scholarly journals The Distribution Pattern of the Neurovascular Structures for Anterior Ankle Arthroscopy to Minimize Structural Injury: Anatomical Study

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Anna Jeon ◽  
Chang Min Seo ◽  
Je-Hun Lee ◽  
Seung-Ho Han
Keyword(s):  
Anatomical Study ◽  
Ankle Arthroscopy ◽  
Lateral Malleolus ◽  
Reference Line ◽  
Medial Malleolus ◽  
Entry Points ◽  
Structural Injury ◽  
Age Range ◽  
Arteries And Veins ◽  
Neurovascular Structures

Introduction. The aim of this study was to investigate entry points for anterior ankle arthroscopy that would minimize the risk of neurovascular injury. Methods. Thirty-eight specimens from 21 Korean cadavers (age range from 43 to 92 years, mean age of 62.3 years) were used for the study. For the measurements, the most prominent points of the lateral malleolus (LM) and the medial malleolus (MM) were identified before dissection. A line connecting the LM and MM, known as the intermalleolar line, was used as a reference line. We measured 14 variables passed on the reference line. Results. This study found that the nerves were located at 40.0%, 50.0%, and 82.0% of the reference line from the lateral malleolus. We also found that the arteries were located at 22.0%, 35.0%, and 60% of the reference line from the lateral malleolus. Discussion. If all the variables are combined (nerves, arteries, and veins), then there is no safety zone for anterior portal placement. Therefore, we recommend that surgeons concentrate primarily on the arteries and nerves in the clinical setting.

scholarly journals Incidence of Chondral and Osteochondral Lesions in Ankle Fracture Patients Identified with Ankle Arthroscopy Following Rotational Ankle Fracture

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0049
Author(s):  
Emilie Williamson ◽  
Kevin Rosas ◽  
John Dankert ◽  
James P. Toale ◽  
Eoghan T. Hurley ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Ankle Arthroscopy ◽  
Chondral Lesion ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Medial Malleolus ◽  
Fracture Type ◽  
Malleolar Fracture ◽  
Chondral Lesions ◽  
Chondral Injury

Category: Ankle; Trauma Introduction/Purpose: It is controversial whether routine arthroscopy is beneficial at the time of ankle fracture fixation. This may be, in part, due to sparse information regarding the incidence of chondral injury in the setting of ankle fractures.The purpose of this study is to systematically review the incidence of chondral injures in patients with ankle fractures and to further characterize intra-articular chondral injuries of the talus, tibial plafond, medial malleolus, and lateral malleolus in patients who undergo ankle arthroscopy following an ankle fracture. Methods: The literature search was performed based on the PRISMA guidelines. Studies evaluating the incidence of chondral lesions at the time of arthroscopy for ankle fractures were included. The incidence of intraarticular chondral lesions was recorded, as well as location within the ankle, ankle fracture type, time of arthroscopy, characterization of chondral injury, complications, and outcome if available. All statistical analyses were carried out with statistical software package SPSS 24.0 (SPSS, Chicago, IL, USA). Multiple comparisons were used to compare incidence rates of chondral injury based on Weber classification, malleolar fracture type, and Lauge-Hansen classification, using Pearson chi-square test. For all analyses, p < 0.05 was considered statistically significant. Results: Fifteen studies with 1,355 ankle fractures were included. Of those ankles, 738 demonstrated evidence of chondral or osteochondral lesion (54.5%). Overall, 648 ankles had chondral lesions on the talus (47.8%), 207 ankles had lesions on the tibial plafond (15.3%), 165 has lesions of the lateral malleolus (12.2%), and 133 had lesions of the medial malleolus (9.8%). Weber C group had significantly higher incidence than Weber A group (p=0.015). Trimalleolar and isolated lateral malleolar fracture groups had significantly higher incidence of chondral injury than bimalleolar and isolated medial malleolar fracture groups (p<0.001). A significant difference was found in occurrence rate of chondral injury among Lauge-Hansen classification, with supination-adduction having the lowest incidence (p=0.001). Conclusion: Our study found a high incidence of intra-articular chondral lesion in the setting of ankle fractures as demonstrated by arthroscopy, with more than half of all patients having a chondral lesion. Talar lesions were most common. This study may help direct greater attention to the Talus as a source of chondral injury particularly in higher grade fracture patterns.

scholarly journals Cadaveric anatomical study of anterior and posterior ankle arthroscopic portals in ankle plantarflexion and dorsiflexion positions

