Surgical Tip: Calcaneal Pin Placement: Anatomic Considerations

Mereau, Trinity; Beck, Dennis; Seligson, David

doi:10.1177/107110070502600316

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…Recent studies suggest that the safe zone can be located beyond a midpoint between the inferior tip of the medial malleolus and the posterior-inferior medial calcaneus (Casey et al, 2002;Mereau et al, 2005), although the MCN remains at risk (Casey et al, 2002). To our knowledge, there are only four cadaveric studies in the literature investigating the zone for safe percutaneous pin insertion (Mekhail et al, 1996;Santi and Botte, 1996;Langdon et al, 2000;Casey et al, 2002).…”

Section: Introductionmentioning

confidence: 96%

“…The percutaneous insertion of pins into the medial calcaneus places a number of vessels, nerves, and tendons at risk of iatrogenic damage (Mekhail et al, 1996;Santi and Botte, 1996;Langdon et al, 2000;Casey et al, 2002;Mereau et al, 2005). Recent studies suggest that the safe zone can be located beyond a midpoint between the inferior tip of the medial malleolus and the posterior-inferior medial calcaneus (Casey et al, 2002;Mereau et al, 2005), although the MCN remains at risk (Casey et al, 2002).…”

Section: Introductionmentioning

confidence: 97%

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The “safe zone” in medial percutaneous calcaneal pin placement

2009

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Percutaneous pin insertion into the medial calcaneus places a number of structures at risk. Evidence suggests that the greatest risk is to the medial calcaneal nerve (MCN). The medial calcaneal region of 24 cadavers was dissected to determine the major structures at risk. By using four palpable anatomical landmarks, the inferior tip of the medial malleolus (point A), the posterior superior portion of the calcaneal tuberosity (point B), the navicular tuberosity (point C), and the medial process of the calcaneal tuberosity (point D), we attempted to define the safe zone taking into account all possible variables in our dissections including ankle position, side, gender, and possible anatomical variations of the MCN. The commonest arrangement of the MCN was two MCNs that arose independently, one arising before the bifurcation of the tibial nerve and the other arising from the medial plantar nerve. A zone could be defined posterior to 75% of the distance along the lines AB, CD, AD, and CB which would avoid most structures. The posterior branches of the MCN, however, would still be at risk and placing the pin too far posteriorly risks an avulsion fracture. This is the first study to employ four palpable anatomical landmarks to identify a zone to minimize damage to neurovascular structures. It may not be possible, however, to avoid injury of the MCN and consequent sensory loss to the sole of the foot.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 97%

The “safe zone” in medial percutaneous calcaneal pin placement

2009

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“…Previous studies recognized the risk of iatrogenic damage to the medial neurovascular bundle during calcaneal pin placement. 1,4,16,17,19 The bundle includes the posterior tibial artery dividing into the medial and lateral plantar artery and the tibial nerve branching into the medial and lateral plantar nerve and the medial calcaneal nerve branch. The safest zone for calcaneal pin placement has been shown to be the posteroinferior, medial calcaneus, although the medial calcaneal nerve remains at risk 4,17 Considering the origin of the tibial nerve, medial and lateral plantar nerve 11 and the number of branches (1 to 4) 7 the medial calcaneal branch of the tibial nerve is highly variable.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Lateral Ankle Stabilization: An Anatomical Investigation

Klammer¹,

Schlewitz²,

Stauffer³

et al. 2011

Foot Ankle Int.

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“…Damage to this nerve branch can result in a painful neuroma or loss of plantar protective sensitivity with ulcer formation as a possible sequel. Previous studies recognized the risk of iatrogenic damage to the medial neurovascular bundle during calcaneal pin placement 1,4,16,17,19 . The bundle includes the posterior tibial artery dividing into the medial and lateral plantar artery and the tibial nerve branching into the medial and lateral plantar nerve and the medial calcaneal nerve branch.…”

Section: The Current Work Presents An Anatomical Study Of a Novel Andmentioning

confidence: 99%

“…The safest zone for calcaneal pin placement has shown to be the postero-inferior medial calcaneus, although the medial calcaneal nerve remains at risk 4,17 Considering the origins of the tibial nerve, medial and lateral plantar nerve 11 and number of branches (1-4) 7 the medial calcaneal branch of the tibial nerve is highly variable. The probably most applicable definition of a safe-zone has been provided by Gamie et al 10 .…”

Section: The Current Work Presents An Anatomical Study Of a Novel Andmentioning

confidence: 99%