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

2018 ◽  
Vol 39 (12) ◽  
pp. 1497-1501 ◽  
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.

scholarly journals Minimally Invasive Dorsal Cheilectomy of the first metatarsal

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0048
Author(s):  
Kar Teoh ◽  
Kartik Hariharan
Keyword(s):  
High Risk ◽  
Minimally Invasive ◽  
Open Approach ◽  
First Metatarsal ◽  
Fresh Frozen ◽  
Stab Incision ◽  
Risk Situation ◽  
High Risk Situation ◽  
Relationship Of ◽  
The Relationship

Category: Other Introduction/Purpose: Traditionally, a dorsal cheilectomy of the first metatarsophalangeal (MTP) joint is performed with an open approach through a dorsomedial or midmedial incision. It is now possible to perform minimally invasive dorsal cheilectomy (MIDC) of the first metatarsal with a wedge burr. The stab incision for MIDC needs to be dorsomedial to allow an ergonomic sweeping movement of the burr. This potentially puts the dorsomedial cutaneous nerve (DMCN) to the hallux at risk. There have been no clinical or cadaveric studies to date quantifying the risk to the DMCN and the surrounding structures when a Wedge burr was used for MIDC. We aim to determine this by using fresh-frozen cadaveric specimens in a “high-risk” situation in which most of the surgeons were novices to the technique. Methods: A total of 13 fresh-frozen cadaveric specimens (7 right, 6 left) amputated below the knee were obtained for this study. 13 foot and ankle surgeons (2 left handed, 11 right handed) who had no or minimal experience in MI surgery participated in this study. After a demonstration by an experienced MI surgeon and a practice on sawbones by participants, each surgeon performed a MIDC over the first metatarsal. Fluoroscopic guidance was available throughout the procedure. After the procedure, the specimens were dissected and the DMCN and the extensor hallucis longus (EHL) were inspected for damage. The same dissection steps were used for each specimen. The relationship of the DMCN to landmarks were measured. All measurements were made to the nearest millimetre. Results: Dissection of the specimens revealed that the DMCN to the hallux was cut completely in two specimens (15%). All the EHL tendon were intact, although in one specimen, the tendon showed some fraying on the underside of the tendon, estimated to be 15%. The average distance of the stab incision from the first MTP joint was 17.7 (range: 10 – 23) mm. In terms of the relationship of the DMCN to the stab incision in specimens where the DMCN was not cut, the DMCN was superior in five specimens and inferior in six specimens. The distance of the DMCN to the incision was 3.8 (range: 0 -7) mm. Conclusion: The DMCN to the hallux has been well studied by several authors and has a variable course. This nerve is at high risk of being damaged with open surgery and is a commonly reported complication of surgery to the hallux with rates reportedly as high as 45%. This nerve was damaged in 15% of our specimens following MIDC in a “high-risk” situation. Patients need to be specifically made aware of this risk when being consented for surgery. A carefully made working capsular pocket for the burr and marking this nerve before placing the incision if palpable could mitigate this risk.

The Hallux Metatarsophalangeal Capsule: An Anatomic Study With Respect to Percutaneous Hallux Valgus Correction

2021 ◽  
pp. 107110072110272
Author(s):  
Kenneth M. Chin ◽  
Nicholas S. Richardson ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
Matthew W. Christian ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Cadaveric Study ◽  
Anatomic Study ◽  
Orthopedic Surgeons ◽  
Popular Knowledge ◽  
Fresh Frozen ◽  
The Mean ◽  
Anatomic Relationship

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.

The anatomical relationship of the diaphragm to the thoracolumbar junction during the minimally invasive lateral extracoelomic (retropleural/retroperitoneal) approach

2012 ◽  
Vol 16 (4) ◽  
pp. 359-364 ◽  
Author(s):  
Elias Dakwar ◽  
Amir Ahmadian ◽  
Juan S. Uribe
Keyword(s):  
Minimally Invasive ◽  
Thoracolumbar Spine ◽  
Transverse Process ◽  
Lateral Approach ◽  
Thoracolumbar Junction ◽  
Specific Reference ◽  
Fresh Frozen ◽  
Anatomical Relationship ◽  
Thoracic And Abdominal ◽  
Relationship Of

