Addressing the use of improper anatomical terminology in clinical practice and the literature (peroneal vs. fibular)

There still exists a disparity between the correct anatomical terminology used in medical educational resources, and that which is used in the clinical environment and surgical journals such as the British Journal of Surgery (BJS).1,2 We wish to highlight this as a problem not only for effective communication between healthcare professionals but also the confusion this can cause for students and doctors sitting important examinations.

Anatomical nomenclature forms the basis of medical language. Consistent and unambiguous terminology is essential in an increasingly globalised world, and is crucial to prevent miscommunication between team members in the clinical environment. However a disconnect persists between the terms used by experienced clinicians, and those endorsed as official by the anatomical community, and therefore taught in educational resources.1,2

Various accepted rules exist for anatomical terminology to mitigate ambiguity and ensure effective communication between clinicians.1 Two key principles are that each anatomical structure should have a single name, and that related anatomical terms should be similar wherever possible. These are enforced where suitable in Terminologia Anatomica (TA), the international gold-standard for anatomical nomenclature.3

Unfortunately, any benefit of such a naming system is negated by the continued use of historical terms within both the clinical environment, and the literature. The example we have chosen to focus on is the use of “peroneal” over “fibular”, which violates both aforementioned rules. To clarify, the term fibular is defined as the preferred anatomical term in both US and UK English according to TA.3 However, as many readers will be aware, its use has been largely neglected by clinicians in the field of surgery, and within the literature.

We conducted a questionnaire at a tertiary plastic surgery hospital (Queen Victoria Hospital, East Grinstead), which asked respondents to name all major nerves and vessels of the lower leg, and whether they were aware of any recent nomenclature changes. Of the 30 doctors who responded, 80% used the term “peroneal” when describing structures of the lateral lower leg, with only 50% of those aware of any synonymous language. Interestingly, of those who used “fibular” as the preferred term, 80% graduated from medical school within the last 5 years.

Furthermore, we performed a search of Medline and Embase, which found over 90% of papers published in major plastics, vascular and orthopaedic journals since 2010 used the term peroneal over fibular. This represents a huge contrast against the terminology used in medical education, as the vast majority of anatomical textbooks use the term fibular exclusively.4,5

The elimination of such erroneous terminology from the language of healthcare professionals will likely occur naturally over time. However, this transitional period holds the potential for confusion, and may negatively affect those sitting important examinations. Awareness of new official terms needs to be improved through education of those already in specialty training and beyond.

The burden of this should be on Royal Colleges, and journals such as BJS to accommodate for both terms during the transitional period, with the aim of agreeing on a single term to be consistent amongst both clinicians and anatomists. Examination bodies should make it very clear on their syllabuses when terms have been changed. Journals should refer authors to a widely accepted guide on anatomical terminology in their submission guidelines. Simultaneously, journal reviewers should be reminded of such changes and ensure papers adhere.

With this proposed change, we can look forward to a world in which students can be assured that the terms they are learning will be relevant to the clinical world, and ambiguity in terminology of an already complex subject matter will be greatly reduced.