Structures at Risk During Percutaneous Screw Fixation for Talonavicular Fusion

Abstract

Based on these results, we recommend a careful dissection be performed prior to percutaneous screw insertion.

Anatomical Structures at Risk in Percutaneous Preparation Talonavicular Fusion

“…This has been reported before. 1,6 Third, our specimen did not have any pathologies or gross deformities. However, most patients requiring talonavicular fusion are fairly arthritic, so we cannot generalize the findings to preparation of a stiff, advanced osteoarthritic joint with osteophytes.…”

“…The average branching position of SPN was 7.5 cm distal to the ankle joint, so it was recommended that incision for arthroscopic portals be made more proximal to reduce risk of damaging the nerve. 2 Lee et al, 6 in their study of 10 cadaveric feet, found difficulty in their screw placement at the edge of the dorsal navicular between medial and intermediate cuneiforms due to the branching pattern of SPN. In the one instance the DPN was contacted, it was transected, and previous literature shows potential concern for this scenario as well.…”

“…15 blade scalpel. 6 The medial portal site was located roughly 1 cm dorsal to the PT tendon insertion on the navicular, and the dorsal portal was located between the TA and EHL tendons. Both portal sites were confirmed on fluoroscopy.…”

“…6 Alternative percutaneous methods have been suggested for talonavicular fusion. 1,5,6,12,18 Although there are benefits to an arthroscopic approach, it may take a longer time to set up an operating room, and instruments may not be available in all facilities.…”

“…However, surgery at the talonavicular joint, both open and percutaneous, poses risk of damage to deep branch of peroneal nerve, superficial peroneal nerve, saphenous nerve, and dorsalis pedis artery. 6 Alternative percutaneous methods have been suggested for talonavicular fusion. 1,5,6,12,18 Although there are benefits to an arthroscopic approach, it may take a longer time to set up an operating room, and instruments may not be available in all facilities.…”