Assessment of Medial and Lateral Neurovascular Structures after Percutaneous Posterior Calcaneal Displacement Osteotomy: A Cadaver Study

DiDomenico, Lawrence A.; Anain, Joseph M.; Wargo-Dorsey, Mari

doi:10.1053/j.jfas.2011.07.006

Cited by 26 publications

(17 citation statements)

References 15 publications

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“…5) is performed more than 9 mm anterior to line A and overpenetrates on the medial side of the calcaneus. Our ndings also indicate that an anteriorly oriented osteotomy places the artery in greater proximity to the osteotomy line than would be the case with an osteotomy that is directed posteriorly, which is consistent with a report by Bruce et al 20 Consistent with ndings reported by both DiDomenico et al and Greene et al that both the LPA and PTA and their branches could cross the Myerson osteotomy line, 3,15 we found that at least one of the medial calcaneal branches crossed line A in all cases. These observations indicate that the medial calcaneal branches (arteries) are at risk during calcaneal osteotomy.…”

Section: Discussionsupporting

confidence: 92%

“…Calcaneal displacement osteotomy has historically been used to correct valgus deformity of the calcaneus seen with exible pes planovalgus deformity, rearfoot varus deformity, frontal plane deformity, sagittal plane deformity, and posterior calcaneal fractures. [1][2][3] Calcaneal osteotomy via a lateral or oblique incision is occasionally associated with neurovascular injury, and complication rates of 5-28% have been reported in the literature. [4][5][6][7] The anatomic location of the lateral plantar artery (LPA) makes it susceptible to iatrogenic injury during operative procedures involving the foot.…”

Section: Introductionmentioning

confidence: 99%

“…has not yet achieved full tensile strength, in addition to the fact that the area is typically subjected to continued trauma. 12 Some reports have described the relationship between neurostructures and the osteotomy line 3,13 and the "safe zone" for nerves during calcaneal osteotomy. 13,14 Talusan et al identi ed a landmark line (line A) extending from the posterosuperior aspect of the calcaneal tuberosity to the origin of the plantar fascia and de ned the safe zone for neural structures during calcaneal osteotomy as 11.2 mm anterior to line A.…”

Section: Introductionmentioning

confidence: 99%

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Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

Tonogai¹,

Sairyo²,

Tsuruo³

2020

Preprint

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Background Calcaneal osteotomy is used to correct hindfoot deformity. Pseudoaneurysms of the lateral plantar artery (LPA) have been reported following calcaneal osteotomy and are at risk of rupture. The vascular structures in close proximity to the calcaneal osteotomy have variable courses and branching patterns. However, there is little information on the “safe zone” during calcaneal osteotomy. This study aimed to identify the safe zone that avoids LPA injury during calcaneal osteotomy.Methods Enhanced computed tomography scans of 25 fresh cadaveric feet (13 male and 12 female specimens; mean age 79.0 years at time of death) were assessed. The specimens were injected with barium via the external iliac artery. A landmark line (line A) connecting the posterosuperior aspect of the calcaneal tuberosity and the origin of the plantar fascia was drawn and the shortest perpendicular distance between the LPA and line A was measured on sagittal images.Results The average perpendicular distance between the LPA and line A at its closest point was 15.2 ± 2.9 mm. In 2 feet (8.0%), the perpendicular distance between the LPA and line A at its closest point was very short (approximately 9 mm). In 18 of the 25 feet (72.0%), the point where the perpendicular distance from line A to the LPA was closest was the bifurcation of one of the medial calcaneal branches of the LPA, and in 7 feet (28.0%) the shortest perpendicular distance from line A to the LPA was the trifurcation of the LPA, medial plantar artery, and one of the medial calcaneal branches.Conclusion Calcaneal osteotomy performed more than 9 mm from line A could damage the LPA by overpenetration on the medial side. Calcaneal osteotomy on the medial side should be performed with caution to avoid iatrogenic injury to the LPA.Level of Evidence: IV, cadaveric study

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

Tonogai¹,

Sairyo²,

Tsuruo³

2020

Preprint

View full text Add to dashboard Cite

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“…Laterally, the sural nerve and lateral calcaneal nerve branches are at risk. [3][4][5][6]8,14 No consensus exists in the literature on the ideal location for the osteotomy. Myerson et al 12 recommended creating the osteotomy 1 cm posterior to the posterior process of the talus, and Greene et al 6 described an osteotomy located within 5 mm posterior to the peroneal tubercle.…”

Section: Introductionmentioning

confidence: 99%

Safe Zone for Neural Structures in Medial Displacement Calcaneal Osteotomy

et al. 2015

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“…A common complication is sural nerve damage around the incision [1, 16, 20]. Although minimally invasive or percutaneous techniques have recently emerged in the hope of minimizing incisional complications, the risk of iatrogenic damage to the sural nerve remains [6, 9, 19].…”

Section: Discussionmentioning

confidence: 99%

The incision strategy for minimizing sural nerve injury in medial displacement calcaneal osteotomy: a cadaveric study

Park

Kim

et al. 2019

J Orthop Surg Res

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BackgroundThe skin incision for medial displacement calcaneal osteotomy (MDCO) often damages the sural nerve. We aimed to identify the practical reference area in which the surgeon can incise the skin to minimize the injury of the sural nerve during MDCO.MethodsThe foot and ankles of 20 cadavers were dissected. The landmarks were the following four anatomical references: point A, the tip of the lateral malleolus; point B, the inferior margin of the calcaneus on the vertical line through point A; point C, the posteroinferior apex of the calcaneus; and point D, the lateral border of the Achilles tendon on the horizontal line through point A. The distances from the sural nerve to points A and B in the vertical direction (lines D1 and D2, respectively), to points A and C in the diagonal direction (lines D3 and D4, respectively), and to points A and D in the horizontal direction (lines D5 and D6, respectively) were measured.ResultsThe median ratios of D1 to D1+D2, D3 to D3+D4, and D5 to D5+D6 were 0.34 (range 0.25 to 0.45), 0.23 (range 0.16 to 0.33), and 0.38 (range 0.26 to 0.50), respectively.ConclusionsThe distance ratios according to easily identifiable references would be a more practical incision strategy for surgeons to minimize sural nerve injury in both open and minimally invasive/percutaneous MDCO.

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Assessment of Medial and Lateral Neurovascular Structures after Percutaneous Posterior Calcaneal Displacement Osteotomy: A Cadaver Study

Cited by 26 publications

References 15 publications

Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

Calcaneal Osteotomy “Safe Zone” for Avoiding Injury to the Lateral Plantar Artery: A Fresh Cadaveric Study

Safe Zone for Neural Structures in Medial Displacement Calcaneal Osteotomy

The incision strategy for minimizing sural nerve injury in medial displacement calcaneal osteotomy: a cadaveric study

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