Peroneal artery safe zone in the posterolateral approach to the distal tibia: A CT angiogram based anatomical study

Mousa, Adham E.M.; Mousa, Mohamed; Singisetti, Kiran

doi:10.1016/j.injury.2021.09.021

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…Eine weitere Struktur, die beim posterolateralen Zugang gefährdet ist, ist die A. peronea. Ihre Bifurkation liegt durchschnittlich 82 mm proximal der Außenknöchelspitze [13]. nung seiner Faszie, von lateral nach medial mobilisiert und von der dorsalen Tibiakortikalis abgeschoben.…”

Section: Posterolateraler Zugangunclassified

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Plecko,

Schwarz

2024

OP-Journal

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Die chirurgischen Zugangsmöglichkeiten zum oberen Sprunggelenk sind mannigfaltig. Die Auswahl des optimalen Zugangsweges basiert auf der vorliegenden Pathologie, verlangt eine exakte Planung, bei Frakturen die Zuhilfenahme von hochwertiger Bildgebung und die Berücksichtigung der lokalen Weichteilverhältnisse. Aufgrund der teilweise geringen Weichteildeckung sind eine weichteilschonende Operationstechnik sowie eine optimales Zeitmanagement Grundvoraussetzungen für ein gutes Ergebnis. Bei entsprechender Sorgfalt und Beachtung sämtlicher Details ist i. d. R. mit einer geringen Komplikationsrate zu rechnen. Ein exaktes Wissen über die lokalen anatomischen Beziehungen ist ein Muss, um alle Zugangsmöglichkeiten sicher einsetzen zu können.

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Section: Posterolateraler Zugangunclassified

Zugänge zum oberen Sprunggelenk

Plecko,

Schwarz

2024

OP-Journal

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“…Hamada et al simulated the suture-button technique using magnetic resonance images and investigated the iatrogenic injury risk of the saphenous vein and nerve [ 16 ]. Mousa et al examined the peroneal artery injury risk for the posterolateral approach to distal tibia via computed tomography angiography [ 17 ]. Besides the studies performed at ankle region, an anatomical relationship between simulated S1 sacroiliac screws’ entrance points and superior gluteal artery has been investigated by computed tomography angiography [ 18 ].…”

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confidence: 99%

Peroneal artery injury potential due to different syndesmosis screw placement options: a simulation study with lower extremity computed tomography angiography

Aytekin,

Çakır,

Taşdemir

et al. 2024

Arch Orthop Trauma Surg

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Introduction The aim of this study is to assess the risk of peroneal artery injury of hardware placement at the fixation of syndesmotic injuries. Materials and methods The lower extremity computed tomography angiography was used to design the study. The syndesmosis screw placement range was simulated every 0.5 cm, from 0.5 to 5 cm proximal to the ankle joint. The screw axes were drawn as 20°, 30° or individual angle according to the femoral epicondylar axis. The proximity between the screw axis and the peroneal artery was measured in millimeters. Potential peroneal artery injury was noted if the distance between the peroneal artery to the axis of the simulated screw was within the outer shaft radius of the simulated screw. The Pearson chi-square test was used and a p-value < 0.05 was considered significant. Results The potential for injury to the peroneal artery increased as the syndesmosis screw level rose proximally from the ankle joint level or as the diameter of the syndesmosis screw increasds. In terms of syndesmosis screw trajection, the lowest risk of injury was observed with the syndesmosis screw angle of 20°. Simulations with a screw diameter of 3.5 mm exhibited the least potential for peroneal artery injury. Conclusion Thanks to this radiological anatomy simulation study, we believe that we have increased the awareness of the peroneal artery potential in syndesmosis screw application. Each syndesmosis screw placement option may have different potential for injury to the peroneal artery. To decrease the peroneal artery injury potential, we recommend the followings. If individual syndesmosis screw angle trajection can be measured, place the screw 1.5 cm proximal to the ankle joint using a 3.5 mm screw shaft. If not, fix it with 30° trajection regardless of the screw diameter at the same level. If the most important issue is the peroneal artery circulation, use the screw level up to 1 cm proximal to the ankle joint regardless of the screw angle trajection and screw diameter.

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The arterial risk posed by the posterolateral approach: An anatomical cadaveric study of the fibular artery and its variability

Heeran,

Gomaa,

Mason

et al. 2023

Clinical Anatomy

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The posterior malleolus of the tibia is commonly accessed surgically through the posterolateral approach. This approach gives good access to the fibula and lateral aspect of the posterior tibia, however; there is little known on the vascular risks with this approach. The aim of this study was to assess and describe the anatomy of the fibular artery and its branches at the ankle region and relate it to the surgical access of the posterior malleolus. Eleven cadaveric foot and ankle specimens were dissected in layers, preserving the fibular artery, anterior tibial artery (ATA), and posterior tibial artery (PTA). Five distinct variations were found in the fibular artery: variable terminal branching with a hyperplastic fibular artery; a superficially located fibular artery; variation in the level and number of anastomoses; variation in the muscular branches; and a variable anterior perforating branch. The mean proximal distance from a horizontal line drawn through the medial protuberance of the medial malleolus of the tibia (horizontal line reference point—HLRP) to the posterior communicating branch of the fibular artery was 37.93 mm (range 19.03–85.43 mm). The mean proximal distance between HLRP and the anterior perforating branch of the fibular artery was 44.23 mm (range 35.44–62.32 mm). In 10 specimens, the fibular artery was immobile distal to its anterior perforating branch. The posterolateral approach specifically puts the fibular artery at risk and knowledge of its anatomy and variability is important when undertaking this approach. Understanding the common variations within the ankle's arterial anatomy can help surgeons protect these vessels from damage during the surgical approach.

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Peroneal artery safe zone in the posterolateral approach to the distal tibia: A CT angiogram based anatomical study

Cited by 3 publications

References 25 publications

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Peroneal artery injury potential due to different syndesmosis screw placement options: a simulation study with lower extremity computed tomography angiography

The arterial risk posed by the posterolateral approach: An anatomical cadaveric study of the fibular artery and its variability

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