scholarly journals Medial Structure Injury During Suture Button Insertion Utilizing “Center-Center” Technique for Syndesmotic Stabilization

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0010
Author(s):  
Christopher Reb ◽  
Roberto Brandao ◽  
Bryan Van Dyke ◽  
Gregory Berlet ◽  
Mark Prissel
Keyword(s):  
Saphenous Vein ◽  
Drill Hole ◽  
Saphenous Nerve ◽  
Posterior Tibial Tendon ◽  
Reliable Technique ◽  
Anatomic Structure ◽  
Suture Button ◽  
Posterior Tibial ◽  
Anterior Tibial ◽  
Anterior Tibial Tendon

Category: Ankle Introduction/Purpose: The “Center-Center” technique for syndesmosis fixation has been described as an improved and reliable technique for proper reduction of the syndesmosis during ankle fracture repair. Concurrently, the use of a flexible suture button is becoming an established means of syndesmotic stabilization. The purpose of this cadaveric study was to assess for medial structure injury during the placement of a suture button utilizing the “Center-Center” technique for ankle syndesmotic repair at 3 insertion intervals. Methods: Simulated open syndesmosis repair was performed on 10 cadaveric specimens. Three intervals were measured at 10 mm, 20 mm, and 30 mm proximal to the level of the distal tibial articular surface along the fibula. Proper longitudinal alignment of the “Center-Center” technique was completed under fluoroscopic guidance and was marked on the medial aspect of the tibia. The 3 intervals were drilled in the appropriate technique trajectory. The suture button was passed through each drill-hole interval. Using a digital caliper, the distance was measured from each suture button aperture with respect to the anterior tibial tendon, posterior tibial tendon, greater saphenous vein and nerve by single observer. Results: The average distance from the suture button to each anatomic structure was -2.61 ± 3.75 mm for the greater saphenous vein, -3.44 ± 6.82 mm for the saphenous nerve, 15.09 ± 4.02 mm for the anterior tibial tendon, and -21.70 ± 4.89 mm for the posterior tibial tendon. Direct impingement of the greater saphenous vein was seen in 11/30 (36.6%) interval measurements. Six of the 11 (54.5%) entrapment intervals occurred at the 10 mm drill hole. Conclusion: The results of the present study suggest the use of the “Center-Center” technique for syndesmotic repair with suture button application does involve risk of injury to the greater saphenous vein and saphenous nerve. These injuries could manifest as persistent lower extremity edema and paresthesias for injury to the saphenous vein and nerve respectively. The “Center-Center” technique with suture button fixation may warrant a minimal medial open dissection, prior to quadricortical drilling, for optimal placement to prevent neurovascular injury.

scholarly journals Anterior Tibial Tendon Side-to-Side Tenorrhaphy after Posterior Tibial Tendon Transfer: A Technique to Improve Reliability in Drop Foot after Common Peroneal Nerve Injury

2021 ◽  
Author(s):  
Miguel Estuardo Rodríguez-Argueta ◽  
Carlos Suarez-Ahedo ◽  
César Alejandro Jiménez-Aroche ◽  
Irene Rodríguez-Santamaria ◽  
Francisco Javier Pérez-Jiménez ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Tendon Transfer ◽  
Common Peroneal Nerve ◽  
Posterior Tibial Tendon ◽  
Drop Foot ◽  
Posterior Tibial ◽  
Anterior Tibial ◽  
Anterior Tibial Tendon ◽  
Peroneal Nerve Injury ◽  
Improve Reliability

Combined Rupture of the Anterior Tibial and Posterior Tibial Tendons: A New Clinical Entity

1994 ◽  
Vol 15 (9) ◽  
pp. 508-511 ◽  
Author(s):  
Tye J. Ouzounian
Keyword(s):  
Severe Pain ◽  
Tendon Rupture ◽  
Elderly Women ◽  
Valgus Deformity ◽  
Clinical Entity ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial ◽  
Anterior Tibial ◽  
Anterior Tibial Tendon ◽  
Significant Clinical Improvement

Two patients with combined rupture of the anterior tibial tendon and posterior tibial tendon are described. Both were elderly women with a gradually progressive valgus deformity of the ankle/hindfoot and severe pain. Arthrodesis procedures were performed in both patients; however, postoperative complications prevented significant clinical improvement. This combined tendon rupture is presented to document a new clinical entity.

