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Background: Augmentation of talonavicular fusion with a retrograde percutaneous naviculocalcaneal screw has been shown to increase fixation stiffness of double (subtalar and talonavicular joint) arthrodesis. However, previous authors have speculated that neurovascular structures could be at risk in a percutaneous procedure. We investigated the safety of this procedure. We hypothesized that a high risk of neurovascular injury would be found. Methods: Dorsolateral talonaviculocalcaneal screw fixation was performed in 17 fresh-frozen cadaver limbs. A 1.5-cm incision was created over the lateral third of the navicular. Using percutaneous technique, a 4.5-mm cannulated screw was inserted using a guide wire. Blunt dissection and careful soft-tissue retraction were performed. The incision was extended, and a caliper was used to measure the distance from the guide wire to the superficial peroneal nerve (SPN), extensor hallucis longus, extensor digitorum longus, deep peroneal nerve (DPN), and deep peroneal artery (DPA). All injuries were recorded. Results: Injury to the deep neurovascular bundle occurred in five of 17 specimens. These injuries involved four insults to the DPN, two to the DPA, and one to branches of the SPN. Conclusions: Use of a retrograde naviculocalcaneal screw to augment talonavicular fusion in the setting of double arthrodesis was associated with high risk of injury to anatomic structures, including the deep neurovascular bundle. Clinical Relevance: An open procedure with careful dissection along the neurovascular bundle should be considered with use of a retrograde naviculocalcaneal screw to augment talonavicular fusion to avoid risk to nearby anatomic structures.
Background: Augmentation of talonavicular fusion with a retrograde percutaneous naviculocalcaneal screw has been shown to increase fixation stiffness of double (subtalar and talonavicular joint) arthrodesis. However, previous authors have speculated that neurovascular structures could be at risk in a percutaneous procedure. We investigated the safety of this procedure. We hypothesized that a high risk of neurovascular injury would be found. Methods: Dorsolateral talonaviculocalcaneal screw fixation was performed in 17 fresh-frozen cadaver limbs. A 1.5-cm incision was created over the lateral third of the navicular. Using percutaneous technique, a 4.5-mm cannulated screw was inserted using a guide wire. Blunt dissection and careful soft-tissue retraction were performed. The incision was extended, and a caliper was used to measure the distance from the guide wire to the superficial peroneal nerve (SPN), extensor hallucis longus, extensor digitorum longus, deep peroneal nerve (DPN), and deep peroneal artery (DPA). All injuries were recorded. Results: Injury to the deep neurovascular bundle occurred in five of 17 specimens. These injuries involved four insults to the DPN, two to the DPA, and one to branches of the SPN. Conclusions: Use of a retrograde naviculocalcaneal screw to augment talonavicular fusion in the setting of double arthrodesis was associated with high risk of injury to anatomic structures, including the deep neurovascular bundle. Clinical Relevance: An open procedure with careful dissection along the neurovascular bundle should be considered with use of a retrograde naviculocalcaneal screw to augment talonavicular fusion to avoid risk to nearby anatomic structures.
Backgound: Mobile (flexible or correctable) hindfoot valgus deformity is common in children with spastic cerebral palsy (CP). It is accompanied by short lateral and long medial foot column. Patients and Methods:Eleven ambulatory children (20 feet) suffering spastic cerebral palsy (CP), two hemiplegic and nine diplegic, presenting with mobile (flexible) hindfoot valgus deformity, were evaluated neurologically, orthopaedically, and radiographically, and operated upon in the National Institute of Neuromotor System between September 2012 and September 2013. Double column foot osteotomy with medial cuneiform closing-wedge and cuboid opening-wedge without attacking the calcaneus was performed in all of them. Results:The results were followed-up clinically and radiographically over a period ranging from a year and half (18 months) to two years (24 months) with an average of a year and 9 months (21 months), and were graded into four categories as excellent, good, fair, and poor according to the total calculated score. According to the suggested grading system, there were 8 excellent results, 8 good results, 4 fair results, and no poor results. Conclusion:Double column foot osteotomy shortening the medial foot column and lengthening the lateral foot column to correct moderate to severe hindfoot valgus in ambulatory children with spastic cerebral palsy (CP), compared favourably with similar series, and offered option for achieving foot alignment, improving pain and skin problems and avoiding the problems associated with arthrodesis. Level of Evidence:The study is type IV therapeutic level of evidence.
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