Skip to main content
SpringerLink
Log in

Branching patterns and localization of the common fibular (peroneal) nerve: an anatomical basis for planning safe surgical approaches

  • Anatomic Variations
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

Given the severity and incidence of injury to the common fibular (peroneal) nerve (CFN), there is a need to further clarify its anatomical location and branching patterns. This project attempts to consolidate current anatomical understanding of this nerve and provide physicians with reproducible measurements regarding the CFN and its branches.

Methods

Dissections were performed on 50 specimens (28 cadavers), both fresh and preserved. The CFN was dissected from its emergence from the fibular tunnel to its anterior tibial recurrent nerve (ATRN), superficial fibular nerve (SFN), and deep fibular nerve (DFN) branches. The CFN branching patterns were assessed and all variations were categorized into four types.

Results

Several significant relationships were identified between observable traits and key anatomical characteristics of the CFN. A significant correlation was found between fibular length and distance from the tip of the fibula to the DFN/ATRN branch, as well as between fibular length and distance from the tibial tuberosity to the SFN/DFN and DFN/ATRN branches. An association was identified between length of exposed sub-cutaneous CFN and height. Thickness of the biceps femoris tendon correlated significantly with BMI.

Conclusions

These findings allow physicians to better assess a patient’s individual CFN anatomy based on correlations with measureable physical traits and will contribute to anatomic education and successful completion of various surgical, anesthetic, and physical therapy procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Agur A, Dalley AI (2005) Grant’s Atlas of Anatomy. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  2. Aigner F, Longato S, Gardetto A, Deibl M, Fritsch H, Piza-Katzer H (2004) Anatomic survey of the common fibular nerve and its branching pattern with regard to the intermuscular septa of the leg. Clin Anat 17:503–512

    Article  PubMed  CAS  Google Scholar 

  3. Al-Kashmiri A, Delaney JS (2007) Case report: fatigue fracture of the proximal fibula with secondary common peroneal nerve injury. Clin Orthop Relat Res 463:225–228

    PubMed  Google Scholar 

  4. Apaydin N, Basarir K, Loukas M, Tubbs RS, Uz A, Kinik H (2008) Compartmental anatomy of the superficial fibular nerve with an emphasis on fascial release operations of the leg. Surg Radiol Anat 30:47–52

    Article  PubMed  Google Scholar 

  5. Babayev M, Bodack MP, Creatura C (1998) Common peroneal neuropathy secondary to squatting during childbirth. Obstet Gynecol 91:830–832

    Article  PubMed  CAS  Google Scholar 

  6. Balasubramaniam R, Rai R, Berridge DC, Scott DJ, Soames RW (2009) The relationship between the saphenopopliteal junction and the common peroneal nerve: a cadveric study. Phlebology 24(2):67–73. doi:10.1258/phleb.2006.006035

    Article  PubMed  CAS  Google Scholar 

  7. Canella C, Demondion X, Guillin R, Boutry N, Peltier J, Cotten A (2009) Anatomic study of the superficial peroneal nerve using sonography. Am J Roentgenol 193:174–179

    Article  Google Scholar 

  8. Chompoopong S, Apinhasmit W, Sangiampong A, Amornmettajit N, Charoenwat B, Rattanathamsakul N, Supachutikul K, Sangvichien S (2009) Anatomical considerations of the deep peroneal nerve for biopsy of the proximal fibula in Thais. Clin Anat 22:256–260

    Article  PubMed  CAS  Google Scholar 

  9. Dellon AL, Ebmer J, Swier P (2002) Anatomic variations related to decompression of the common peroneal nerve at the fibular head. Ann Plast Surg 48:30–34

    Article  PubMed  Google Scholar 

  10. Deutsch A, Wyzykowski RJ, Victoroff BN (1999) Evaluation of the anatomy of the common peroneal nerve. Defining nerve-at-risk in arthroscopically assisted lateral meniscus repair. Am J Sports Med 27:10–15

    PubMed  CAS  Google Scholar 

  11. El Gharbawy RM, Skandalakis LJ, Skandalakis JE (2009) Protective mechanisms of the common fibular nerve in and around the fibular tunnel: a new concept. Clin Anat 22:738–746

    Article  PubMed  Google Scholar 

  12. Fabre T, Piton C, Andre D, Lasseur E, Durandeau A (1998) Peroneal nerve entrapment. J Bone Joint Surg Am 80:47–53

    PubMed  CAS  Google Scholar 

  13. Ferraresi S, Garozzo D, Buffatti P (2003) Common peroneal nerve injuries: results with one-stage nerve repair and tendon transfer. Neurosurg Rev 26:175–179

    PubMed  Google Scholar 

  14. Flores LP, Koerbel A, Tatagiba M (2005) Peroneal nerve compression resulting from fibular head osteophyte-like lesions. Surg Neurol 64:249–252 (discussion 252)

    Article  PubMed  Google Scholar 

  15. Gloobe H, Chain D (1973) Fibular fibrous arch. Anatomical considerations in fibular tunnel syndrome. Acta Anat 85:84–87

