Lateralizing calcaneal osteotomy performed with a percutaneous burr results in a significantly lower increase in tarsal tunnel pressure
Purpose Tarsal tunnel syndrome is well documented following lateralizing calcaneal osteotomy to manage varus hindfoot deformity. Traditionally, calcaneal osteotomy is performed with an oscillating saw. No studies have investigated the effect of alternative surgical techniques on postoperative tarsal...
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Veröffentlicht in: | European journal of orthopaedic surgery & traumatology 2024-05, Vol.34 (4), p.1865-1870 |
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creator | Siddiqui, Ali A. Troyer, Wesley D. Bango, Jugert Mustafa, Moawiah S. Buckner, Jeannie F. Shi, Glenn G. Haupt, Edward T. |
description | Purpose
Tarsal tunnel syndrome is well documented following lateralizing calcaneal osteotomy to manage varus hindfoot deformity. Traditionally, calcaneal osteotomy is performed with an oscillating saw. No studies have investigated the effect of alternative surgical techniques on postoperative tarsal tunnel pressure. The purpose of this study was to investigate the difference in tarsal tunnel pressures following lateralizing calcaneal osteotomy performed using a high-torque, low-speed “minimally invasive surgery” (MIS) Shannon burr versus an oscillating saw.
Methods
Lateralizing calcaneal osteotomy was performed on 10 below-knee cadaveric specimens. This was conducted on 5 specimens each using an oscillating saw (Saw group) or MIS burr (Burr group). The calcaneal tuberosity was translated 1 cm laterally and transfixed using 2 Kirschner wires. Tarsal tunnel pressure was measured before and after osteotomy via ultrasound-guided percutaneous needle barometer. Mean pre/post-osteotomy pressures were compared between groups. Differences were analyzed using Student’s
t
test.
Results
The mean pre-procedure tarsal tunnel pressure was 25.8 ± 5.1 mm Hg in the Saw group and 26.4 ± 4.3 mm Hg in the Burr group (
p
= 0.85). The mean post-procedure pressure was 63.4 ± 5.1 in the Saw group and 47.8 ± 4.3 in the Burr group (
p
= 0.01). Change in tarsal tunnel pressure was significantly lower in the Burr group (21.4 ± 4.5) compared to the Saw group (37.6 ± 12.5) (
p
= 0.03). The increase in tarsal tunnel pressure was 43% lower in the Burr group.
Conclusion
In this cadaveric study, tarsal tunnel pressure increase after lateralizing calcaneal osteotomy was significantly lower when using a burr versus a saw. This is likely because the increased width (“kerf”) of the 3 mm MIS burr, compared to the submillimeter saw blade width, causes calcaneal shortening. Given the smaller increase in tarsal tunnel pressure, using the MIS burr for lateralizing calcaneal osteotomy may decrease the risk of postoperative tarsal tunnel syndrome. Future research in vivo should explore this. |
doi_str_mv | 10.1007/s00590-024-03865-2 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2937333908</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3056071082</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-24295f145af4f8300cdce08d8cb3dc3cd25d61f62cde52c418c2bad0d084e6e03</originalsourceid><addsrcrecordid>eNp9kU1vVCEYhYmpsbX6B1w0JG7cXH2Byx3usmn8SiZxo2vCwHunNMxlykea8Q_4t2W8rTUuuoJwnnNe4BDyhsF7BrD6kAHkCB3wvgOhBtnxZ-SM9YJ3DAZ18s_-lLzM-QaAyZHJF-RUqF4wNcoz8mttCiYT_E8_b6k1wZoZTaAxF4wl7g50j2mKaYeO3vlyTc3xwNbSsFgz3dSUaMJcQ8nUz03Ofjv7ybecEg40xDtMTbAJTcYjUUzKbUCp84yB7ps314SvyPPJhIyv79dz8uPTx-9XX7r1t89fry7XnRV8KB3v-Sgn1ksz9ZMSANZZBOWU3QhnhXVcuoFNA7cOJbc9U5ZvjAMHqscBQZyTd0vuPsXbirnonc8WQ1jeo_koVkKIEVRD3_6H3sSa5nY7LUAOsGKgeKP4QtkUc0446X3yO5MOmoE-1qSXmnSrSf-pSR9NF_fRddN-9q_loZcGiAXITZq3mB5nPxH7G9UxoO0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3056071082</pqid></control><display><type>article</type><title>Lateralizing calcaneal osteotomy performed with a percutaneous burr results in a significantly lower increase in tarsal tunnel pressure</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Siddiqui, Ali A. ; Troyer, Wesley D. ; Bango, Jugert ; Mustafa, Moawiah S. ; Buckner, Jeannie F. ; Shi, Glenn G. ; Haupt, Edward T.</creator><creatorcontrib>Siddiqui, Ali A. ; Troyer, Wesley D. ; Bango, Jugert ; Mustafa, Moawiah S. ; Buckner, Jeannie F. ; Shi, Glenn G. ; Haupt, Edward T.</creatorcontrib><description>Purpose
Tarsal tunnel syndrome is well documented following lateralizing calcaneal osteotomy to manage varus hindfoot deformity. Traditionally, calcaneal osteotomy is performed with an oscillating saw. No studies have investigated the effect of alternative surgical techniques on postoperative tarsal tunnel pressure. The purpose of this study was to investigate the difference in tarsal tunnel pressures following lateralizing calcaneal osteotomy performed using a high-torque, low-speed “minimally invasive surgery” (MIS) Shannon burr versus an oscillating saw.