Object The thoracolumbar junction (T11–L2) poses an anatomical dilemma, given the presence of the lower rib cage and the diaphragm when performing anterolateral approaches. To circumvent dealing with the diaphragm, a minimally invasive lateral extracoelomic approach has been used to approach the thoracolumbar junction by mobilizing the diaphragm anteriorly. No anatomical studies have described the attachments of the diaphragm and their surgical significance during the lateral approach to the thoracolumbar spine. The objective of this study is to describe the anatomical relationship of the diaphragm in reference to the minimally invasive lateral approach to the thoracolumbar spine and its surgical significance. Methods Nine adult fresh-frozen cadaveric specimens were dissected and studied (18 sides). All specimens were placed in the lateral decubitus position, similar to the surgical technique, for the dissections. The relationship between the retroperitoneum, retropleural space, diaphragm, and thoracolumbar spine was analyzed in reference to the minimally invasive lateral approach. Special attention was given to the attachments of the diaphragm and their relationship to the ribs during the early stages of the approach. Results All 18 sides were successfully dissected, analyzed, and photographed. The diaphragm is a musculotendinous sheet extending between the thoracic and abdominal cavities. Its attachments can be divided into 3 main categories: 1) sternal or anterior, 2) costal or lateral, and 3) lumbar or posterior. These attachments are described in detail, with specific reference to the lateral approach. When performing the minimally invasive lateral extracoelomic approach to the thoracolumbar spine, the lateral and posterior attachments must be identified and dissected to successfully mobilize the diaphragm anteriorly. Conclusions The diaphragm has multiple attachments that can be categorized as anterior, lateral, and posterior. In reference to the minimally invasive lateral extracoelomic approach to the thoracolumbar junction, the surgically significant attachments are primarily to the 12th rib and transverse process of L-1.

scholarly journals Cavus Foot Correction Using a Full Percutaneous Procedure: A Case Series

2021 ◽  
Vol 18 (19) ◽  
pp. 10089
Author(s):  
Rodrigo Schroll Astolfi ◽  
José Victor de Vasconcelos Coelho ◽  
Henrique César Temóteo Ribeiro ◽  
Alexandre Leme Godoy dos Santos ◽  
José A. Dias Leite
Keyword(s):  
Minimally Invasive ◽  
Bone Healing ◽  
Weight Bearing ◽  
Wound Complications ◽  
Invasive Technique ◽  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
First Metatarsal ◽  
Closing Wedge ◽  
Cavus Foot

Cavus foot is a tri-planar deformity that requires correction in several bones and soft tissue. Minimally invasive surgeries are less aggressive, faster and easier to recover from. Here, we describe the initial results of a technique for percutaneous cavus foot correction. The procedure consists of calcaneal dorsal/lateral closing wedge osteotomy (with fixation), cuboid, medial cuneiform and first metatarsal closing wedge osteotomy (without fixation), and plantar fascia and tibialis posterior tenotomy with the patient in the prone position. Immediate weight bearing is permitted. Twenty patients were selected to undergo the procedure. The mean follow-up was 4.2 months and mean age 42.3 years. Eight of the 20 patients were submitted to cuboid and first metatarsal osteotomy, and 12 (60%) only calcaneal osteotomy. The median time for complete bone healing was 2.2 months. No wound complications were observed. No cases of non-consolidation of the cuboid or first metatarsal osteotomies were detected. The most common complication was sural nerve paresthesia. This is the first description of cavus foot correction using a minimally invasive technique. Complete bone healing is obtained even with immediate weight bearing and without cuboid and first metatarsal fixation.

An Anatomic Study of the Percutaneous Endoscopically Assisted Calcaneal Osteotomy Technique to Correct Hindfoot Malalignment

2016 ◽  
Vol 38 (2) ◽  
pp. 192-199 ◽  
Author(s):  
Andrea Veljkovic ◽  
Joshua Tennant ◽  
Chamnanni Rungprai ◽  
Kaniza Zahra Abbas ◽  
Phinit Phisitkul
Keyword(s):  
Minimally Invasive ◽  
Open Surgery ◽  
Invasive Technique ◽  
Surgical Incision ◽  
Calcaneal Osteotomy ◽  
Osteotomy Technique ◽  
Fresh Frozen ◽  
Wound Healing Problems ◽  
Potential Risks ◽  
Invasive Techniques

