Safe Zone for Neural Structures in Medial Displacement Calcaneal Osteotomy: A Cadaveric and Radiographic Investigation

Background: We aimed to define reference lines on standard lateral ankle radiographs that could be used intraoperatively to minimize iatrogenic nerve injury risk in medial displacement calcaneal osteotomy. Methods: Forty cadaveric specimens were used. In 20 specimens, the sural, medial plantar (MP),...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Foot & ankle international 2015-12, Vol.36 (12), p.1493-1498
Hauptverfasser: Talusan, Paul G., Cata, Ezequiel, Tan, Eric W., Parks, Brent G., Guyton, Gregory P.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 1498
container_issue 12
container_start_page 1493
container_title Foot & ankle international
container_volume 36
creator Talusan, Paul G.
Cata, Ezequiel
Tan, Eric W.
Parks, Brent G.
Guyton, Gregory P.
description Background: We aimed to define reference lines on standard lateral ankle radiographs that could be used intraoperatively to minimize iatrogenic nerve injury risk in medial displacement calcaneal osteotomy. Methods: Forty cadaveric specimens were used. In 20 specimens, the sural, medial plantar (MP), and lateral plantar (LP) nerves were sutured to radiopaque wire, and a lateral ankle radiograph was obtained. On the radiograph, a line was drawn from the posterior superior apex of the calcaneal tuberosity to the origin of the plantar fascia and labeled as the “landmark line.” A parallel line was drawn 2 mm posterior to the most posterior nerve, and the area between these lines was defined as the safe zone. In 20 additional specimens, an osteotomy was performed 1 cm anterior to the landmark line using a percutaneous or open technique. Dissection was performed to assess for laceration of the sural, MP, LP, medial calcaneal (MC), or lateral calcaneal (LC) nerves. Results: The safe zone was determined to be within the area 11.2 ± 2.7 mm anterior to the landmark line. After open osteotomy, lacerations were found in 3 of 10 MC nerves and 3 of 10 LC nerves. After percutaneous osteotomy, lacerations were found in 2 of 10 MC nerves and 1 of 10 LC nerves. No lacerations of the sural, MP, or LP nerves were found with either osteotomy. Conclusions: The safe zone extended 11.2 ± 2.7 mm anterior to the described landmark line. The MC and LC nerves were always at risk during medial displacement calcaneal osteotomy. Clinical Relevance: Nerve injury to both major and minor sensory nerves is likely underrecognized as a source of morbidity after calcaneal osteotomy. The current study provides a ready intraoperative guideline for minimizing this risk.
doi_str_mv 10.1177/1071100715595696
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1744664144</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_1071100715595696</sage_id><sourcerecordid>1744664144</sourcerecordid><originalsourceid>FETCH-LOGICAL-c220t-7c994fa29ba2203cc1bc7238560467b81903ff502cf67df5e870550e39fcfe4e3</originalsourceid><addsrcrecordid>eNp1ULtOwzAUtRCIlsLOhDKyBGzHj3hE5a1Ch8LCEjnuNUqVxMV2hv49rloYkFju85yjew9C5wRfESLlNcGSEJwC54oLJQ7QmCjGcllKcZjqtMm3-xE6CWGFMZEFUcdoRAUtCMV4jJ4X2kL24XrIrPPZKwxet9ki-sHEwUPImj57gWWThrdNWLfaQAd9zKa6NbqHNJ6HCC66bnOKjqxuA5zt8wS939-9TR_z2fzhaXozyw2lOObSKMWspqrWqS-MIbWRtCi5wEzIuiQKF9ZyTI0Vcmk5lBJzjqFQ1lhgUEzQ5U537d3XACFWXRMMtG26xw2hIpIxIRhhLEHxDmq8C8GDrda-6bTfVARXWwervw4mysVefag7WP4SfixLgHwHCPoTqpUbfJ--_V_wG73jdxs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1744664144</pqid></control><display><type>article</type><title>Safe Zone for Neural Structures in Medial Displacement Calcaneal Osteotomy: A Cadaveric and Radiographic Investigation</title><source>Access via SAGE</source><source>MEDLINE</source><creator>Talusan, Paul G. ; Cata, Ezequiel ; Tan, Eric W. ; Parks, Brent G. ; Guyton, Gregory P.</creator><creatorcontrib>Talusan, Paul G. ; Cata, Ezequiel ; Tan, Eric W. ; Parks, Brent G. ; Guyton, Gregory P.