Safe Localization for Placement of Percutaneous Pins in the Calcaneus

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:10.1016/s2255-4971(15)30128-2

Cited by 3 publications

(3 citation statements)

References 15 publications

(21 reference statements)

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“…Due to the unique bone morphology accurate screw placement is a challenge. The entry points, screw paths trajectories and screw lengths depends on the type of the fracture and the direction of dislocated fragments (12,13,14). The aim is to place the screws in such way to create a support in the dense spongy bone and to ensure stable fixation of the posterior facet.…”

Section: Discussionmentioning

confidence: 99%

Cannulated screw fixation for dislocated fractures of the calcaneus

Ivanov

2019

SSM

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INTRODUCTION: Fractures of the calcaneus still remain some of the most challenging injuries that an orthopedic surgeon should manage. The difficulties about these fractures arise from the specific anatomy of the region, from the unique shape and morphology of the bone, and from the mechanism of the injury (in most cases high energy trauma). Despite the progress of the medical implants that can be used for fracture fixation in the last decade there are a lot of controversies, regarding the best option. AIM: The aim of the study is to present our experience with the use of cannulated screws for fixation of dislocated fractures of os calcis. MATERIALS AND METHODS: Twenty patients with dislocated fractures of os calcis using cannulated screws for fixation were operated on for a period of two years (2017-2018). The classifications used in the study included: the Essex-Lopresti x-ray classification modified by Stulik and Stehlik and the CT classification of Sanders. Two of the patients were with dislocated extraarticular fractures of tuber calcanei, three patients with "extreme beak" type fractures, the remaining 15 patients were with intraarticular fractures with more than 2 mm step off in the subtalar joint: 9 patients with tongue type and 5 patients with joint depression type. Gender distribution: 18 men, 2 women. RESULTS: Evaluation of the results was made by using the Maryland Foot Score. Satisfaction from the treatment was graded using the Visual Analogue Scale (VAS) score (mean 7,5). The reduction is evaluated by measurement of the angle of Gissane, Bohler and Preis pre-and postoperatively. Assessment of the calcaneal height, length and width was initiated on lateral, axial and Broden views. CONCLUSION: Fixation of displaced calcaneal fractures by cannulated screw is effective and reliable method. These screws are introduced by stab incisions which leads to minimal soft tissue dissection in such complex area of the hindfoot. It is an enormous advantage for fracture healing and reduces the percentage of possible complications.

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Section: Discussionmentioning

confidence: 99%

Cannulated screw fixation for dislocated fractures of the calcaneus

Ivanov

2019

SSM

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“…In the study by Labronici et al 20 , the calcaneus was divided into six areas, to try to replicate a fracture of the calcaneus that would be fixed using six 2 mm Kirshner wires. The three most medial and proximal zones of the calcaneus (IA, IB and IIA) presented the most significant risks of injury to arteries, veins and nerves.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have attempted to divide the surfaces of the calcaneus into zones according to increasing risk of injury to neurovascular and tendinous structures [16][17][18][19][20] but have yet to come to a clear agreement. It has been suggested by Labronici et al that vascular structures found superficially to the anteromedial surface of the calcaneus are at high risk of damage during wire fixation performed via the lateral aspect of the hindfoot 20 .…”

Section: Introductionmentioning

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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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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Safe Localization for Placement of Percutaneous Pins in the Calcaneus

Cited by 3 publications

References 15 publications

Cannulated screw fixation for dislocated fractures of the calcaneus

Cannulated screw fixation for dislocated fractures of the calcaneus

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

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

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