Background: Injury to the peroneal nerve is one of the most serious
complications in orthopaedic surgery. Because percutaneous procedures at the
level of the proximal aspect of the tibia are becoming increasingly popular,
it is critical to have a thorough knowledge of the trajectory of the peroneal
nerve and its main branches at the level of the proximal aspect of the tibia.
This anatomic study was conducted in an attempt to (1) define the anatomy of
the common peroneal nerve and its branches in a three-dimensional fashion and
(2) identify an anatomic landmark on the surface to help define a safe area
that is void of the main nerve and its branches.
Methods: Thirty-one adult unembalmed cadaveric legs were dissected.
The peroneal nerve was identified at the level of the posterior aspect of the
lateral femoral condyle and was dissected distally to the level of its
intramuscular branches. The relationship between the peroneal nerve and
Gerdy's tubercle was explored, and the distances from the nerve and its
branches to the tubercle were measured and recorded in millimeters. The
average distances and standard deviations from Gerdy's tubercle to the neural
structures were calculated.
Results: The course of the common peroneal nerve trunk and its
anterior recurrent branch defined an arc with a circumference having an
average radius of 45 mm. This circumferential trajectory was seen to be
centered at the most prominent aspect of Gerdy's tubercle.
Conclusions and Clinical Relevance: The path of the common peroneal
nerve and its proximal branch were notable in two regards: their circular
nature and their consistent relationship to the most prominent aspect of
Gerdy's tubercle. With Gerdy's tubercle used as a landmark, the trajectory of
the peroneal nerve can be easily defined at the level of the proximal aspect
of the tibia and marked prior to the placement of devices and instrumentation,
thereby avoiding damage to the peroneal nerve and its branches.