Background: Open calcaneal osteotomy using traditional methods is associated with complications such as sural nerve injury and potential wound healing problems. We hypothesized that by using novel minimally invasive techniques, these potential risks could be mitigated. This anatomic cadaveric study serves to assess the safety of percutaneous endoscopically assisted calcaneal osteotomy (PECO) compared to a traditional open osteotomy technique. Methods: Anatomic safety of PECO was assessed using 8 fresh-frozen cadaver below-knee specimens. Lateral calcaneal nerve (LCN) damage was primarily noted and then secondly compared to a potential open surgical incision approach. Results: Only 1 of 11 LCN branches (n = 8 limbs) was transected using PECO, compared to up to 8 of 10 LCN branches (n = 6 limbs) that potentially would have been injured during open surgery. Conclusions: Percutaneous endoscopically assisted calcaneal osteotomy is a minimally invasive technique that had fewer nerve injuries in this cadaveric model than traditional open surgery. Clinical Relevance: Percutaneous endoscopically assisted calcaneal osteotomy due to its less invasive nature may result in fewer neurovascular injuries relative to an open procedure.

Endoscopic Plantar Fascia Release: An Anatomical Study

1995 ◽  
Vol 16 (11) ◽  
pp. 719-723 ◽  
Author(s):  
Eric P. Hofmeister ◽  
Michael J. Elliott ◽  
Paul J. Juliano
Keyword(s):  
Average Distance ◽  
Anatomical Study ◽  
Plantar Fascia ◽  
Average Amount ◽  
Lateral Plantar Nerve ◽  
Flexor Digitorum Brevis ◽  
Fresh Frozen ◽  
Abductor Digiti Minimi ◽  
Relationship Of ◽  
Neurovascular Structures

The anatomical relationship of neurovascular structures to the plantar fascia after endoscopic fasciotomy was studied in 13 adult fresh-frozen cadaver feet. Using a single portal technique, an endoscopic system was placed into the plantar compartment through a 1-cm medial incision. Under direct endoscopic visualization, the plantar fascia was released. The feet were then dissected and the anatomic relationship of the neurovascular structures to the area of release was studied. The average amount of plantar fascia released was 81%. The average distance of the release to the lateral plantar nerve, and the nerve to the abductor digiti minimi was 10.5 and 12.3 mm, respectively. The flexor digitorum brevis muscle was partially transected in 46% of the cases, and the average amount of muscle transected was 0.8 mm. The endoscopic approach to the release of the plantar fascia provides adequate release and does not appear to pose any danger to underlying neurovascular structures.

In Vitro Determination of Midfoot Motion

Foot & Ankle ◽  
1989 ◽  
Vol 10 (3) ◽  
pp. 140-146 ◽  
Author(s):  
Tye J. Ouzounian ◽  
Michael J. Shereff
Keyword(s):  
Dimensional Space ◽  
Plantar Flexion ◽  
Three Dimensional ◽  
First Metatarsal ◽  
Below The Knee ◽  
Medial Cuneiform ◽  
Second Metatarsal ◽  
Fresh Frozen ◽  
Vitro Model

Midfoot motion was determined using an in vitro model. Ten fresh-frozen below-the-knee amputation specimens were instrumented by inserting reference pins into each of the bones of the hindfoot, midfoot and metatarsals. Dorsiflexion-plantar flexion and supination-pronation were simulated and the reference pin location in three dimensional space was determined. Comparing the location of the reference pins at each simulated position, motion was determined. Motion occurring through each articulation (dorsiflexion-plantar flexion/supination-pronation) in degrees was: talonavicular (7.0/17.7), calcaneocuboid (2.3/ 7.3), naviculo-medial cuneiform (5.0/7.3), naviculo-middle cuneiform (5.2/3.5), naviculo-lateral cuneiform (2.6/2.1), medial cuneiform-first metatarsal (3.5/1.5), middle cuneiform-second metatarsal (0.6/1.2), lateral cuneiform-third metatarsal (1.6/2.6), cuboid-fourth metatarsal (9.6/11.1), and cuboid-fifth metatarsal (10.2/9.0).

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