Minimally Invasive Calcaneal Osteotomy: Does the Shannon Burr Endanger the Neurovascular Structures? A Cadaveric Study

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Type of Study: Cadaveric Study.

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Navigation-assisted fluoroscopy in minimally invasive direct lateral interbody fusion: a cadaveric study

SAS Journal ◽

10.1016/j.esas.2010.09.002 ◽

2010 ◽

Vol 4 (4) ◽

pp. 115-121 ◽

Cited By ~ 5

Author(s):

Jonathan E. Webb ◽

Gilad J. Regev ◽

Steven R. Garfin ◽

Choll W. Kim

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Cadaveric Study ◽

Lateral Interbody Fusion ◽

Lateral Interbody

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Minimally invasive calcaneal osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00484 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0048

Author(s):

Kar Teoh ◽

Kartik Hariharan

Keyword(s):

Length Of Stay ◽

Minimally Invasive ◽

Average Length ◽

Achilles Tendinopathy ◽

Complication Rates ◽

Union Rate ◽

Average Length Of Stay ◽

Calcaneal Osteotomy ◽

Cavus Foot ◽

One Year

Category: Hindfoot Introduction/Purpose: A calcaneal osteotomy can be used to treat a variety of pathologic entities in which the hindfoot needs realignment. Minimally invasive calcaneal osteotomy (MICO) is becoming increasingly popular due to being soft tissue friendly, its ability to place other incisions nearby and high union rate. Previous studies have look specifically at medialising MICO or comparing open calcaneal osteotomy versus MICO. The purpose of our study was to compare 3 different types of commonly used MICO in our centre. Methods: Sixty-two MICO which fit the criteria were included in this study. They were performed in our unit from 2010 and 2016 and all patients had at least one year follow up data. The type of osteotomies was as follows: Medialising, n = 34, Lateralising, n =15 and Zadek (Dorsal closing wedge), n =13. Clinical and radiographic data were recorded. The diagnosis for 31/34 of the medialising MICO was Stage 2 PTTD, the diagnosis for 12/15 of the lateralising MICO was cavus foot, while the diagnosis for all Zadek MICO was for insertional Achilles tendinopathy. Apart from the Zadek MICO, the other MICO were all associated with other procedures. The average age (years) were as follows: Medialising, 58 (30 – 74); Lateralising, 33 (14 – 67) and Zadek, 47 (42-62). Results: The average calcaneal displacement was 10.2 (range: 8 – 12) mm for medialising MICO, and 6.6 (4 – 8) mm for lateralising MICO(p=0.021). Average time to union was 7.8 (5.4 – 11.6) weeks for medialising MICO, 6.2 (4.6 to 7.9) weeks for lateralising MICO, and 6.1 (4.1 – 7.6) weeks for Zadek MICO. All the MICO healed radiologically and clinically. Five (8%) patients (Medialising, n = 2; Lateralising n =2; Zadek, n =1) reported transient sural nerve paraesthesia following surgery. Wound problems developed in 5 patients (Lateralising, n =3; Zadek, n =2). The number of total complications were as follow: Medialising, n = 5, Lateralising, n = 7 and Zadek, n =5. Average length of stay was as follows: Medialising, 2(0-8) days; Lateralising, 1(0-3) day and Zadek, 1(0-3) day. Conclusion: Minimally invasive calcaneal osteotomy was safe with a high union rate and low complication rates and length of stay across all 3 common osteotomies. The average calcaneal displacement was significantly less for lateralising than medialising which is similar to reported figures for open osteotomy. Wound problems were more likely for lateralising and Zadek MICO compared to medialising and this could be because of how the osteotomies are shifted.