</creatorcontrib><description>Background: We aimed to define reference lines on standard lateral ankle radiographs that could be used intraoperatively to minimize iatrogenic nerve injury risk in medial displacement calcaneal osteotomy. Methods: Forty cadaveric specimens were used. In 20 specimens, the sural, medial plantar (MP), and lateral plantar (LP) nerves were sutured to radiopaque wire, and a lateral ankle radiograph was obtained. On the radiograph, a line was drawn from the posterior superior apex of the calcaneal tuberosity to the origin of the plantar fascia and labeled as the “landmark line.” A parallel line was drawn 2 mm posterior to the most posterior nerve, and the area between these lines was defined as the safe zone. In 20 additional specimens, an osteotomy was performed 1 cm anterior to the landmark line using a percutaneous or open technique. Dissection was performed to assess for laceration of the sural, MP, LP, medial calcaneal (MC), or lateral calcaneal (LC) nerves. Results: The safe zone was determined to be within the area 11.2 ± 2.7 mm anterior to the landmark line. After open osteotomy, lacerations were found in 3 of 10 MC nerves and 3 of 10 LC nerves. After percutaneous osteotomy, lacerations were found in 2 of 10 MC nerves and 1 of 10 LC nerves. No lacerations of the sural, MP, or LP nerves were found with either osteotomy. Conclusions: The safe zone extended 11.2 ± 2.7 mm anterior to the described landmark line. The MC and LC nerves were always at risk during medial displacement calcaneal osteotomy. Clinical Relevance: Nerve injury to both major and minor sensory nerves is likely underrecognized as a source of morbidity after calcaneal osteotomy. The current study provides a ready intraoperative guideline for minimizing this risk.</description><identifier>ISSN: 1071-1007</identifier><identifier>EISSN: 1944-7876</identifier><identifier>DOI: 10.1177/1071100715595696</identifier><identifier>PMID: 26231200</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Aged, 80 and over ; Cadaver ; Calcaneus - diagnostic imaging ; Calcaneus - innervation ; Calcaneus - surgery ; Female ; Humans ; Intraoperative Complications - prevention &amp; control ; Male ; Middle Aged ; Osteotomy - methods ; Peripheral Nerve Injuries - prevention &amp; control ; Radiography ; Tibial Nerve - anatomy &amp; histology ; Tibial Nerve - diagnostic imaging ; Tibial Nerve - injuries</subject><ispartof>Foot &amp; ankle international, 2015-12, Vol.36 (12), p.1493-1498</ispartof><rights>The Author(s) 2015</rights><rights>The Author(s) 2015.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c220t-7c994fa29ba2203cc1bc7238560467b81903ff502cf67df5e870550e39fcfe4e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1071100715595696$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1071100715595696$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26231200$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Talusan, Paul G.</creatorcontrib><creatorcontrib>Cata, Ezequiel</creatorcontrib><creatorcontrib>Tan, Eric W.</creatorcontrib><creatorcontrib>Parks, Brent G.</creatorcontrib><creatorcontrib>Guyton, Gregory P.</creatorcontrib><title>Safe Zone for Neural Structures in Medial Displacement Calcaneal Osteotomy: A Cadaveric and Radiographic Investigation</title><title>Foot &amp; ankle international</title><addtitle>Foot Ankle Int</addtitle><description>Background: We aimed to define reference lines on standard lateral ankle radiographs that could be used intraoperatively to minimize iatrogenic nerve injury risk in medial displacement calcaneal osteotomy. Methods: Forty cadaveric specimens were used. In 20 specimens, the sural, medial plantar (MP), and lateral plantar (LP) nerves were sutured to radiopaque wire, and a lateral ankle radiograph was obtained. On the radiograph, a line was drawn from the posterior superior apex of the calcaneal tuberosity