Anatomic Location of the Peroneal Nerve at the Level of the Proximal Aspect of the Tibia: Gerdy’s Safe Zone

• Published in: Journal of bone and joint surgery. American volume 2004-08, Vol.86 (8), p.1625-1628
• Main Authors: Rubel, Ivan F, Schwarzbard, Itchak, Leonard, Anthony, Cece, Donna
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Cadaver; Diseases of the osteoarticular system; Humans; Medical sciences; Peroneal Nerve - anatomy & histology; Tibia - anatomy & histology
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200408000-00004

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 regardstheir 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.