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Minimally Invasive Dorsal Cheilectomy of the First Metatarsal: A Cadaveric Study

Foot & Ankle International ◽

10.1177/1071100718791588 ◽

2018 ◽

Vol 39 (12) ◽

pp. 1497-1501 ◽

Cited By ~ 6

Author(s):

Kar Hao Teoh ◽

Esten Konstad Haanaes ◽

Saud Alshalawi ◽

Hiro Tanaka ◽

Kartik Hariharan

Keyword(s):

Minimally Invasive ◽

Average Distance ◽

Cadaveric Study ◽

Invasive Technique ◽

Optimal Position ◽

First Metatarsal ◽

Below The Knee ◽

Fresh Frozen ◽

Stab Incision ◽

Relationship Of

Background: Minimally invasive dorsal cheilectomy (MIDC) for hallus rigidus is gaining in popularity. The optimal position for the stab incision for MIDC is dorsomedial to allow an ergonomic sweeping movement of the burr, potentially putting the dorsomedial cutaneous nerve (DMCN) to the hallux at risk. We aimed to quantify the risk of using this minimally invasive technique with a cadaveric study. Methods: A total of 13 fresh-frozen cadaveric specimens amputated below the knee were obtained for this study. After the procedure, the specimens were dissected, and structures were inspected for damage. Results: The DMCN to the hallux was cut completely in 2 specimens (15%). All the extensor hallucis longus tendons were intact, although in 1 specimen, the tendon showed some fraying on the underside of the tendon. The average distance of the stab incision from the first metatarsophalangeal (MTP) joint was 17.7 (range, 10-23) mm. The relationship of the DMCN to the stab incision was variable. The average distance of the DMCN to the incision was 3.8 (range, 0-7) mm. The danger zone for damaging the DMCN was at one-third the length of the first metatarsal proximal to the first MTP joint. Conclusion: The DMCN has been well studied by several authors and has a variable course. This nerve was damaged in 15% of our specimens following MIDC. Clinical Relevance: We believe patients should be made aware of this risk when considering surgery. A carefully made working capsular pocket for the burr and marking this nerve before making the incision if palpable could mitigate this risk.

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Efficacy of 3-D-imaging in minimally-invasive screw fixation of proximal phalanx fractures: A cadaveric study

Technology and Health Care ◽

10.3233/thc-2010-0569 ◽

2010 ◽

Vol 18 (1) ◽

pp. 19-29

Author(s):

A. Oldewurtel ◽

D. Kendoff ◽

P.F. O'Loughlin ◽

U. Wolfhard ◽

L.C. Olivier

Keyword(s):

Minimally Invasive ◽

Screw Fixation ◽

Proximal Phalanx ◽

Cadaveric Study

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Proximity of the Coracoid Process to the Neurovascular Structures in Various Patient and Shoulder Positions: A Cadaveric Study

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2018.09.031 ◽

2019 ◽

Vol 35 (2) ◽

pp. 372-379 ◽

Cited By ~ 3

Author(s):

Chaiwat Chuaychoosakoon ◽

Porames Suwanno ◽

Prapakorn Klabklay ◽

Chitpon Sinchai ◽

Yada Duangnumsawang ◽

...

Keyword(s):

Coracoid Process ◽

Cadaveric Study ◽

Neurovascular Structures

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Does nerve injury following minimally invasive calcaneal osteotomy clinically correlate to Talusan’s Zone?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00483 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0048

Author(s):

Kar Teoh ◽

Kartik Hariharan

Keyword(s):