to the origin of the plantar fascia and labeled as the “landmark line.” A parallel line was drawn 2 mm posterior to the most posterior nerve, and the area between these lines was defined as the safe zone. In 20 additional specimens, an osteotomy was performed 1 cm anterior to the landmark line using a percutaneous or open technique. Dissection was performed to assess for laceration of the sural, MP, LP, medial calcaneal (MC), or lateral calcaneal (LC) nerves. Results: The safe zone was determined to be within the area 11.2 ± 2.7 mm anterior to the landmark line. After open osteotomy, lacerations were found in 3 of 10 MC nerves and 3 of 10 LC nerves. After percutaneous osteotomy, lacerations were found in 2 of 10 MC nerves and 1 of 10 LC nerves. No lacerations of the sural, MP, or LP nerves were found with either osteotomy. Conclusions: The safe zone extended 11.2 ± 2.7 mm anterior to the described landmark line. The MC and LC nerves were always at risk during medial displacement calcaneal osteotomy. Clinical Relevance: Nerve injury to both major and minor sensory nerves is likely underrecognized as a source of morbidity after calcaneal osteotomy. The current study provides a ready intraoperative guideline for minimizing this risk.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cadaver</subject><subject>Calcaneus - diagnostic imaging</subject><subject>Calcaneus - innervation</subject><subject>Calcaneus - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Intraoperative Complications - prevention &amp; control</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Osteotomy - methods</subject><subject>Peripheral Nerve Injuries - prevention &amp; control</subject><subject>Radiography</subject><subject>Tibial Nerve - anatomy &amp; histology</subject><subject>Tibial Nerve - diagnostic imaging</subject><subject>Tibial Nerve - injuries</subject><issn>1071-1007</issn><issn>1944-7876</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1ULtOwzAUtRCIlsLOhDKyBGzHj3hE5a1Ch8LCEjnuNUqVxMV2hv49rloYkFju85yjew9C5wRfESLlNcGSEJwC54oLJQ7QmCjGcllKcZjqtMm3-xE6CWGFMZEFUcdoRAUtCMV4jJ4X2kL24XrIrPPZKwxet9ki-sHEwUPImj57gWWThrdNWLfaQAd9zKa6NbqHNJ6HCC66bnOKjqxuA5zt8wS939-9TR_z2fzhaXozyw2lOObSKMWspqrWqS-MIbWRtCi5wEzIuiQKF9ZyTI0Vcmk5lBJzjqFQ1lhgUEzQ5U537d3XACFWXRMMtG26xw2hIpIxIRhhLEHxDmq8C8GDrda-6bTfVARXWwervw4mysVefag7WP4SfixLgHwHCPoTqpUbfJ--_V_wG73jdxs</recordid><startdate>201512</startdate><enddate>201512</enddate><creator>Talusan, Paul G.</creator><creator>Cata, Ezequiel</creator><creator>Tan, Eric W.</creator><creator>Parks, Brent G.</creator><creator>Guyton, Gregory P.</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201512</creationdate><title>Safe Zone for Neural Structures in Medial Displacement Calcaneal Osteotomy</title><author>Talusan, Paul G. ; Cata, Ezequiel ; Tan, Eric W. ; Parks, Brent G. ; Guyton, Gregory P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c220t-7c994fa29ba2203cc1bc7238560467b81903ff502cf67df5e870550e39fcfe4e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cadaver</topic><topic>Calcaneus - diagnostic imaging</topic><topic>Calcaneus - innervation</topic><topic>Calcaneus - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Intraoperative Complications - prevention &amp; control</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Osteotomy - methods</topic><topic>Peripheral Nerve Injuries - prevention &amp; control</topic><topic>Radiography</topic><topic>Tibial Nerve - anatomy &amp; histology</topic><topic>Tibial Nerve - diagnostic imaging</topic><topic>Tibial Nerve - injuries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Talusan, Paul G.</creatorcontrib><creatorcontrib>Cata, Ezequiel</creatorcontrib><creatorcontrib>Tan, Eric W.</creatorcontrib><creatorcontrib>Parks, Brent G.</creatorcontrib><creatorcontrib>Guyton, Gregory P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Foot &amp; ankle international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Talusan, Paul G.