Executive Editor: Ernst Raaymakers, Joseph Schatzker, Rick Buckley

Authors: Matthias Hansen, Rodrigo Pesantez

Proximal tibia Extraarticular fracture, avulsion of fibular head

back to skeleton


1 Principles top


Peroneal nerve

The peroneal nerve runs around the fibular neck. So be careful with the reduction and clamp placement.

2 Patient preparation top


This procedure is normally performed with the patient in a lateral position.

3 Approaches top

Safe zones for percutaneous instrumentation

Inserting percutaneous instrumentation through safe zones reduces the risk of damage to neurovascular structures.


Anterolateral approach

For open reduction an anterolateral approach is used.

4 Reduction top


After direct exposure of ligaments and the avulsed fibular head, reduction may be achieved with the use of a small clamp that is placed on the fibula and the bone fragment. Protect the peroneal nerve which runs below the tendon of biceps femoris and then winds around the fibular neck from back to front in contact with bone.

5 Fixation top


Lag screw application

Optimal fixation is achieved by lag screw fixation in a proximal–lateral to medial–distal direction. The medial cortex of the fibula may be engaged. Usually 3.5 mm cortical screws are used.

Click here for a detailed description of the lag screw technique.


Alternative: lag screw in medullary canal

Alternatively, a lag screw may be inserted at a steeper angle, into the medullary canal of the fibula. 4.0 mm cancellous bone screws can be used.


Any injury to the posterolateral corner should be repaired very early in the healing process. Residual knee instability will be the result if the posterolateral corner is not dealt with definitively at an early stage.

Secondary reconstruction provides worse results than early posterolateral corner repair.

v2.0 2010-05-15