Methods
Lateralizing calcaneal osteotomy was performed on 10 below-knee cadaveric specimens. This was conducted on 5 specimens each using an oscillating saw (Saw group) or MIS burr (Burr group). The calcaneal tuberosity was translated 1 cm laterally and transfixed using 2 Kirschner wires. Tarsal tunnel pressure was measured before and after osteotomy via ultrasound-guided percutaneous needle barometer. Mean pre/post-osteotomy pressures were compared between groups. Differences were analyzed using Student’s
t
test.
Results
The mean pre-procedure tarsal tunnel pressure was 25.8 ± 5.1 mm Hg in the Saw group and 26.4 ± 4.3 mm Hg in the Burr group (
p
= 0.85). The mean post-procedure pressure was 63.4 ± 5.1 in the Saw group and 47.8 ± 4.3 in the Burr group (
p
= 0.01). Change in tarsal tunnel pressure was significantly lower in the Burr group (21.4 ± 4.5) compared to the Saw group (37.6 ± 12.5) (
p
= 0.03). The increase in tarsal tunnel pressure was 43% lower in the Burr group.
Conclusion
In this cadaveric study, tarsal tunnel pressure increase after lateralizing calcaneal osteotomy was significantly lower when using a burr versus a saw. This is likely because the increased width (“kerf”) of the 3 mm MIS burr, compared to the submillimeter saw blade width, causes calcaneal shortening. Given the smaller increase in tarsal tunnel pressure, using the MIS burr for lateralizing calcaneal osteotomy may decrease the risk of postoperative tarsal tunnel syndrome. Future research in vivo should explore this.</description><identifier>ISSN: 1432-1068</identifier><identifier>ISSN: 1633-8065</identifier><identifier>EISSN: 1432-1068</identifier><identifier>DOI: 10.1007/s00590-024-03865-2</identifier><identifier>PMID: 38431895</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Aged ; Cadaver ; Calcaneus - surgery ; Female ; Flowers & plants ; Humans ; Laparoscopy ; Male ; Medicine ; Medicine & Public Health ; Minimally invasive surgery ; Minimally Invasive Surgical Procedures - methods ; Original Article ; Orthopedics ; Osteotomy - instrumentation ; Osteotomy - methods ; Pressure ; Rehabilitation ; Surgeons ; Surgery ; Surgical Orthopedics ; Surgical techniques ; Tarsal Tunnel Syndrome - etiology ; Tarsal Tunnel Syndrome - surgery ; Traumatic Surgery ; Ultrasonic imaging</subject><ispartof>European journal of orthopaedic surgery & traumatology, 2024-05, Vol.34 (4), p.1865-1870</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-24295f145af4f8300cdce08d8cb3dc3cd25d61f62cde52c418c2bad0d084e6e03</cites><orcidid>0000-0001-5476-3204</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00590-024-03865-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00590-024-03865-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38431895$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Siddiqui, Ali A.</creatorcontrib><creatorcontrib>Troyer, Wesley D.</creatorcontrib><creatorcontrib>Bango, Jugert</creatorcontrib><creatorcontrib>Mustafa, Moawiah S.</creatorcontrib><creatorcontrib>Buckner, Jeannie F.</creatorcontrib><creatorcontrib>Shi, Glenn G.</creatorcontrib><creatorcontrib>Haupt, Edward T.</creatorcontrib><title>Lateralizing calcaneal osteotomy performed with a percutaneous burr results in a significantly lower increase in tarsal tunnel pressure</title><title>European journal of orthopaedic surgery & traumatology</title><addtitle>Eur J Orthop Surg Traumatol</addtitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><description>Purpose
Tarsal tunnel syndrome is well documented following lateralizing calcaneal osteotomy to manage varus hindfoot deformity. Traditionally, calcaneal osteotomy is performed with an oscillating saw. No studies have investigated the effect of alternative surgical techniques on postoperative tarsal tunnel pressure. The purpose of this study was to investigate the difference in tarsal tunnel pressures following lateralizing calcaneal osteotomy performed using a high-torque, low-speed “minimally invasive surgery” (MIS) Shannon burr versus an oscillating saw.