    Article  PubMed  CAS  Google Scholar 

  16. Hwang K, Jin S, Hwang JH, Han SH (2008) Proximity of the common peroneal nerve to the tibial nerve entering the gastrocnemius muscle: the implications for calf reduction. Aesthetic Plast Surg 32:116–119

    Article  PubMed  Google Scholar 

  17. Ihunwo AO, Dimitrov ND (1999) Anatomical basis for pressure on the common peroneal nerve. Cent Afr J Med 45:77–79

    PubMed  CAS  Google Scholar 

  18. Jeyaseelan N (1989) Anatomical basis of compression of common peroneal nerve. Anat Anz 169:49–51

    PubMed  CAS  Google Scholar 

  19. Kabukcuoglu Y, Kabukcuoglu F, Kuzgun U, Ozturk I (1997) Compression neuropathy of the peroneal nerve caused by a ganglion. Am J Orthop 26:700–701 (discussion 701–702)

    PubMed  CAS  Google Scholar 

  20. Kline DG (1972) Operative management of major nerve lesions of the lower extremity. Surg Clin N Am 52:1247–1265

    PubMed  CAS  Google Scholar 

  21. Kurtoglu Z, Aktekin M, Uluutku MH (2006) Branching patterns of the common and superficial fibular nerves in fetus. Clin Anat 19:621–626

    Article  PubMed  Google Scholar 

  22. Lannotti JP, Parker RD (2013) The netter collection of medical illustrations: musculoskeletal system, Part III—biology and systemic diseases, vol 6, 2nd edn. Saunders, Philadelphia

    Google Scholar 

  23. Lee JH, Lee BN, An X, Chung RH, Kwon SO, Han SH (2011) Anatomic localization of motor entry point of superficial peroneal nerve to peroneus longus and brevis muscles. Clin Anat 24:232–236

    Article  PubMed  Google Scholar 

  24. Mackinnon SE, Dellon AL (1988) Results of nerve repair and grafting. Surgery of the peripheral nerve. Thieme, New York

    Google Scholar 

  25. Manaster BJ (2006) Diagnostic and surgical imaging anatomy. Musculoskeletal, 1st edn. Amirsys, Salt Lake City

    Google Scholar 

  26. Mitra A, Stern JD, Perrotta VJ, Moyer RA (1995) Peroneal nerve entrapment in athletes. Ann Plast Surg 35:366–368

    Article  PubMed  CAS  Google Scholar 

  27. Mooney EK (2008) Lower limb embryology gross morphologic overview of lower limb development, embryology. Available via emedicine at http://emedicine.medscape.com/article/1291712-overview#a30

  28. Reebye O (2004) Anatomical and clinical study of the common fibular nerve. Part 1: anatomical study. Surg Radiol Anat 26:365–370

    PubMed  CAS  Google Scholar 

  29. Ryan W, Mahony N, Delaney M, O’Brien M, Murray P (2003) Relationship of the common peroneal nerve and its branches to the head and neck of the fibula. Clin Anat 16:501–505

    Article  PubMed  Google Scholar 

  30. Sandhu HS, Sandhey BS (1976) Occupational compression of the common peroneal nerve at the neck of the fibula. Aust N Z J Surg 46:160–163

    Article  PubMed  CAS  Google Scholar 

  31. Strandring S (2004) Gray’s anatomy: the anatomical basis of clinical practice, 39th edn. Elsevier Health Sciences, Amsterdam

    Google Scholar 

Download references

Acknowledgments

The authors would like to thank Dean Mueller and the Department of Anatomical Donations for providing the cadavers that were used in this study. The authors would also like to thank Tom Gest, Ph.D. for his input on the naming of the anterior tibial recurrent nerve.

Conflict of interest

The authors report no conflicts of interest. Funding of this project was provided by the University of Michigan Summer Biomedical Research Program (SBRP). Cadaveric specimens were secure through the University’s Anatomical Donations Program. There are no ties to industry or any other sponsor. Statistical analysis was performed by the Center for Statistical Consultation and Research (CSCAR). This facility provides free statistical consulting to all UM faculty, staff, and graduate students with the design, planning, analysis, and presentation of research studies.

Author information

Authors and Affiliations

  1. University of Michigan Medical School, Ann Arbor, MI, 48104, USA

    Tessa Watt & Arun R. Hariharan

  2. Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI, 48104, USA

    David W. Brzezinski & John L. Zeller

  3. Department of Orthopedic Surgery, University of Michigan Health System, Ann Arbor, MI, 48104, USA

    Michelle S. Caird & John L. Zeller

  4. Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI, 48104, USA

    John L. Zeller

  5. University of Michigan, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA

    Michelle S. Caird

Authors
  1. Tessa Watt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arun R. Hariharan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David W. Brzezinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michelle S. Caird
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John L. Zeller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michelle S. Caird.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Watt, T., Hariharan, A.R., Brzezinski, D.W. et al. Branching patterns and localization of the common fibular (peroneal) nerve: an anatomical basis for planning safe surgical approaches. Surg Radiol Anat 36, 821–828 (2014). https://doi.org/10.1007/s00276-013-1242-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-013-1242-x

Keywords

Search

Navigation