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0049
Author(s):  
Ichiro Tonogai
Keyword(s):  
Great Saphenous Vein ◽  
Anatomical Study ◽  
Posterior Tibial Artery ◽  
Ankle Dorsiflexion ◽  
Ankle Arthroscopy ◽  
Invasive Technique ◽  
Foot And Ankle ◽  
Posterior Ankle Arthroscopy ◽  
The Mean ◽  
Neurovascular Structures

Category: Arthroscopy Introduction/Purpose: Arthroscopy of the foot and ankle, which is minimally invasive technique, is able to be used in the treatment of various foot and ankle pathologies. However, complications after anterior or posterior ankle arthroscopies have been described, such as neurovascular structures injury around portals. On the other hand, plantarflexion and dorsiflexion of the ankle joint leads movement of the neurovascular structures. However, there were a few reports about the change of the distance between each portal and nerves or vessels during motion of the ankle. The purpose of this study was to evaluate the distance between each anterior or posterior portal and neurovascular structures, to elucidate the change of the distance between each portal and neurovascular structures in ankle plantarflexion and dorsiflexion positions. Methods: Six feet of 6 fresh cadavers (3 males and 3 females) were enrolled in this study. The mean age was 81.5 years. Standard antero-lateral (AL), antero-medial (AM), postero-lateral (PL) and postero-medial (PM) portals were identified using needles. Skin was dissected from the underlying soft tissue to visualize neurovascular structures clearly as little as possible. The distances were assessed in ankle plantarflexion position and dorsiflexion position, from AL portal to superficial peroneal nerve (SPN), from AM portal to saphenous nerve (SpN), great saphenous vein (SpV), from PL portal to sural nerve (SN) and lesser SpV, and from PM portal to flexor hallux longus, posterior tibial artery PTA and tibial nerve (TN). Results: SPN was the closest structure to any of the anterior portals (3.2 /8.3 mm in ankle plantarflexion position and 5.2 /10.8 mm in ankle dorsiflexion position from AL portal as Fig.1 was showing), followed by SpN in anterior ankle arthroscopy. Distances from SPN to AL portal, and from SpN and great SpV to AM portal increased with ankle dorsiflexion and decreased with plantarflexion. SN was the closest structure to any of the posterior portals (10.4 mm in ankle plantarflexion position and 8.5 mm in ankle dorsiflexion position from PL portal), followed by lesser SpV in posterior ankle arthroscopy. Distances from SN, SpN and lesser SpV to PL portal, and from FHL, PTA and TN to PM portal increased with ankle plantarflexion and decreased with dorsiflexion. Conclusion: Results of this study showed the distances from each anterior or posterior arthroscopic portal to neurovascular structures, and elucidated the change of the distances between each portal and neurovascular structures in ankle plantarflexion and dorsiflexion positons in ankle plantarflexion and dorsiflexion positions. The ankle dorsiflexion position for the standard AL and AM portals placement and the ankle plantarflexion position for PL and PM portals placement might be recommended. Results of this study might be useful to prevent injury to the neurovascular structures during anterior or posterior ankle arthroscopy.

Neurovascular structures adjacent to the lumbar intervertebral discs: an anatomical study of their morphometry and relationships

2011 ◽  
Vol 14 (5) ◽  
pp. 630-638 ◽  
Author(s):  
Mehmet Arslan ◽  
Ayhan Cömert ◽  
Halil İbrahim Açar ◽  
Mevci Özdemir ◽  
Alaittin Elhan ◽  
...  
Keyword(s):  
Nerve Root ◽  
Lumbar Disc ◽  
Anatomical Study ◽  
Intervertebral Discs ◽  
Nerve Roots ◽  
Disc Space ◽  
Anatomical Knowledge ◽  
The Mean ◽  
The Right ◽  
Neurovascular Structures