Methods
Lateralizing calcaneal osteotomy was performed on 10 below-knee cadaveric specimens. This was conducted on 5 specimens each using an oscillating saw (Saw group) or MIS burr (Burr group). The calcaneal tuberosity was translated 1 cm laterally and transfixed using 2 Kirschner wires. Tarsal tunnel pressure was measured before and after osteotomy via ultrasound-guided percutaneous needle barometer. Mean pre/post-osteotomy pressures were compared between groups. Differences were analyzed using Student’s
t
test.
Results
The mean pre-procedure tarsal tunnel pressure was 25.8 ± 5.1 mm Hg in the Saw group and 26.4 ± 4.3 mm Hg in the Burr group (
p
= 0.85). The mean post-procedure pressure was 63.4 ± 5.1 in the Saw group and 47.8 ± 4.3 in the Burr group (
p
= 0.01). Change in tarsal tunnel pressure was significantly lower in the Burr group (21.4 ± 4.5) compared to the Saw group (37.6 ± 12.5) (
p
= 0.03). The increase in tarsal tunnel pressure was 43% lower in the Burr group.
Conclusion
In this cadaveric study, tarsal tunnel pressure increase after lateralizing calcaneal osteotomy was significantly lower when using a burr versus a saw. This is likely because the increased width (“kerf”) of the 3 mm MIS burr, compared to the submillimeter saw blade width, causes calcaneal shortening. Given the smaller increase in tarsal tunnel pressure, using the MIS burr for lateralizing calcaneal osteotomy may decrease the risk of postoperative tarsal tunnel syndrome. Future research in vivo should explore this.</description><subject>Aged</subject><subject>Cadaver</subject><subject>Calcaneus - surgery</subject><subject>Female</subject><subject>Flowers & plants</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally invasive surgery</subject><subject>Minimally Invasive Surgical Procedures - methods</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Osteotomy - instrumentation</subject><subject>Osteotomy - methods</subject><subject>Pressure</subject><subject>Rehabilitation</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Surgical techniques</subject><subject>Tarsal Tunnel Syndrome - etiology</subject><subject>Tarsal Tunnel Syndrome - surgery</subject><subject>Traumatic Surgery</subject><subject>Ultrasonic imaging</subject><issn>1432-1068</issn><issn>1633-8065</issn><issn>1432-1068</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1vVCEYhYmpsbX6B1w0JG7cXH2Byx3usmn8SiZxo2vCwHunNMxlykea8Q_4t2W8rTUuuoJwnnNe4BDyhsF7BrD6kAHkCB3wvgOhBtnxZ-SM9YJ3DAZ18s_-lLzM-QaAyZHJF-RUqF4wNcoz8mttCiYT_E8_b6k1wZoZTaAxF4wl7g50j2mKaYeO3vlyTc3xwNbSsFgz3dSUaMJcQ8nUz03Ofjv7ybecEg40xDtMTbAJTcYjUUzKbUCp84yB7ps314SvyPPJhIyv79dz8uPTx-9XX7r1t89fry7XnRV8KB3v-Sgn1ksz9ZMSANZZBOWU3QhnhXVcuoFNA7cOJbc9U5ZvjAMHqscBQZyTd0vuPsXbirnonc8WQ1jeo_koVkKIEVRD3_6H3sSa5nY7LUAOsGKgeKP4QtkUc0446X3yO5MOmoE-1qSXmnSrSf-pSR9NF_fRddN-9q_loZcGiAXITZq3mB5nPxH7G9UxoO0</recordid><startdate>20240501</startdate><enddate>20240501</enddate><creator>Siddiqui, Ali A.</creator><creator>Troyer, Wesley D.</creator><creator>Bango, Jugert</creator><creator>Mustafa, Moawiah S.</creator><creator>Buckner, Jeannie F.</creator><creator>Shi, Glenn G.</creator><creator>Haupt, Edward T.</creator><general>Springer Paris</general><general>Springer Nature B.V</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>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5476-3204</orcidid></search><sort><creationdate>20240501</creationdate><title>Lateralizing calcaneal osteotomy performed with a percutaneous burr results in a significantly lower increase in tarsal tunnel pressure</title><author>Siddiqui, Ali A. ; Troyer, Wesley D. ; Bango, Jugert ; Mustafa, Moawiah S. ; Buckner, Jeannie F. ; Shi, Glenn G. ; Haupt, Edward T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-24295f145af4f8300cdce08d8cb3dc3cd25d61f62cde52c418c2bad0d084e6e03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Cadaver</topic><topic>Calcaneus - surgery</topic><topic>Female</topic><topic>Flowers & plants</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minimally invasive surgery</topic><topic>Minimally Invasive Surgical Procedures - methods</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Osteotomy - instrumentation</topic><topic>Osteotomy - methods</topic><topic>Pressure</topic><topic>Rehabilitation</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Surgical techniques</topic><topic>Tarsal Tunnel Syndrome - etiology</topic><topic>Tarsal Tunnel Syndrome - surgery</topic><topic>Traumatic Surgery</topic><topic>Ultrasonic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Siddiqui, Ali A.