Surgical approaches to the calcaneus and the sural nerve: There is no safe zone

Smyth, Niall A.; Zachwieja, Erik; Buller, Leonard T.; Miranda, Alejandro; Steinlauf, Steven D.

doi:10.1016/j.fas.2017.06.005

Cited by 20 publications

(11 citation statements)

References 26 publications

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“…According to the study of Smyth (11), the sural nerve is known to give rise to a variable number of lateral calcaneal branches (LCBs) and might give rise to an anastomotic branch connecting to the intermediate dorsal cutaneous nerve (Figure 6). Lawrence and Smyth demonstrated that in 34 cadaveric foot specimens, each specimen had at least 1 LCB (11,12), with the number of LCBs ranging from 1 to 5. Although the ELA incision route did not pass through the main sural nerve, the position of the LCBs put them at significant risk of transection when the full thickness flap was elevated off the calcaneus.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the modified sinus tarsi approach versus the extensile lateral approach for displaced intra-articular calcaneal fractures

Ma¹,

Zhao²,

Zhang³

et al. 2021

Ann Transl Med

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Background: This study sought to assess and compare the clinical efficacy and complications of a modified sinus tarsi approach (MSTA) and the extensile lateral approach (ELA) in the treatment of displaced intraarticular calcaneal fractures. Methods: This retrospective study enrolled 108 patients (117 feet) with Sanders II-IV calcaneal fractures, including 52 patients (56 feet) in the MSTA group and 56 patients (61 feet) in the ELA group. The functional and radiological results of the affected feet were analysed retrospectively. Functional evaluation included American Orthopaedic Foot and Ankle Society (AOFAS), visual analog scale (VAS), and Short Form-36 Health Survey (SF-36). Radiological evaluation included preoperative and postoperative changes in the Bohler Angle, Gissane Angle, length, width, and height of the calcaneus. The postoperative complications were also collected and analysed. The independent-samples t-test and analysis of variance (ANOVA)were employed to compare differences between the two groups. Differences within the same group were compared by paired Student's t-test, and categorical variables were compared using the chi-square test. Results:The postoperative functional and radiological results showed that the mean AOFAS, VAS and physical component summary of SF-36 scores in the MSTA group were higher than those in the ELA group (P<0.05). After surgery, the Bohler and Gissane angles were significantly improved in both groups, as were the length, width, and height of the calcaneus; no statistically significant differences existed between the two groups. The incidences of wound healing complications and postoperative sural nerve injury were lower in the MSTA group than in the ELA group (P<0.000). Conclusions:The MSTA can achieve similar effects to the ELA in terms of anatomical reconstruction and functional recovery. It also can also effectively reduce the incidences of wound healing complications and postoperative sural nerve injury, and shorten the length of hospital stay.

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Section: Discussionmentioning

confidence: 99%

“…This may be one of the reasons for the sural nerve symptoms seen following ORIF of the calcaneus. According to relevant studies, the incidence of sural nerve symptoms after surgery with the ELA is 6.68-7.69% (7,11).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the modified sinus tarsi approach versus the extensile lateral approach for displaced intra-articular calcaneal fractures

Ma¹,

Zhao²,

Zhang³

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

show abstract

“…6). Lawrence and Smyth NA demonstrated that in a total of 34 cadaveric foot specimens, each specimen had at least one LCB 11,12 . The number of LCBs ranged from 1 to 5.…”

Section: Discussionmentioning

confidence: 99%

“…This may be one of the reasons for the sural nerve symptoms seen following ORIF of the calcaneus. According to relevant studies, the incidence of sural nerve symptoms after the ELA is 6.68%~7.69% 7,11 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Surgical Approaches for Displaced Intra-Articular Calcaneal Fractures: The Modified Sinus Tarsi Approach Versus The Extensile Lateral Approach