Object Although infrequent, injury to adjacent neurovascular structures during posterior approaches to lumbar intervertebral discs can occur. A detailed anatomical knowledge of relationships may decrease surgical complications. Methods Ten formalin-fixed male cadavers were used for this study. Posterior exposure of the lumbar thecal sac, nerve roots, pedicles, and intervertebral discs was performed. To identify retroperitoneal structures at risk during posterior lumbar discectomy, a transabdominal retroperitoneal approach was performed, and observations were made. The distances between the posterior and anterior edges of the lumbar intervertebral discs were measured, and the relationships between the disc space, pedicle, and nerve root were evaluated. Results For right and left sides, the mean distance from the inferior pedicle to the disc gradually increased from L1–2 to L4–5 (range 2.7–3.8 mm and 2.9–4.5 mm for right and left side, respectively) and slightly decreased at L5–S1. For right and left sides, the mean distance from the superior pedicle to the disc was more or less the same for all disc spaces (range 9.3–11.6 mm and 8.2–10.5 mm for right and left, respectively). The right and left mean disc-to-root distance for the L3–4 to L5–S1 levels ranged from 8.3 to 22.1 mm and 7.2 to 20.6 mm, respectively. The root origin gradually increased from L-1 to L-5. The right and left nerve root–to-disc angle gradually decreased from L-3 to S-1 (range 105°–110.6° and 99°–108°). Disc heights gradually increased from L1–2 to L5–S1 (range 11.3–17.4 mm). The mean distance between the anterior and posterior borders of the intervertebral discs ranged from 39 to 46 mm for all levels. Conclusions To avoid neighboring neurovascular structures, instrumentation should not be inserted into the lumbar disc spaces more than 3 cm from their posterior edge. Accurate anatomical knowledge of the relationships of intervertebral discs to nerve roots is needed for spine surgeons.

scholarly journals Functional outcome of bimalleolar ankle fractures treated with fibular plate for lateral malleolus and C.C. screws for medial malleolus

2020 ◽  
Vol 6 (1) ◽  
pp. 1126-1132
Author(s):  
Dr. Sachin Kale ◽  
Dr. Pratik Tank ◽  
Dr. Rahul Ghodke ◽  
Dr. Pankaj Singh ◽  
Dr. Abhiraj Patel
Keyword(s):  
Functional Outcome ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Medial Malleolus

scholarly journals Change in Bone Mineral Density after Total Ankle Replacement: Two Year Follow Up

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0009
Author(s):  
Mohammad Alkhreisat ◽  
M Al-Maiyah ◽  
Jayasree Ramas Ramaskandhan ◽  
Andrea Pujol Nicolas ◽  
D Rawlings ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Stress Fracture ◽  
Bone Mineral ◽  
Total Ankle Replacement ◽  
Lateral Malleolus ◽  
Medial Malleolus ◽  
Specific Method ◽  
Mineral Density ◽  
Ankle Arthroplasty ◽  
Ankle Replacement

Category: Ankle, Ankle Arthritis Introduction/Purpose: Bone strength about the components is an important factor in Arthroplasty survival. This importance has been studied in total hip & knee replacement. However, there is paucity of literature Where little has been published regarding the quality of the bone and bone mineral content postoperatively surrounding Ankle Arthroplasty and circumstances surrounding the development of stress fracture. This prospective study used a method to quantify Bone Mineral Density BMD in different regions of the surrounding bones adjacent to tibia and talar components of uncemented Mobility ankle prosthesis, and to study the effect of loading on local ankle bone in the presence of un-cemented three components ankle replacement, by analyzing the BMD of the areas around tibia and talus before and after Mobility total ankle replacement. Methods: Twenty three Ankles (7Females, 15 Males) who underwent a Mobility Total Ankle Arthroplasty (TAA) between March 2008 and April 2009 were included prospectively in this study. They underwent a Bone Density Scan using the DEXA HOLIGIC Scanner with the specific method designed for measuring BMD. Seven areas (R1-R7) around the prosthesis were studied (Please see attached figure). Scans were carried out pre-operatively and repeated at 1 and 2 years post-operatively. The results were also compared with clinical outcomes, using (AOFAS scores) both pre, 1 and 2 years post-op. Results: Mean age of patients was 63.3 years (SD 9, range 43 to 80). AOFAS scores showed significant improvement (from 28.8 pre-op to 78.7,76.9 at 12 and 24 months post-op respectively; p<0.05). BMD within the lateral malleolus decreased significantly from 0.5g/cm2 to 0.42g/cm2 (17%, P < 0.01), at one and two years postoperatively - R2. There was an insignificant increase in Mean BMD at medial side metaphysis of tibia increased by,7% (+0.07 g cm -2, R6), but this just failed to reach statistical significance, mean BMD within medial malleolus decreased slightly from 0.67g/cm2 to 0.64 g/cm2 at the same period which was statistically insignificant. There was little insignificant increase in BMD in tibia just proximal to implant (R7) and at talus (R5). Conclusion: Stemmed implant causes changes in Tibial BMD around prosthesis. There was stress shielding over the lateral malleolus resulting in decrease BMD in lateral malleolus and to a lesser extent of the medial malleolus. The increase in BMD at tibial metaphysis indicates an increase in mechanical stresses at that region, which may explain occasional postoperative stress fracture of medial malleolus or medial sided ankle pain. There is no further change in BMD from year 1 to year 2 following TAR.