</creatorcontrib><creatorcontrib>Troyer, Wesley D.</creatorcontrib><creatorcontrib>Bango, Jugert</creatorcontrib><creatorcontrib>Mustafa, Moawiah S.</creatorcontrib><creatorcontrib>Buckner, Jeannie F.</creatorcontrib><creatorcontrib>Shi, Glenn G.</creatorcontrib><creatorcontrib>Haupt, Edward T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of orthopaedic surgery & traumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Siddiqui, Ali A.</au><au>Troyer, Wesley D.</au><au>Bango, Jugert</au><au>Mustafa, Moawiah S.</au><au>Buckner, Jeannie F.</au><au>Shi, Glenn G.</au><au>Haupt, Edward T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lateralizing calcaneal osteotomy performed with a percutaneous burr results in a significantly lower increase in tarsal tunnel pressure</atitle><jtitle>European journal of orthopaedic surgery & traumatology</jtitle><stitle>Eur J Orthop Surg Traumatol</stitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><date>2024-05-01</date><risdate>2024</risdate><volume>34</volume><issue>4</issue><spage>1865</spage><epage>1870</epage><pages>1865-1870</pages><issn>1432-1068</issn><issn>1633-8065</issn><eissn>1432-1068</eissn><abstract>Purpose
Tarsal tunnel syndrome is well documented following lateralizing calcaneal osteotomy to manage varus hindfoot deformity. Traditionally, calcaneal osteotomy is performed with an oscillating saw. No studies have investigated the effect of alternative surgical techniques on postoperative tarsal tunnel pressure. The purpose of this study was to investigate the difference in tarsal tunnel pressures following lateralizing calcaneal osteotomy performed using a high-torque, low-speed “minimally invasive surgery” (MIS) Shannon burr versus an oscillating saw.
Methods
Lateralizing calcaneal osteotomy was performed on 10 below-knee cadaveric specimens. This was conducted on 5 specimens each using an oscillating saw (Saw group) or MIS burr (Burr group). The calcaneal tuberosity was translated 1 cm laterally and transfixed using 2 Kirschner wires. Tarsal tunnel pressure was measured before and after osteotomy via ultrasound-guided percutaneous needle barometer. Mean pre/post-osteotomy pressures were compared between groups. Differences were analyzed using Student’s
t
test.
Results
The mean pre-procedure tarsal tunnel pressure was 25.8 ± 5.1 mm Hg in the Saw group and 26.4 ± 4.3 mm Hg in the Burr group (
p
= 0.85). The mean post-procedure pressure was 63.4 ± 5.1 in the Saw group and 47.8 ± 4.3 in the Burr group (
p
= 0.01). Change in tarsal tunnel pressure was significantly lower in the Burr group (21.4 ± 4.5) compared to the Saw group (37.6 ± 12.5) (
p
= 0.03). The increase in tarsal tunnel pressure was 43% lower in the Burr group.
Conclusion
In this cadaveric study, tarsal tunnel pressure increase after lateralizing calcaneal osteotomy was significantly lower when using a burr versus a saw. This is likely because the increased width (“kerf”) of the 3 mm MIS burr, compared to the submillimeter saw blade width, causes calcaneal shortening. Given the smaller increase in tarsal tunnel pressure, using the MIS burr for lateralizing calcaneal osteotomy may decrease the risk of postoperative tarsal tunnel syndrome. Future research in vivo should explore this.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>38431895</pmid><doi>10.1007/s00590-024-03865-2</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-5476-3204</orcidid></addata></record> |
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subjects | Aged Cadaver Calcaneus - surgery Female Flowers & plants Humans Laparoscopy Male Medicine Medicine & Public Health Minimally invasive surgery Minimally Invasive Surgical Procedures - methods Original Article Orthopedics Osteotomy - instrumentation Osteotomy - methods Pressure Rehabilitation Surgeons Surgery Surgical Orthopedics Surgical techniques Tarsal Tunnel Syndrome - etiology Tarsal Tunnel Syndrome - surgery Traumatic Surgery Ultrasonic imaging |
title | Lateralizing calcaneal osteotomy performed with a percutaneous burr results in a significantly lower increase in tarsal tunnel pressure |
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