Lecture 6 fibula bone

ANATOMY OF FIBULA

1. Lecture 6 FIBULA BONE Dr Eimaan Sumayyah [email protected]

2. The leg has two bones – tibia and fibula. Fibula is very thin bone compared to tibia and can be expended except for small length distally. This makes it usable for various orthopedic procedures. Fibula is homologous with the ulna. The fibula is a located on the lateral side of the tibia, with which it is connected above and below. Fibula is the slenderest of all the long bones.

3. Side Determination The upper end, or head, is slightly expanded in all directions. The lower end or lateral malleolus is expanded anteroposteriorly and is flattened from side to side The medial side of the lower end bears a triangular articular facet anteriorly, and a deep fossa posteriorly.

4. Structure of Fibula The fibula has an upper end, shaft and a lower end.

5. Upper End of Fibula Upper end is slightly expanded in all directions making irregular quadrate form. Its superior surface bears a circular articular facet directed upward, forward, and medialward , for articulation with a corresponding surface on the lateral condyle of the tibia. On the lateral side is a thick and rough prominence continued behind into a pointed eminence, the apex or styloid process, which projects upward from the posterior part of the head.

6. Immediately below the head, the fibula constricts and the part is referred to as neck of fibula.

7. Shaft of Fibula The shaft of fibula is slim and its shape is moulded by attached muscles and therefore shows considerable variation in its form. It has three borders -anterior, posterior and interosseus and three surface –  medial ,  lateral  and posterior

8. The Anterior Border It begins just below the anterior aspect of the head. At the lower end, it divides to enclose an elongated triangular area which is continuous with the lateral surface of the lateral malleolus. The Posterior Border It is rounded and its upper end is in line with the styloid process. Below, the border is continuous with the medial margin of the groove on the back of the lateral malleolus .

9. Interosseus or Medial Border It lies just medial to the anterior border, but on a more posterior plane. It ends below at the upper end of a roughened area above the talar facet of the lateral malleolus. In its upper two thirds the interosseus border lies very close to the anterior border and may be indistinguishable from it.

10. Surfaces of Fibula The medial surface It lies between the anterior and interosseus borders. In its upper two thirds it is very narrow, measuring 1 mm or less. The lateral surface It lies between the anterior and posterior borders. It is twisted backwards in its lower part.

11. The posterior surface It is the largest of the three surfaces. It lies between the interosseus and posterior borders. In its upper two thirds it is divided into two parts by a vertical ridge called the medial crest.

12. Lower End of Fibula It is also called lateral malleolus and along with inferior surface of tibia and medial malleolus participates in formation of ankle joint. The tip of the lateral malleolus is 0.5 cm lower than that of the medial malleolus, and its anterior surface is 1.5 cm posterior to that of the medial malleolus. It has the following four surfaces. The anterior surface is rough and rounded. The posterior surface is marked by a groove. The lateral surface is subcutaneous. The medial surface bears a triangular articular facet for the talus (anteriorly); and the malleolar fossa (posteriorly).

13. Attachments of Fibula

14. Head of Fibula The fibular collateral ligament of the knee joint Extensions of origins of: the extensor digitorum the peroneus longus the peroneus longus the soleus The capsular ligament of the superior tibio fibular joint – Around the articular facet.

15. Medial Surface of Fibula Origin of the Extensor digitorum longus Extensor hallucis longus Peroneus tertius

16. Lateral Surface of Fibula Origin of The peroneus longus The peroneus brevis

17. Posterior Surface of Fibula Tibialis Posterior – The part of the posterior surface between the medial crest and the interosseus border Soleus – Upper one fourth of the part of the posterior surface between the medial crest and the posterior border Flexor hallucis longus – Lower three fourths of the part of the posterior surface between the medial crest and the posterior border

18. Anterior Border The anterior border of the fibula gives attachment to : The anterior intermuscular septum The superior extensor retinaculum The superior peroneal retinaculum

19. Posterior Border Posterior intermuscular septum. Anterior tibiofibular ligament (anteriorly) Interosseus tibiofibular ligament (in the middle) Posterior tibifibular ligament (posteriorly).

20. Interosseus border Interosseus membrane. The attachment leaves a gap at the upper end for passage of the anterior tibial vessels. Deep transverse fascial septum at the medial crest.

21. Lateral Malleolus Anterior talofibular ligament to the anterior surface. Inferior transverse tibiofibular ligament (above) and posterior tibiofibular ligament (below) to the malleolar fossa. The capsule of the ankle joint along the edges of the malleolar articular surface. The groove on the posterior surface of the malleolus lodges the tendon of the peroneus brevis and of the peroneus longus . Longus is superficial and brevis is deep .

22. Clinical Significance Fibula is a common bone to be fractured in ankle fractures and it is very important to restore normal fibular anatomy in ankle fractures with low fibula fractures. The common peroneal nerve can be rolled against the neck of the fibula. This is important landmark in clinical examination of nerve. The fibula is an ideal spare bone for a bone graft and is commonly used in replacing the length of the bone or serve as to increase graft measure in various bone surgeries. The lateral malleolus and the ligaments attached to it are very important in maintaining stability at the ankle joint