ABSTRACT
Sural nerve injury may occur during the posterolateral approach to the ankle during
fracture fixation. We aimed to map its location in a posterolateral approach in cadaveric
specimens. A posterolateral approach was used in 28 cadaver legs with the incision
made halfway between the medial border of the fibula and the lateral border of Achilles
tendon, extending proximally from the tip of the lateral malleolus. The sural nerve
was identified and the distance from the distal tip of the incision to where it crossed
the incision proximally was measured. The mean distance was 3.4 ± 1.2 (range 0.5-7.0)
cm. In 22 cases (78.5%), the distance from the lowest part of the incision to the
inferior part of the nerve was between 2.7 and 4.5 cm. The nerve did not cross the
incision in 2 cases. We have demonstrated that the sural nerve crossed the posterolateral
incision between 2.7 and 4.5 cm proximal to the tip of the fibula in the majority
of cases. However, there remains individual anatomical variation, and we would recommend
that care should be taken to look for the nerve closer to the Achilles tendon proximally
and nearer the fibula distally. We hope that this information can help surgeons plan
their approach and minimize iatrogenic injury to the sural nerve.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: August 11, 2022
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
All cadavers were voluntarily donated and all donations were covered by the human tissue act (2004) and regulated by the Human Tissue Authority. Ethical approval was granted.
Identification
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© 2022 by the American College of Foot and Ankle Surgeons. All rights reserved.
