Anatomical consideration of vascularized bone graft transfer from the medial calcaneus to the talus

Abstract

To investigate the possibility of use of the calcaneal branches of the posterior tibial artery as the pedicle for the vascularized bone graft to the talus, a detailed anatomical study was carried out on 30 fresh cadaver feet. Although there are several branches from the posterior tibial artery to the calcaneus, the largest posterior branch was defined as the main calcaneal branch. We recognized frequently a large branch nourishing the superior part of the calcaneus and named it the superior calcaneal branch. Twenty feet had the superior calcaneal branches. Pedicled bone grafts using the superior calcaneal branch to the postero-medial portion of the talar body were possible in 18 of 20 feet. Pedicled bone grafts using the main calcaneal branches were possible in 9 of 12 feet in which the superior calcaneal branches were not available. Finally, vascularized bone grafts were judged to be feasible in 27 feet (90%).

Vascularized Bone Graft from the Medial Calcaneus for Treatment of Large Osteochondral Lesions of the Medial Talus

“…One disadvantage associated with the present technique is the short vascular pedicle, and a cadaveric study 24 showed that the vascularized bone graft harvested from the medial calcaneus and transplanted to the talus does not reach far enough in 10% of cases. This procedure may not be indicated for all the patients.…”

“…We have previously shown that transplanting a bone graft with the calcaneal branch of the posterior tibial artery is anatomically possible. 24 The present study clinically applied this method and reviewed the results.…”

Long-term follow-up after surgical treatment of talar fractures

“…It's a challenge to deal with talar fractures because of the bone's special anatomic characteristics. The talus has no muscle or tendon attachment and about 60% of the bone surface is covered with articular cartilage, which leaves a limited region for vascularization [8,9] . The outcome of talar fractures varies widely and depends on the degree of initial damage and the accuracy of fracture reduction [10] .…”