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

Esparon, Tom; Thomson, Callum; Rea, Paul; Jamal, Bilal

doi:10.1016/j.injury.2016.10.005

Cited by 6 publications

(3 citation statements)

References 23 publications

(26 reference statements)

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“…Although there are concerns about damaging the medial neurovascular structures during tunnel positioning, no studies have assessed the optimal directions to avoid this problem [8]. Earlier studies focused on the risk to medial neurovascular structures when applying fixation frames or performing osteotomies [7, 29]. The guidelines put forth by us correspond with those studies identifying the posterior part of the calcaneus as a safer zone.…”

Section: Discussionmentioning

confidence: 99%

A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity

Michels

Matricali

Wastyn

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose Anatomical reconstruction of the calcaneoibular ligament (CFL) is a common technique to treat chronic lateral ankle instability. A bone tunnel is used to ix the graft in the calcaneus. The purpose of this study is to provide some recommendations about tunnel entrance and tunnel direction based on anatomical landmarks. Methods The study consisted of two parts. The irst part assessed the lateral tunnel entrance for location and safety. The second part addressed the tunnel direction and safety upon exiting the calcaneum on the medial side. In the irst part, 29 specimens were used to locate the anatomical insertion of the CFL based on the intersection of two lines related to the ibular axis and speciic landmarks on the lateral malleolus. In the second part, 22 specimens were dissected to determine the position of the neurovascular structures at risk during tunnel drilling. Therefore, a method based on four imaginary squares using external anatomical landmarks was developed. Results For the tunnel entrance on the lateral side, the mean distance to the centre of the CFL footprint was 2.8 ± 3.0 mm (0-10.4 mm). The mean distance between both observers was 4.2 ± 3.2 mm (0-10.3 mm). The mean distance to the sural nerve was 1.4 ± 2 mm (0-5.8 mm). The mean distance to the peroneal tendons was 7.3 ± 3.1 mm (1.2-12.4 mm). For the tunnel exit on the medial side, the two anterior squares always contained the neurovascular bundle. A safe zone without important neurovascular structures was found and corresponded to the two posterior squares. Conclusion Lateral landmarks enabled to locate the CFL footprint. Precautions should be taken to protect the nearby sural nerve. A safe zone on the medial side could be determined to guide safe tunnel direction. A calcaneal tunnel should be directed to the posterior inferior medial edge of the calcaneal tuberosity.

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Section: Discussionmentioning

confidence: 99%

A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity

Michels

Matricali

Wastyn

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…The external fixator pins must be carefully placed in order to avoid damage to neurovascular structures. Two cadaveric studies, one for circular frames and one for monolateral frames, were recently published [46,47]. They found that structures at high risk include the posterior tibial artery, posterior tibial vein, and posterior tibial nerve medially.…”

Section: External Fixationmentioning

confidence: 99%

Limited Approaches to Calcaneal Fractures

Wagstrom

Downes

2018

Curr Rev Musculoskelet Med

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Numerous randomized control trials, cohort studies, and meta-analyses have been done in the last 3 years comparing surgical treatment of calcaneus fractures. These studies indicate minimally invasive procedures decrease wound complication rates and achieve similar radiographic and clinical outcomes to open reduction internal fixation. In comparing different surgical treatment methods to non-operative treatment, operative management has increased complication rates but may lead to better functional outcomes in certain patient populations. Optimal treatment for displaced intra-articular calcaneus fractures continues to be debated. Current literature would suggest that the decision to operate be based on patient and fracture characteristics and surgeon capabilities. Minimally invasive techniques aim to improve patient reported outcomes and quality of life while decreasing complications and offer another option for surgeons in the treatment of displaced intra-articular calcaneal fractures.

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“…The wire running from posterolateral to anteromedial through the calcaneum specifically places the posterior tibial neurovascular bundle (PTNVB) at risk. 16 Surgical variables affecting this risk include the wire insertion point and the angle of insertion. The relationship between these variables and risk of injury to the PTNVB is not well described.…”

Section: Cite This Article: Bone Joint J 2018;100-b:1054-9mentioning

confidence: 99%

A safe technique for insertion of heel wires for hindfoot external fixation frames

Kelly

Harwood

Loughenbury

et al. 2018

The Bone & Joint Journal

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Insertion of wires using an entry point one-third along a line from the point of the heel to the tip of the lateral malleolus (Group A) appears to be the safer technique. An insertion angle of up to 30° to the coronal plane can be used without significant risk to the PTNVB. Insertion of wires halfway along a line from the point of the heel to the tip of the lateral malleolus (Group B) carried a significantly higher risk of injury to neurovascular structures and, if necessary, an angle of insertion parallel to the coronal plane should be used. Cite this article: Bone Joint J 2018;100-B:1054-9.

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

Cited by 6 publications

References 23 publications

A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity

A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity

Limited Approaches to Calcaneal Fractures

A safe technique for insertion of heel wires for hindfoot external fixation frames

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