Fibular head

A 48-year-old woman developed avascular necrosis 9 months after she had completed a 3-month course of hydrocortisone 100 mg retention enemas once or twice daily for ulcerative proctitis (470). An MRI scan showed multiple bony infarcts in her distal femora, proximal tibiae, and posterior proximal right fibular head, extending from the diaphysis to the epiphysis, consistent with avascular necrosis. 

Hand-rectified PTB sockets for transtibial amputees involve donning a stockinet over the residual limb, identifying anatomic landmarks (patellar ligament, tibial flares, fibular head) with an ink pen, and casting the residual limb with plaster bandages. This cast is then removed and filled with plaster to create a positive model of the residual limb. The inked bony landmarks are thus transferred to this plaster model. The plaster model is then modified or rectified such that plaster is built up over areas of intended socket relief. A rasp is used to remove plaster over regions of preferential loading. The socket is then vacuum-formed or laminated over this modified plaster positive. 

Anterolateral dislocation is the commonest and is the result of a twisting fall. On an AP radiograph, the head of the fibula is seen almost in its entirety while on the lateral view, it is completely overlaid by the tibial condyle. In posteromedial dislocation, the fibular head is overlaid by the tibial condyle on the AP radiograph but is displaced posteriorly on the lateral view. In superior dislocation, the tibia is foreshortened as a result of a shaft fracture. 

Dislocation is typically classified according to the direction of displacement of the fibular head, and can occur anterolaterally, posteromedially or superiorly. 

The fibular head, lateral to the knee joint, should be articulated in an anterior/posterior glide. Because of the combined mechanics with the ankle mortise, a posterior glide somatic dysfunction is the most common knee somatic dysfunction with anterior glide the next. 

Proximal Fibular Head Dysfunction—Fibula on Tibia... 

The fibula is not anatomically part of the knee joint. However, the proximity of the fibular head to the knee joint and the overlapping symptom... 

FIG. 94-11 Motion testing for proximal fibular head dysfunctions. 

Increased anterior slide with decreased posterior slide signifies anterior fibular head dysfunction increased posterior slide with decreased anterior slide signifies posterior fibular head dysfunction. 

The body of the talus is wedge-shaped and wider in its anterior portion. Dorsiflexion creates a close-packed position of the talus in the crural arch. Further dorsiflexion induces separation of the tibiofibular articulation, with lateral and caudal displacement of the distal fibula and medial rotation around the tibia. This motion of the fibula can be a major source of fibular head dysfunction. 

A posterior fibular head somatic dysfunction is accompanied by foot inversion, forefoot adduction, and lower leg internal rotation. 

An anterior fibular head is accompanied by foot eversion, forefoot abduction, and lower leg external rotation. 

The physician s cephalad hand stabilizes the patient s bent knee and holds the anterior fibular head with his thenar eminence. 

Tender point on the lateral hamstring muscle at its attachment near the fibular head. 

Fibular head somatic dysfunctions are the commonly seen somatic dysfunctions of the knee. They are often the cause of lateral knee pain. 

FIG. 100-1 High-velocity, low-amplitude thrusting technique for an anterior fibular head dysfunction. 

FIG. 100-2 High-velocity, low-amplitude thrusting technique for a posterior fibular head somatic dysfunction. (Physician is on opposite side to allow viewing of hand positions.)... 

There are two additional, interesting dysfunctions often seen in the knee region, which really are not part of the knee joint function. These are the pes anserine bursitis and the fibular head somatic dysfunction. 

This patient s problem developed as a result of a mild strain with twisting of the knee joint. Should the pain continue, an MRl should be performed to rule out ligamentous or meniscal tear. The patient should recover fully in a few weeks and be able to gradually return to full activity. When evaluating this type of report, the physician must be aware that the ankle joint and the fibular head could be involved. 

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