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
Hauptverfasser: Siddiqui, Ali A., Troyer, Wesley D., Bango, Jugert, Mustafa, Moawiah S., Buckner, Jeannie F., Shi, Glenn G., Haupt, Edward T.
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container_issue 4
container_start_page 1865
container_title European journal of orthopaedic surgery & traumatology
container_volume 34
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
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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 &amp; plants ; Humans ; Laparoscopy ; Male ; Medicine ; Medicine &amp; 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 &amp; 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. 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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. 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Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of orthopaedic surgery &amp; 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 &amp; 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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