FIBULAR ARTERY. 



267 



though the subjacent bone has been partly 

 absorbed, that the fungoid disease entirely 

 originated from the periosteum.* 



Malignant fungus occasionally arises from 

 the periosteum. I have seen one case of this 

 disease connectea with the tibia, in which 

 amputation was performed, but with an un- 

 favourable result, the patient sinking rapidly 

 from mortification. In medullary sarcoma 

 that membrane is often involved. 



Osteo - sarcoma, according to Howship, 

 Craigie, and Meckel, occasionally has its ori- 

 gin in the periosteum. 



(R. D. Grainger.) 



FIBULAR ARTERY, (arteria peronxa ; 

 Fr. arttre peroniere ; Germ, die Wadenbein- 

 arterie). This artery is commonly described 

 as a branch of the posterior tibial, or it may 

 be said to be one of the branches resulting 

 from the bifurcation of a short trunk which has 

 its origin immediately from the popliteal, and 

 which has been described under the name of 

 the tibio-peroneal artery, the other branch of the 

 bifurcation being what is ordinarily considered 

 as the continued posterior tibial trunk. 



The origin of the fibular artery is situated 

 about an inch below the inferior margin of the 

 popliteus muscle, thence the artery extends 

 downwards and with a very gradual inclination 

 outwards, and terminates in the region of the 

 external ankle, just above the os calcis and 

 behind the fibula. It is a vessel of smaller 

 size than the posterior tibial, and about equal to 

 the anterior tibial, and it is interesting to ob- 

 serve that the varieties in its calibre are in the 

 inverse ratio of the calibre of the anterior and 

 posterior tibial, but more especially of the 

 former. 



To expose the fibular artery in dissection the 

 gastrocnemius and soleus muscles must be 

 raised, and the deep fascia of the leg dissected 

 away. The artery is then seen resting at first 

 for a very short distance upon the tibialis posti- 

 cus muscle, and from it getting upon the pos- 

 terior surface of the fibula near its tibial edge, 

 where the vessel is imbedded in the flexor pol- 

 licis proprius and encased between that muscle 

 and the bone. Inferiorly it passes between the 

 flexor pollicis proprius and tibialis posticus, 

 and is applied to the posterior surface of the 

 interosseous ligament. 



The fibular artery is sometimes altogether 

 absent, and then its place is supplied by rami- 

 fications of the posterior tibial. Sometimes 

 the fibular artery takes its rise higher up than the 

 point we have indicated ; but more frequently 

 it has a lower origin, in which case it presents 

 a calibre smaller than that which may be con- 

 sidered as usual ; the vessel, indeed, is found to 

 be smaller the lower down its origin is. It is 

 in these cases that the anterior tibial especially 

 and the posterior tibial occur of a larger size than 



* The result of dissection induces me to suppose 

 that in many old and intractable ulcers, the fun- 

 goid excrescences seen on the surface aiise either 

 from the fascia of the leg or from the periosteum, 

 according as they are placed on the outc r or inner 

 part of the limb. 



natural, as it were to compensate for the de- 

 ficiency of the fibular. 



Branches. The first branches the fibular 

 artery gives off are small muscular ones on 

 either side to the soleus, tibialis posticus, flexor 

 pollicis proprius, to which in its whole course 

 it gives a liberal supply; also to the fibula and 

 the peronaei muscles. From its inner side, 

 according to Cruveilhier, it gives an anasto- 

 motic branch to the posterior tibial, which 

 passes transversely or obliquely from one artery 

 to the other. This branch sometimes attains a 

 considerable size, and in such cases after its 

 communication with the posterior tibial, that 

 artery also becomes considerably enlarged. 



The fibular artery divides into its two termi- 

 nal arteries in the inferior third of the leg; 

 these are the anterior and posterior peronaeal 

 arteries. 



Anterior peroneal artery, (arteria peronaa 

 anterior and perforans peronaa.) This branch 

 gains the anterior surface of the leg by piercing 

 the interosseous ligament, where it is covered 

 by the peronaeus tertius muscle. The situation 

 at which this perforation takes place is stated 

 by Harrison to be about two inches above the 

 external ankle; it then inclines downwards 

 upon the outer side of the tibia, anastomoses 

 by a transverse branch with the anti-tibial, com- 

 municates with the external malleolar artery 

 from the anterior tibial, giving off numerous 

 branches both before and after the anastomosis, 

 which pass down to the tarsus and communi- 

 cate with the tarsal arteries. This artery is 

 generally smaller than the posterior, some- 

 times so small that the ordinary injection fails 

 to penetrate it. If there be any anomaly in the 

 size of the anterior tibial artery, this branch is 

 generally large in proportion as that artery is 

 small, and in such a case it might exceed the 

 posterior peroneal in calibre. The arteries of 

 the dorsum of the foot spring from the anterior 

 peroneal when the anterior tibial exhibits this 

 deficiency. 



Posterior peroneal artery, (A. peronaa pos- 

 terior; calcanienne externe, Cruveilhier). This 

 branch continues the course of the fibular artery 

 behind the external malleolus to the outer side 

 of the os calcis; it runs parallel to the outer edge 

 of the tendo Achillis, being immediately covered 

 by the continuation of the fascia of the leg. 

 A transverse branch from the inner side of this 

 artery establishes its communication with the 

 posterior tibial, and inferiorly it distributes its 

 terminal branches to the muscles and other 

 parts on the outside of the os calcis to anasto- 

 mose with the external tarsal and plantar 

 arteries ; some small vessels proceed round the 

 tendo Achillis to effect a further communication 

 with the posterior tibial. 



This may be considered as the terminal 

 branch of the fibular artery ; it is absent only 

 when the fibular artery passes entirely forwards, 

 or when it directly opens into the posterior 

 tibial without having any further communica- 

 tion with the arteries of the ankle. 



The fibular artery is evidently a valuable 

 anastomotic trunk to both the tibial arteries, a 

 deficiency in either of which it is prepared to 