</au><au>Cata, Ezequiel</au><au>Tan, Eric W.</au><au>Parks, Brent G.</au><au>Guyton, Gregory P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safe Zone for Neural Structures in Medial Displacement Calcaneal Osteotomy: A Cadaveric and Radiographic Investigation</atitle><jtitle>Foot &amp; ankle international</jtitle><addtitle>Foot Ankle Int</addtitle><date>2015-12</date><risdate>2015</risdate><volume>36</volume><issue>12</issue><spage>1493</spage><epage>1498</epage><pages>1493-1498</pages><issn>1071-1007</issn><eissn>1944-7876</eissn><abstract>Background: We aimed to define reference lines on standard lateral ankle radiographs that could be used intraoperatively to minimize iatrogenic nerve injury risk in medial displacement calcaneal osteotomy. Methods: Forty cadaveric specimens were used. In 20 specimens, the sural, medial plantar (MP), and lateral plantar (LP) nerves were sutured to radiopaque wire, and a lateral ankle radiograph was obtained. On the radiograph, a line was drawn from the posterior superior apex of the calcaneal tuberosity to the origin of the plantar fascia and labeled as the “landmark line.” A parallel line was drawn 2 mm posterior to the most posterior nerve, and the area between these lines was defined as the safe zone. In 20 additional specimens, an osteotomy was performed 1 cm anterior to the landmark line using a percutaneous or open technique. Dissection was performed to assess for laceration of the sural, MP, LP, medial calcaneal (MC), or lateral calcaneal (LC) nerves. Results: The safe zone was determined to be within the area 11.2 ± 2.7 mm anterior to the landmark line. After open osteotomy, lacerations were found in 3 of 10 MC nerves and 3 of 10 LC nerves. After percutaneous osteotomy, lacerations were found in 2 of 10 MC nerves and 1 of 10 LC nerves. No lacerations of the sural, MP, or LP nerves were found with either osteotomy. Conclusions: The safe zone extended 11.2 ± 2.7 mm anterior to the described landmark line. The MC and LC nerves were always at risk during medial displacement calcaneal osteotomy. Clinical Relevance: Nerve injury to both major and minor sensory nerves is likely underrecognized as a source of morbidity after calcaneal osteotomy. The current study provides a ready intraoperative guideline for minimizing this risk.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>26231200</pmid><doi>10.1177/1071100715595696</doi><tpages>6</tpages></addata></record>
fulltext fulltext
identifier ISSN: 1071-1007
ispartof Foot & ankle international, 2015-12, Vol.36 (12), p.1493-1498
issn 1071-1007
1944-7876
language eng
recordid cdi_proquest_miscellaneous_1744664144
source Access via SAGE; MEDLINE
subjects Aged
Aged, 80 and over
Cadaver
Calcaneus - diagnostic imaging
Calcaneus - innervation
Calcaneus - surgery
Female
Humans
Intraoperative Complications - prevention & control
Male
Middle Aged
Osteotomy - methods
Peripheral Nerve Injuries - prevention & control
Radiography
Tibial Nerve - anatomy & histology
Tibial Nerve - diagnostic imaging
Tibial Nerve - injuries
title Safe Zone for Neural Structures in Medial Displacement Calcaneal Osteotomy: A Cadaveric and Radiographic Investigation
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T21%3A13%3A56IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Safe%20Zone%20for%20Neural%20Structures%20in%20Medial%20Displacement%20Calcaneal%20Osteotomy:%20A%20Cadaveric%20and%20Radiographic%20Investigation&rft.jtitle=Foot%20&%20ankle%20international&rft.au=Talusan,%20Paul%20G.&rft.date=2015-12&rft.volume=36&rft.issue=12&rft.spage=1493&rft.epage=1498&rft.pages=1493-1498&rft.issn=1071-1007&rft.eissn=1944-7876&rft_id=info:doi/10.1177/1071100715595696&rft_dat=%3Cproquest_cross%3E1744664144%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1744664144&rft_id=info:pmid/26231200&rft_sage_id=10.1177_1071100715595696&rfr_iscdi=true