Zhao

Zhang

et al. 2021

Preprint

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The purpose of this study was to assess the clinical efficacy and complications of a modified sinus tarsi approach (MSTA) and the extensile lateral approach (ELA) for the treatment of displaced intra-articular calcaneal fractures. In a retrospective design, 108 patients (117 feet) with Sanders II~IV calcaneal fractures were enrolled in this study, including 52 patients (56 feet) in the MSTA group and 56 patients (61 feet) in the ELA group. The postoperative functional and radiological results showed that the average AOFAS scores and VAS scores of the MSTA group were higher than that of the ELA group (p<0.05). After surgery, the Bohler Angle, Gissane Angle, and the length, width, and height of the calcaneus were significantly improved in the MSTA group and the ELA group, but there were no statistically significant differences between the two groups. The incidences of wound healing complications and postoperative sural nerve injury were lower in the MSTA group than in the ELA group (p<0.000). In conclusion, the MSTA was able to achieve similar effects of anatomical reconstruction and function recovery as the ELA, while also effectively reducing the incidences of wound healing complications and postoperative sural nerve injury and shortening the length of hospital stay.

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“…12 Several studies have analyzed the relationship of the SN to common foot and ankle approaches including the ELAC. Smyth et al 34 observed the relationship of the SN to the ELAC in 17 cadaveric foot specimens and found that although the ELAC crossed the path of at least 1 lateral cutaneous branch of the SN in 88% of specimens, the main branch of the SN was avoided in all specimens. Although no instances of direct SN injury were observed, the small sample size by Smyth et al 34 may not be as representative of the true variation of SN course when compared to an analysis with a larger sample size, such as our current study.…”

Section: Vertical Distance From the Sn To The Dtlmmentioning

confidence: 99%

An Anatomic Study of the Sural Nerve Using 3-Tesla MRI: A Comparison to Cadaveric Data With Surgical Applications

et al. 2021

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Background: The sural nerve (SN) is a sensory cutaneous nerve that is at risk of iatrogenic injury during surgery at the lateral ankle. Prior anatomic studies of the SN are limited primarily to cadaveric studies with small sample sizes. Our study analyzed a large cohort of magnetic resonance images (MRIs) of the ankle to obtain a more generalizable, in vivo sample of distal SN course. Methods: A total of 204 3-tesla MRI studies of the ankle were analyzed. Three reviewers measured the distance from the SN to various landmarks including the distal tip of the lateral malleolus (DTLM) and the lateral border of the Achilles tendon (LBA). Results: Mean vertical distance from SN to DTLM was 2.2 cm (range, 0.9-3.6 cm). Mean horizontal distance from SN to DTLM and to LBA at the level of DTLM was 1.7 cm (range, 0.8-3.0 cm) and 1.9 cm (range, 1.0-2.9 cm), respectively. Mean horizontal distance from SN to LBA at the level of superior Achilles tendon insertion onto the calcaneus (SAI) was 2.6 cm (range, 1.4-3.7 cm), and mean horizontal distance from SN to LBA at 5 cm above SAI was 0.9 cm (range, 0.4-1.8 cm). Conclusion: The variation in SN course observed in our study allowed us to propose “safe zones” for several surgical approaches including the extensile lateral approach to the calcaneus (ELAC), the sinus tarsi approach (STA), the direct lateral approach to the lateral malleolus (DLA), and the posterolateral approach to the ankle (PLA), which we hope will minimize iatrogenic injury to the SN. Level of Evidence: Level IV, case series.

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Surgical approaches to the calcaneus and the sural nerve: There is no safe zone

Cited by 20 publications

References 26 publications

Comparison of the modified sinus tarsi approach versus the extensile lateral approach for displaced intra-articular calcaneal fractures

Comparison of the modified sinus tarsi approach versus the extensile lateral approach for displaced intra-articular calcaneal fractures

Comparison of Two Surgical Approaches for Displaced Intra-Articular Calcaneal Fractures: The Modified Sinus Tarsi Approach Versus The Extensile Lateral Approach

An Anatomic Study of the Sural Nerve Using 3-Tesla MRI: A Comparison to Cadaveric Data With Surgical Applications

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