A cadaveric study of the medial relations of the calcaneum

Langdon, Ilana; Harling, R.; Atkins, Roger M.; Nicholson, Helen

doi:10.1046/j.1460-9584.2000.00211.x

Cited by 10 publications

(11 citation statements)

References 5 publications

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“…The distance of tendinous and neurovascular structures in relation to various anatomical landmarks has been used as the method for the description of the ''safe zone'' in a small number of recent cadaveric studies (Mekhail et al, 1996;Santi and Botte, 1996;Langdon et al, 2000;Casey et al, 2002). The safe zone has consistently been described in relation to the MCN.…”

Section: Discussionmentioning

confidence: 99%

“…The percutaneous insertion of pins into the medial calcaneus places a number of vessels, nerves, and tendons at risk of iatrogenic damage (Mekhail et al, 1996;Santi and Botte, 1996;Langdon et al, 2000;Casey et al, 2002;Mereau et al, 2005). Recent studies suggest that the safe zone can be located beyond a midpoint between the inferior tip of the medial malleolus and the posterior-inferior medial calcaneus (Casey et al, 2002;Mereau et al, 2005), although the MCN remains at risk (Casey et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies suggest that the safe zone can be located beyond a midpoint between the inferior tip of the medial malleolus and the posterior-inferior medial calcaneus (Casey et al, 2002;Mereau et al, 2005), although the MCN remains at risk (Casey et al, 2002). To our knowledge, there are only four cadaveric studies in the literature investigating the zone for safe percutaneous pin insertion (Mekhail et al, 1996;Santi and Botte, 1996;Langdon et al, 2000;Casey et al, 2002). We are aware of no cadaveric study, which takes into account the variations of the MCN with regard to the safe zone.…”

Section: Introductionmentioning

confidence: 99%

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The “safe zone” in medial percutaneous calcaneal pin placement

2009

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Percutaneous pin insertion into the medial calcaneus places a number of structures at risk. Evidence suggests that the greatest risk is to the medial calcaneal nerve (MCN). The medial calcaneal region of 24 cadavers was dissected to determine the major structures at risk. By using four palpable anatomical landmarks, the inferior tip of the medial malleolus (point A), the posterior superior portion of the calcaneal tuberosity (point B), the navicular tuberosity (point C), and the medial process of the calcaneal tuberosity (point D), we attempted to define the safe zone taking into account all possible variables in our dissections including ankle position, side, gender, and possible anatomical variations of the MCN. The commonest arrangement of the MCN was two MCNs that arose independently, one arising before the bifurcation of the tibial nerve and the other arising from the medial plantar nerve. A zone could be defined posterior to 75% of the distance along the lines AB, CD, AD, and CB which would avoid most structures. The posterior branches of the MCN, however, would still be at risk and placing the pin too far posteriorly risks an avulsion fracture. This is the first study to employ four palpable anatomical landmarks to identify a zone to minimize damage to neurovascular structures. It may not be possible, however, to avoid injury of the MCN and consequent sensory loss to the sole of the foot.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The “safe zone” in medial percutaneous calcaneal pin placement

2009

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“…Several studies have attempted to define an anatomical "safe zone" for placing external fixation wires using the distance of the neurovascular and tendinous structures to various anatomical landmarks as a means of describing this 18,19,21,22 .…”

Section: Discussionmentioning

confidence: 99%

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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“…They concluded that pins placed in the subchondral bone of the posterior facet, or anteriorly to the Gisane critical angle could increase the risk of injuring the medial structures of the calcaneus. Langdon et al (13) defined the safety zone as a line connecting a point 2 cm posteriorly to the subtalar joint at the upper margin of the calcaneus, 2 cm posteriorly to the supporting midpoint of the talus and a point on the lower margin of the calcaneus 5 cm posteriorly to the calcaneocuboid joint. In 2002, Casey et al (11) redefined the safety zone as a region posterior to a midpoint between the lower tip of the medial malleolus and a posteroinferior point in the medial region of the calcaneus, and posterior to a mark one-third across the medial posteroinferior region of the calcaneus, on the tuberosity of the navicular.…”

Section: Discussionmentioning

confidence: 99%

Localização segura na colocação dos pinos percutâneos no calcâneo

Labronici¹,

Pereira²,

Pilar³

et al. 2012

Rev. bras. ortop.

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Objective: To determine the areas presenting risk in six zones of the calcaneus, and to quantify the risks of injury to the anatomical structures (artery, vein, nerve and tendon). Method: Fifty--three calcanei from cadavers were used, divided into three zones and each subdivided in two areas (upper and lower) by means of a longitudinal line through the calcaneus. The risk of injury to the anatomical structures in relation to each Kirschner wire was determined using a graded system according to the Licht classification. The total risk of injury to the anatomical structures

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A cadaveric study of the medial relations of the calcaneum

Cited by 10 publications

References 5 publications

The “safe zone” in medial percutaneous calcaneal pin placement

The “safe zone” in medial percutaneous calcaneal pin placement

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

Localização segura na colocação dos pinos percutâneos no calcâneo

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