The intramedullary anatomy of the distal fibula as it pertains to current fibular nail offerings: A CT scan analysis

Abstract

There has been recent increased interest in intramedullary fibular nails for the treatment of fibular fractures. While most publications highlight the clinical outcomes and decreased complication rates associated with fibular nails in comparison to their plate and screw counterparts, no studies to date have discussed the intramedually anatomy of the distal fibula as it pertains to fibular nailing. We retrospectively reviewed 197 tibial/fibular CT scans. Measurements of the intramedullary canal were taken at set points (180 mm, 130 mm from the fibular tip, the isthmus, and the widest portion of the fibula) in both the coronal and sagittal planes. 43 CT scans met inclusion criteria. The average width of the isthmus was 4.21 ± 1.08 mm (range, 2.19–7.33 mm) in the coronal plane and 5.27 ± 1.40 mm (range, 1.7–7.91 mm) in the sagittal plane. The average width of the fibula at 130 mm from the distal tip of the fibula was 5.18 ± 1.15 mm (range, 2.46–8.31 mm) in the coronal plane and 6.41 ± 1.45 mm (range, 2.88–9.89 mm) in the sagittal plane. 180 mm from the distal tip of the fibula, the average diameter was 5.77 ± 1.49 mm (range, 3.02–10.2 mm) and 7.18 ± 1.66 mm (range, 2.42–10.42 mm), for the coronal and sagittal planes, respectively. This is the first study of its kind to provide important insight into the distal fibula’s intramedullary anatomy, specifically as it pertains to fibular nails.

Level of Evidence

3