Increasing the safety of minimally invasive hallux surgery—An anatomical study introducing the clock method

Malagelada, Francesc; Dalmau-Pastor, Miki; Fargues, Betlem; Manzanares-Céspedes, María Cristina; Peña, Fernando; Vega, Jordi

doi:10.1016/j.fas.2016.11.004

Cited by 30 publications

(18 citation statements)

References 14 publications

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“…To avoid injuries, the recently described clock method may be applied. 30 This method accurately describes the position of the DLDN and DMDN, which were described frequently as being located between 10 and 2 o’clock. This system represents a useful instrument in percutaneous surgery.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study

Vecchio

Ghioldi

Uzair³

et al. 2019

Foot Ankle Int.

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Background: Percutaneous surgery is experiencing sustained growth based on third-generation techniques. This cadaveric study was designed with the main goal of exploring the risk of iatrogenic tendon and neurovascular lesions and defining the safe zones in a percutaneous, intra-articular, chevron osteotomy (PeICO) procedure, as well as assessing the accuracy of the osteotomy itself. Methods: Eight feet from below-knee fresh-frozen specimens were selected. After the procedure, the specimens were dissected, and structures were inspected for damage. Results: The results of the safety measurements were as follows: (1) distance between portal 1 (P1) and the lateral border of the extensor hallucis longus (EHL) tendon: average 17.6 mm (range 12.7-21.3); (2) distance between P1 and the dorsomedial digital nerve (DMDN): average 7.2 mm (range 1.6-10.4); (3) distance between P1 and the metatarsophalangeal joint: average 15.7 mm (range 9.4-20.5); distance between portal 2 (P2), or the osteosynthesis portal, and the metatarsophalangeal joint: average 25.5 mm (range 22-30.4); distance between P2 and the lateral border of the EHL tendon: average 12.7 mm (range 8-16.7); and distance between P2 and the DMDN: average 4.1 mm (range 1.7-8.2). There were no iatrogenic injuries. The osteotomy angulation in the sagittal plane (reproducibility) average was 85.6 degrees. Conclusion: There were no iatrogenic injuries on this cadaveric study of PeICO. Clinical Relevance: This study will help orthopedic surgeons understand the risks of performing percutaneous surgery by mimicking an accepted open technique (chevron).

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Section: Discussionmentioning

confidence: 99%

Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study

Vecchio

Ghioldi

Uzair³

et al. 2019

Foot Ankle Int.

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“…The development of new surgical and imaging techniques requires a new understanding of both the bi-dimensional and the tri-dimensional location of anatomical landmarks. Previously reported anatomical dissection techniques were developed by our team to overcome the limitations of the classic dissection techniques 3,4,5,6 and here are applied to reproduce the skin incisions and instrument entry portals corresponding to the MIS procedures used to treat hallux valgus (HV) and rigidus (HR) pathology. The method is thus applicable to those surgical techniques that evolved from traditional open surgery to MIS…”

Section: Introductionmentioning

confidence: 99%

“…An increasing number of surgical procedures are nowadays performed by minimally invasive methods, where neurological structures are not directly visualized 2,3 . In these cases, three-dimensional orientation is paramount for the surgeon.…”

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confidence: 99%

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An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery

Dalmau-Pastor

Vega

Malagelada

et al. 2018

JoVE

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The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional orientation and localization of structures that are not directly visible to the surgeon. This is especially critical for structures at risk like nerves or blood vessels. Optimization of the handling of cadaveric material and the combination of multiple techniques compensate for the limited availability of adequate specimens. The described protocol combines anatomical plane-by-plane dissection and sectional anatomy of fresh-frozen specimens to help localize relevant structures, such as nerves, arteries, veins and to correctly position the portals during MIS procedures. Depiction of these structures in anatomy textbooks can differ from what is encountered in the surgical field; and for this reason, new anatomical studies with a surgical orientation are needed. However, this is a complex, time-consuming technique requiring specific training. The anatomical references described with the so-called 'clock method' provide the surgeon with an easy and reproducible system to locate the path of the nerves at risk in Hallux Valgus MIS procedures. This model can be extrapolated to many other minimally invasive surgical procedures.

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“…Some of them may be related to studies that have measured the distance between minimally invasive surgery (MIS) portals and anatomical structures. 2,4,5,9 Thus, surgeons can more accurately assess the risk of injury, especially in small neurologic structures.…”

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confidence: 99%

Letter Regarding: Minimally Invasive Dorsal Cheilectomy of the First Metatarsal: A Cadaveric Study / Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus

Vecchio¹,

Laffenêtre²,

Dealbera³

et al. 2019

Foot Ankle Int.

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Increasing the safety of minimally invasive hallux surgery—An anatomical study introducing the clock method

Abstract: Using the clock method the DMDN and DLDN were found consistently between 10 o'clock and 2 o'clock in either right and left feet. The clock method may facilitate avoiding the area where these nerves are located serving as a valuable tool in minimally invasive foot surgery.

Cited by 30 publications

References 14 publications

Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study

Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study

An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery

Letter Regarding: Minimally Invasive Dorsal Cheilectomy of the First Metatarsal: A Cadaveric Study / Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus

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