Fibular head posterior

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. 

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. 

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. 

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

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

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.)... 

Fig. 14.10a-d. Anatomy of the peroneal nerve, a Schematic drawing of a lateral view of the knee illustrates the course of the common peroneal nerve (curved arrows) which branches from the sciatic nerve (black arrow) at the apex of the popliteal fossa and descends posterior to the biceps femoris muscle (Bf) and tendon (asterisk) to turn anteriorly around the fibular head. The nerve then continues down between the lateral side of the neck of the fibula and the peroneus longus muscle (PI). Here the peroneal nerve divides into its two terminal branches, the superficial peroneal nerve (white arrowhead) and the deep peroneal nerve (white arrow), md sends a recurrent articular branch (open arrowhead).b-d Transverse Tl-weighted MR images obtained at the levels indicated in a (horizontal bars) reveal the normal position of the common peroneal nerve (curved arrow) relative to the biceps tendon, the crural fascia (open arrowhead) fibular head (FH). Note the relationships of the main trunk and the superficial (white arrowhead) and deep (white arrow) peroneal nerves with the fibular and neck (FN). Black arrow, tibial nerve... 

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