Localização segura na colocação dos pinos percutâneos no calcâneo

Labronici, Pedro José; Pereira, Diogo do Nascimento; Pilar, Pedro Henrique Vargas Moreira; Franco, José Sergio; Serra, Marcos Donato Franco de Araújo; Cohen, Jose Carlos; Bitar, Rogério Carneiro

doi:10.1590/s0102-36162012000400009

Cited by 4 publications

(4 citation statements)

References 13 publications

(19 reference statements)

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“…Structures contained within the tarsal tunnel, which are close to the medial region of the calcaneus, are vulnerable to injury caused by pins, drill bits or screws that penetrate the medial cortex of the calcaneus. 15 Albert et al 17 divided the calcaneus into three zones. Zone I starts at the calcaneocuboid joint and extends posteriorly as far as Gisane's critical angle; zone II starts at Gisane's angle and extends posteriorly to include all of the posterior facet; and zone III encompasses the posterior tuberosity.…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that pins placed in the subchondral bone of the posterior facet or anterior to Gisane's critical angle might increase the risk of injury to the medial structures of the calcaneus. Labronici et al 15 demonstrated that division into six zones was more reproducible, with their respective risks of injury to the anatomical structures. The risk of injury can be quantified through the law of addition of probabilities, and this allows better planning with regard to the sites of lower risk for pin placement.…”

Section: Discussionmentioning

confidence: 99%

“…According to Labronici et al, 15 the probability of injuries to the arteries, veins, nerves and tendons in the six zones studied was based on the classification of Licht et al 16 for high risk, as shown in Table 1 . This study demonstrated that, for example, the likelihood of artery injury upon crossing the medial cortex in zone IA was 0.434 or 43.4%.…”

Section: Methodsmentioning

confidence: 99%

“… 12 Independent of the technique used, various anatomical structures in the medial region of the heel may be at risk of iatrogenic injuries caused by the tips of screws, drill bits, external fixator pins or Kirschner wires. 13 , 14 , 15 …”

Section: Introductionmentioning

confidence: 99%

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Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

Labronici

Reder

Filho

et al. 2016

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveTo ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures.Method126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events.ResultsAll of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R2) were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries.ConclusionThe risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

Labronici

Reder

Filho

et al. 2016

Revista Brasileira de Ortopedia (English Edition)

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Circular frame fixation for calcaneal fractures risks injury to the medial neurovascular structures: A cadaveric description

Esparon

Thomson

Rea

et al. 2016

Injury

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Aim: There is a risk of iatrogenic injury to the soft tissues of the calcaneus and this study assesses the risk of injury to these structures in circular frame calcaneal fracture fixation. Materials and Methods:After olive tip wires were inserted, an L-shaped incision on the lateral and medial aspects of 5 formalin fixed cadaveric feet was performed to expose the underlying soft tissues. The calcaneus was divided into zones corresponding to high, medium and low risk using a grading system.Results: Structures at high risk included the posterior tibial artery, posterior tibial vein and posterior tibial nerve on the medial aspect. Soft tissue structures on the lateral side that were shown to be at lower risk of injury were the small saphenous vein and the sural nerve and the tendons of fibularis longus and fibularis brevis. Conclusion:The lateral surface of the calcaneus provides a lower risk area for external fixation.The risk of injury to significant soft tissues using a circular frame fixation approach has been shown to be greater on the medial aspect.Clinical Relevance: This study highlights the relevant anatomical relations in circular frame fixation for calcaneal fractures to minimize damage to these structures.

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Risco de lesão do feixe vasculonervoso após fratura do calcâneo: comparação entre três técnicas

Labronici

Reder

Filho

et al. 2016

Revista Brasileira de Ortopedia

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Localização segura na colocação dos pinos percutâneos no calcâneo

Cited by 4 publications

References 13 publications

Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

Circular frame fixation for calcaneal fractures risks injury to the medial neurovascular structures: A cadaveric description

Risco de lesão do feixe vasculonervoso após fratura do calcâneo: comparação entre três técnicas

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