Endoscopic approach to colloid cyst: what is the optimal entry point and trajectory?

2014 ◽  
Vol 121 (4) ◽  
pp. 790-796 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Fangxiang Chen ◽  
Lawrence Choi ◽  
Justin C. Clark ◽  
Peter Nakaji
Keyword(s):  
Colloid Cyst ◽  
Mean Value ◽  
Entry Point ◽  
Preoperative Imaging ◽  
Target Point ◽  
Coronal Suture ◽  
Anatomical Structures ◽  
Entry Points ◽  
Stereotactic Navigation ◽  
Neurovascular Structures

Object An optimal entry point and trajectory for endoscopic colloid cyst (ECC) resection helps to protect important neurovascular structures. There is a large discrepancy in the entry point and trajectory in the neuroendoscopic literature. Methods Trajectory views from MRI or CT scans used for cranial image guidance in 39 patients who had undergone ECC resection between July 2004 and July 2010 were retrospectively evaluated. A target point of the colloid cyst was extended out to the scalp through a trajectory carefully observed in a 3D model to ensure that important anatomical structures were not violated. The relation of the entry point to the midline and coronal sutures was established. Entry point and trajectory were correlated with the ventricular size. Results The optimal entry point was situated 42.3 ± 11.7 mm away from the sagittal suture, ranging from 19.1 to 66.9 mm (median 41.4 mm) and 46.9 ± 5.7 mm anterior to the coronal suture, ranging from 36.4 to 60.5 mm (median 45.9 mm). The distance from the entry point to the target on the colloid cyst varied from 56.5 to 78.0 mm, with a mean value of 67.9 ± 4.8 mm (median 68.5 mm). Approximately 90% of the optimal entry points are located 40–60 mm in front of the coronal suture, whereas their perpendicular distance from the midline ranges from 19.1 to 66.9 mm. The location of the “ideal” entry points changes laterally from the midline as the ventricles change in size. Conclusions The results suggest that the optimal entry for ECC excision be located at 42.3 ± 11.7 mm perpendicular to the midline, and 46.9 ± 5.7 mm anterior to the coronal suture, but also that this point differs with the size of the ventricles. Intraoperative stereotactic navigation should be considered for all ECC procedures whenever it is available. The entry point should be estimated from the patient's own preoperative imaging studies if intraoperative neuronavigation is not available. An estimated entry point of 4 cm perpendicular to the midline and 4.5 cm anterior to the coronal suture is an acceptable alternative that can be used in patients with ventriculomegaly.

Feasible and Accurate Occipitoatlantal Transarticular Fixation: An Anatomic Study

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-173-ons-177 ◽  
Author(s):  
Mehmet Senoglu ◽  
Sam Safavi-Abbasi ◽  
Nicholas Theodore ◽  
Neil R. Crawford ◽  
Volker K.H. Sonntag
Keyword(s):  
Anatomical Study ◽  
Craniovertebral Junction ◽  
Screw Placement ◽  
Occipital Condyle ◽  
X Rays ◽  
Anatomic Study ◽  
Screw Insertion ◽  
Computed Tomographic ◽  
Entry Points ◽  
Transarticular Fixation

Abstract Background: Defining the anatomic zones for the placement of occiput-C1 transarticular screws is essential for patient safety. Objective: The feasibility and accuracy of occiput-C1 transarticular screw placement were evaluated in this anatomical study of normal cadaveric specimens. Material and Methods: Sixteen measurements were determined for screw entry points, trajectories, and lengths for placement of transarticular screws, as applied in the technique described by Grob, on the craniovertebral junction segments (occiput-C2) of 16 fresh human cadaveric cervical spines and 41 computed tomographic reconstructions of the craniovertebral junction. Acceptable angles for screw positioning were measured on digital x-rays. Results: All 32 screws were placed accurately. As determined by dissection of the specimens, none of the screws penetrated the spinal canal. Screw insertion caused no fractures, and the integrity of the hypoglossal canal was maintained in all the disarticulated specimens. Conclusion: Viable transarticular occiput-C1 screw placement is possible, despite variability of the anatomy of the occipital condyle.

Sign in / Sign up

Export Citation Format

Share Document