The Lateral Dorsal Cutaneous Branch of the Sural Nerve

Fansa, Ashraf M.; Smyth, Niall A.; Murawski, Christopher D.; Kennedy, John G.

doi:10.1177/0363546512448320

Cited by 22 publications

(27 citation statements)

References 20 publications

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“…Subsequently, a surgical “safe zone” for incision and dissection during the proximal approach to the 5MT was proposed with the intent to minimize iatrogenic injury to the LDCN and AB. We found the mean vertical distance from the LDCN to the most proximal aspect of the 5MT was 0.8 cm, which is similar to that observed by Fansa et al 10 (0.9 cm). This finding confirms the close proximity of the LDCN when making the lateral approach to the proximal fifth metatarsal (LA-5MT).…”

Section: Discussionsupporting

confidence: 91%

“…In our study, several instances were observed in which the LDCN resided superior to the PBT at its insertion onto the 5MT (n = 12; 10%). This observation, combined with our upper and lower distribution frequencies for the vertical distance from the LDCN and AB to the 5MT, respectively, led us to propose a modified “safe zone” building off of the work of Fansa et al 10 Our proposed incision is made more than 1 to 2 mm superior to the PBT and resides between 1.2 and 1.6 cm superior to the most proximal aspect of the 5MT, shown in Figure 5. This incision would remain superior to the LDCN and inferior to the AB in >95% of our analyzed MRI studies.…”

Section: Discussionmentioning

confidence: 70%

“…When a bifurcation is present, prior studies have reported distances from the dorsomedial branch of the LDCN, which is more dorsal and nearer to the PBT. 7,10,28 The present study’s measurements of the LDCN to the proximal aspect of the 5MT were made of the main continuing branch that travels distally along the lateral dorsum of the foot, which corresponds to the dorsomedial branch described by previous studies. Therefore, this study further describes the relevant anatomy at the dorsolateral foot, which may be relevant in surgical planning to avoid iatrogenic injury to the LDCN.…”

Section: Discussionmentioning

confidence: 99%

“…16,24 Previous cadaveric studies have observed a frequency of AB ranging from 24% to 63%. 1,9,10,17,30…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Background: The lateral dorsal cutaneous nerve (LDCN) and the anastomotic branch of the sural nerve (AB) are cutaneous sensory nerves at risk of iatrogenic injury during lateral foot surgery. This study is the first to use a large cohort of high-resolution magnetic resonance images (MRIs) of the ankle to better describe the course of these nerves in vivo in order to aid surgeons intraoperatively. Our study intends to build on the “high and inside” approach to the proximal 5MT by accounting for variations in course of the LDCN and AB. Methods: One hundred twenty-five 3-tesla (T) MRI studies of the ankle were analyzed. Three reviewers measured the distance from the LDCN and AB to landmarks including the most proximal aspect of the fifth metatarsal tuberosity (5MT) and the peroneus brevis tendon (PBT). Results: Mean vertical distance from the LDCN to the 5MT was 0.8 ± 0.2 cm. Presence of an AB was visualized in 59 of 125 studies (47.2%) and was found 2.2 ± 0.5 cm dorsal to the 5MT. The AB was found to become superior to PBT at a horizontal distance 1.9 ± 0.5 cm proximal to the 5MT. The LDCN was found superior to the PBT at its insertion onto the 5MT in approximately 10% (n = 12) of our studies. During these instances, the LDCN was located an average of 0.3 cm dorsal to the PBT. Conclusion: Our proposed “safe zone” for the approach to the proximal 5MT remains superior to the LDCN and inferior to the AB and avoids crossing directly over either nerve in >95% of analyzed MRI studies. This incision begins 1.5 cm dorsal to the most proximal aspect of the 5MT and extends no more than 1 cm posteriorly. Careful dissection and identification of the LDCN and possible AB is necessary prior to further extension of incision. Level of Evidence: Level IV, case series.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

“…16,24 Previous cadaveric studies have observed a frequency of AB ranging from 24% to 63%. 1,9,10,17,30…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2022

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“…Careful dissection through the subcutaneous tissues to the base of the fifth metatarsal will protect the peroneus brevis and the sural nerve. Surgeons are less likely to injure the lateral dorsal cutaneous branch of the sural nerve when using a percutaneous approach to fifth metatarsal fractures compared to the standard lateral approach based on cadaveric studies [15]. Utilizing a tissue sleeve for all steps described, a guide wire is placed into the dorsal and medial aspect base of the fifth metatarsal near the metatarsal-cuboid articulation.…”

Section: Treatmentmentioning

confidence: 99%

Zone II and III fifth metatarsal fractures in athletes

Anderson

2017

Curr Rev Musculoskelet Med

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Evaluation of Two Types of Intramedullary Jones Fracture Fixation in a Cyclic and Ultimate Load Model

Willegger

Benca

Hirtler

et al. 2019

Journal Orthopaedic Research

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Implant choice is a matter of concern in athletes and active patients who sustain a Jones fracture because they are prone to failure including non‐union, screw failure, and refracture. The aim of this study was to compare the biomechanical behavior of a Jones fracture‐specific screw (JFXS) with a cannulated headless compression screw (HCS) in a simulated partial weight‐bearing and ultimate load Jones fracture fixation model. Ten matched pairs of human anatomical specimens underwent Jones fracture creation and consecutive intramedullary stabilization with a solid JFXS or a cannulated HCS. The bone mineral density was assessed prior to testing. Cyclic plantar to dorsal loading was applied for 1000 cycles, followed by load to failure testing. Angulation was measured by an opto‐electronic motion capture system and mode of failure classification was determined by video analysis. Paired analysis showed no statistically significant difference between both screw constructs. Ultimate load reached 236.9 ± 107.8 N in the JFXS group compared with 210.8 ± 150.7 N in the HCS group (p = 0.429). The bone mineral density correlated positive with the pooled ultimate load (R = 0.580, p = 0.007) for all constructs and negatively with angulation (R = −0.680, p = 0.002) throughout cyclic loading. Solid fracture‐specific and cannulated headless compression screws provide equal ultimate loads and stiffness for Jones fracture fixation. A low bone mineral density significantly impairs the construct stability and the ultimate load of both intramedullary screw constructs. © 2019 The Authors. Journal of Orthopaedic Research ® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 38:911‐917, 2020

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The Lateral Dorsal Cutaneous Branch of the Sural Nerve

Cited by 22 publications

References 20 publications

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

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

Zone II and III fifth metatarsal fractures in athletes

Evaluation of Two Types of Intramedullary Jones Fracture Fixation in a Cyclic and Ultimate Load Model

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