Minimally Invasive ◽

Nerve Injury ◽

Sural Nerve ◽

Safe Zone ◽

Lateral Side ◽

Surgical Morbidity ◽

Closing Wedge ◽

Calcaneal Osteotomy ◽

Alternative Method ◽

Calcaneal Tuberosity

Category: Hindfoot Introduction/Purpose: Talusan et al (FAI, 2005) described a safe zone for neural structures in medial displacement calcaneal osteotomy following a cadaveric and radiographic investigation. The safe zone was determined to be within the area 11.2 ± 2.7 mm anterior to the landmark line which is from the plantar fascia origin through the center of the posterosuperior aspect of the calcaneal tuberosity. Minimally invasive calcaneal osteotomies been gaining in popularity as it minimises soft tissue disruption and surgical morbidity. However, neural structures are at risk on both the medial and lateral side of the foot during this procedure. We aim to correlate our clinical results with Talusan’s Radiographic Zone (TRZ) following minimally invasive calcaneal osteotomies. Methods: Sixty-three calcaneal osteotomies were performed in our unit from 2010 and 2016. The type of osteotomies was as follows: Medialising, n = 34; Lateralising n =15; Zadek (Dorsal closing wedge), n =13; and Dwyer (lateral closing wedge), n = 1. Clinical data were recorded with any nerve injury noted. The calcaneal osteotomies were graded into whether they fell into TRZ. We also evaluated Talusan’s alternative method which he described and is based on alternative line 60% of the distance from the angle of Gissane to the tip of most posterior aspect of the calcaneal tuberosity where the safe zone is a window 5.6 mm anterior to this. Results: Five (8%) patients (Medialising, n = 2; Lateralising n =2; Zadek, n =1) reported sural nerve paraesthesia following surgery in our series. However, this was transient and they recovered fully. In total, seven patients (Medialising, n = 4; Lateralising n =1; Zadek, n =1; Dwyer, n=1) fell outside TRZ in our series, of which 2 reported transient sural nerve paraesthesia. Based on our results, TRZ clinically correlated with nerve injury (Chi square test, p=0.032). The other three patients who reported sural nerve paraesthesia but fell inside TRZ measured on average 10.4 mm from the landmark line (10.2, 10.4, 10.7 mm). However when we used the alternative method, they all fell outside the safe zone of this alternative line. Conclusion: Our results suggest that TRZ clinically correlated with nerve injury. However, the alternative line (where the safe zone is a window 5.6 mm anterior to this line) might be more accurate than the landmark line (where the safe zone is 11.2 ± 2.7 mm anterior to this line). More clinical studies with larger numbers might be required to confirm this.

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Medial Displacement Calcaneal Osteotomy: Loss of Correction with Varying Drilling Techniques

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00471 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0047

Author(s):

Benjamin D. Umbel ◽

B. Dale Sharpe ◽

Adam L. Halverson ◽

Mark A. Prissel

Keyword(s):

Screw Fixation ◽

Cadaveric Study ◽

Matched Pair ◽

Osteotomy Site ◽

Control Group ◽

Posterior Tibial Tendon ◽

Loss Of Correction ◽

Calcaneal Osteotomy ◽

Displacement Osteotomy ◽

Simultaneous Group

Category: Hindfoot Introduction/Purpose: Surgical correction of Stage 2 posterior tibial tendon dysfunction typically involves a combination of soft tissue and bony corrections, often including a medial displacement calcaneal osteotomy (MDCO). This osteotomy is often fixated utilizing two parallel screws; however, it remains unknown how much correction is lost based on various accepted drilling techniques for common fixation of this osteotomy. Our cadaveric study compares three different surgical drilling techniques, using two parallel cannulated screws for fixation, to best maintain desired translation of the MDCO. Methods: Fifteen above knee, fresh-frozen, matched pair cadaveric specimens (30 limbs) were randomized equally into three groups. Calcanealosteotomies were performed, followed by manual 10 mm medial translation of the tuberosity. Two parallel 2.5mm guide wires were advanced across the osteotomy site under fluoroscopy. The first group involved a ‘staggered’ drilling technique in which one guide wire was over drilled to the osteotomy site with a 4.5mm cannulated drill and then a 7.0 mm cannulated screw was placed across the osteotomy, followed by a second screw in similar fashion. The second, ‘simultaneous’ group consisted of over drilling both guide wires sequentially followed by placement of both screws. The third control group involved simultaneously over drilling only the near cortex, followed by placement of the 2 screws. Following screw fixation, the calcaneal tuberosity was manually translated in a lateral direction. The loss of correction was then marked and measured in millimeters. Results: All thirty cadaveric specimens underwent standard medializing calcaneal displacement osteotomy without significant variation, or complication. Loss of medialization was measured in millimeters following a manual lateral displacing force after the screw fixation of the osteotomy. The ‘simultaneous’ drilling group experienced the greatest loss of medial displacement with the mean loss of correction being 2.6 mm (range 1.37 - 3.48 mm) following manual lateral translation. The ‘staggered’ group showed an average loss of 1.16 mm (range 0.36 - 2.67 mm). The control group, that simply involved drilling of the near cortex, demonstrated the greatest maintenance of medial displacement with a mean loss of only 0.036 mm (range 0.01 - 0.06 mm). Conclusion: Our cadaveric study comparing three different drilling techniques for maintaining the intended correction following MDCO demonstrates that simultaneous over drilling of only the tuberosity near cortex prior to screw fixation was the most resistant to loss of medial displacement; whereas mean loss of correction with simultaneous drilling of both wires to the osteotomy resulted in the greatest loss of correction at an average of 26%.

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