Osteomyelitis of the fibula is uncommon. If the patient's tibia is not involved, you can remove a sequestrum from his fibula as soon as is convenient, without waiting for an involucrum to form, because his tibia will support his leg. You can expose any part of his fibula by approaching it between his peroneal muscles anteriorly and his soleus posteriorly. His posterior tibial nerve and vessels are well out of harm's way; but be careful not to injure his peroneal artery and veins which are close to the postero-medial angle of the shaft of his fibula. If the head of his fibula is involved (rare) be very careful not to injure his common peroneal nerve.
OSTEOMYELITIS OF THE FIBULA Follow the general method for osteomyelitis in Sections 7.4 to 7.6. Apply a tourniquet.
INCISION. Lay the patient on his side with his affected leg uppermost, and his knee slightly bent. Use the appropriate part of an incision which starts 5 cm below the head of his fibula, and curves gently posteriorly down towards his lateral malleolus. Reflect short skin flaps anteriorly and posteriorly. Avoid the head and neck of his fibula, because his common peroneal nerve winds round it. If you have to remove sequestra from the head, try to pull them down from below.
If you are working on the middle third of his fibula, incise the periosteum vertically, and separate muscle from bone subperiosteally.
CAUTION ! The peroneal vessels are close to the medial side of the fibula, so strip the muscles carefully.
EXCISING THE FIBULA. If necessary, and he is more than 10 years old, you can remove the entire shaft of his fibula, except for its lower 5 cm. Use a Gigli saw, not an osteotome, or bone- cutting forceps, which will splinter it. Be very careful to avoid his common peroneal nerve winding round its upper end.
Fig. 7-12 OSTEOMYELITIS OF THE CALCANEUS. Splitting a patient's heel is the easiest approach to his calcaneus; a split heel is no disability. This is the Gaenslen incision. A, and B, after the operation. C, exposing the calcaneus. D, osteomyelitis of the right calcaneus with a sinus. After Edmondson AS and Crenshaw AH, ''Campbell's Operative Orthopaedics', Fig. 10-18. CV Mosby, with kind permission.