inserted from a lateral starting point to nearby anatomic structures about the distal fibula. Methods Ten fresh-frozen cadaveric lower extremities were utilized. A 1.6-mm Kirschner wire was inserted into the distal fibula from a far-lateral starting point. A 3.2-mm cannulated drill bit was then inserted over the Kirschner wire. After placement of the drill bit, dissection of the lateral ankle was undertaken. The proximity of nearby anatomic structures to the drill bit was measured using calipers. A 4.5-mm cortical screw was then inserted using fluoroscopic guidance. Measurements were then taken again to assess the relationship of the screw head to adjacent structures. Results Mean distance from drill bit to nearby structures is as follows: Peroneus longus tendon 4.56 mm, peroneus brevis tendon 6.62 mm, sural nerve 4.13 mm, superior peroneal retinaculum 7.52 mm, inferior peroneal retinaculum 6.61 mm, anterior talofibular ligament (ATFL) 6.1 mm, calcaneofibular ligament (CFL) 6.7 mm. Average distance from 4.5-mm screw head to nearby structures is as follows: peroneus longus tendon 6.79 mm, peroneus brevis tendon 6.73 mm, ATFL 4.16 mm, CFL 5.14 mm, lateral talar process 9.41 mm. Conclusion Retrograde medullary fibular screw fixation may be safely carried out through a lateral start point. Anatomic structures about the lateral ankle are nearby but not immediately adjacent to the drill bit. Keywords Fibula · Anatomy · Trauma · Medullary screw · Peroneal tendons
Introduction While extensive literature exists documenting the effectiveness of open reduction and internal fixation of unstable fractures of the lateral malleolus using plate and screw constructs, this approach can require extensive soft tissue dissection and wound complications are not uncommon, particularly in frail patients or those with pre-existing comorbidities [1–3]. Though minimally invasive approaches have been described, fibular plating is commonly carried out through an open surgical exposure and fixation relies upon a surface implant [4, 5]. In addition, plate osteosynthesis of lateral malleolus fractures can be associated with
* Matthew P. Sullivan [email protected] 1
SUNY Upstate Medical University, Syracuse, NY, USA
implant-related symptoms necessitating subsequent reoperation for removal [1, 6–8]. The use of a retrograde intramedullary fibular screw represents a less-invasive, biomechanically sound method of internal fixation for certain fracture patterns of the lateral malleolus, particularly patterns that are length-stable and those in which a lag screw and
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