Location of the Sural Nerve During Posterolateral Approach to the Ankle

Abstract

When performing a posterolateral approach to the ankle, particular care should be taken at the midpoint of the incision.

Single Oblique Posterolateral Approach for Open Reduction and Internal Fixation of Posterior Malleolar Fractures With an Associated Lateral Malleolar Fracture

“…However, from the findings of their cadaveric study, Jowett et al (19) located the sural nerve on the posterior margin of the fibula running obliquely downward to the Achilles tendon. Therefore, the sural nerve crossed the incision an average of 6.3 mm from the distal end of the incision when a pre-existing posterolateral straight longitudinal incision was made between the Achilles and peroneus tendons.…”

Complications in ankle fracture surgery

“…Symptomatic injuries to SPN have been reported in 15% of patients following lateral approach to the fibula (Redfern et al 2003). With a posterolateral approach, the sural nerve can potentially be damaged, causing a painful neuroma or numbness along the lateral border of foot (Talbot et al 2005, Jowett et al 2010. Chronic pain overlying hardware in another possible complication, and 23% of patients desire hardware removal due to persistent lateral pain (Brown et al 2001).…”

A Complication of Posterior Malleolar Fracture Fixation

“…Potential pitfalls include damage to the sural nerve, which on average crosses the incision 57 mm proximal to the tip of the lateral malleolus (18) and injury to the short saphenous vein, which runs with the sural nerve (16). An internervous plane between the peroneus brevis and flexor hallucis longus is used, and the posterior malleolus is exposed by anterolateral retraction of the peroneal tendons and medial retraction of flexor hallucis longus, which also protects the neurovascular structures (14)(15)(16).…”