Medial Structure Injury During Suture Button Insertion Using the Center-Center Technique for Syndesmotic Stabilization

2018 ◽  
Vol 39 (8) ◽  
pp. 984-989 ◽  
Author(s):  
Christopher W. Reb ◽  
Roberto A. Brandão ◽  
B. Collier Watson ◽  
Bryan Van Dyke ◽  
Gregory C. Berlet ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Articular Surface ◽  
Drill Hole ◽  
Fracture Repair ◽  
Tibialis Posterior ◽  
Reliable Technique ◽  
Suture Button ◽  
Ankle Anatomy ◽  
Digital Caliper ◽  
Cadaveric Model

Background: The center-center technique for syndesmosis fixation has been described as an improved and reliable technique for proper reduction of the syndesmosis during ankle fracture repair. Concurrently, the use of flexible fixation with a suture button is becoming an established means of syndesmosis stabilization. The purpose of this cadaveric study was to assess for medial structure injury during the placement of a suture button using the center-center technique for ankle syndesmosis repair at 3 insertion intervals. Methods: Simulated open syndesmosis repair was performed on 10 cadaveric specimens. Three intervals were measured at 10 mm, 20 mm, and 30 mm proximal to the level of the distal tibial articular surface along the fibula. Proper longitudinal alignment of the center-center technique was completed under fluoroscopic guidance and was marked on the medial aspect of the tibia. The 3 intervals were drilled in the appropriate technique trajectory. The suture button was subsequently passed through each drill-hole interval. A single observer used a digital caliper to measure the distance from each suture button aperture with respect to the tibialis anterior tendon, tibialis posterior tendon, and greater saphenous vein and nerve. Results: A total of 30 interval measurements (10 cadavers with 3 suture button segments each) were used for data analysis. Direct impingement on the greater saphenous vein was seen in 11 of 30 (36.6%) interval measurements. Six of the 11 (54.5%) observed saphenous structure impingement events occurred at the 10-mm drill hole. Conclusion: The results of the present study suggest that the use of the center-center technique for syndesmosis repair with suture button fixation risks preventable injury to the greater saphenous neurovasculature. Clinical Relevance: To understand the medial ankle anatomy, as it pertains to insertion of flexible syndesmotic fixation in a cadaveric model, to aid in prevention of clinical iatrogenic injury.

Syndesmotic Fixation With Suture Button: Neurovascular Structures at Risk: A Cadaver Study

2019 ◽  
Vol 13 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Eva J. Lehtonen ◽  
Martim C. Pinto ◽  
Harshadkumar A. Patel ◽  
Nicholas Dahlgren ◽  
Eildar Abyar ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Cadaver Study ◽  
Saphenous Nerve ◽  
Nerve Branch ◽  
Suture Button ◽  
Level Ii ◽  
Direct Injury ◽  
Prospective Comparative Study ◽  
Neurovascular Structures ◽  
Respective Rate

Objectives: The objective of this study was to describe the anatomic variations in the saphenous nerve and risk of direct injury to the saphenous nerve and greater saphenous vein during syndesmotic suture button fixation. Methods: Under fluoroscopic guidance, syndesmotic suture buttons were placed from lateral to medial at 1, 2, and 3 cm above the tibial plafond on 10 below-knee cadaver leg specimens. The distance and position of each button from the greater saphenous vein and saphenous nerve were evaluated. Results: The mean distance of the saphenous nerve to the suture buttons at 1, 2, and 3 cm were 7.1 ± 5.6, 6.5 ± 4.6, and 6.1 ± 4.2, respectively. Respective rate of nerve compression was as follows, 20% at 1 cm, 20% at 2 cm, and 10% at 3 cm. Mean distance of the greater saphenous vein from the suture buttons at 1, 2, and 3 cm was 8.6 ± 7.1, 9.1 ± 5.3, and 7.9 ± 4.9 mm, respectively. Respective rate of vein compression was 20%, 10%, and 10%. A single nerve branch was identified in 7 specimens, and 2 branches were identified in 3 specimens. Conclusion: There was at least one case of injury to the saphenous vein and nerve at every level of button insertion at a rate of 10% to 20%. Neurovascular injury may occur despite vigilant use of fluoroscopy and adequate surgical technique. Further investigation into the use of direct medial visualization of these high-risk structures should be done to minimize the risk. Levels of Evidence: Therapeutic, Level II: Prospective, comparative study

The Bridle Procedure in the Treatment of Paralysis of the Foot

Foot & Ankle ◽  
1992 ◽  
Vol 13 (2) ◽  
pp. 63-69 ◽  
Author(s):  
Raoul P. Rodriguez
Keyword(s):  
Peroneal Nerve ◽  
Tendon Transfer ◽  
Nerve Palsy ◽  
Valgus Deformity ◽  
Lateral Malleolus ◽  
Posterior Tibial Tendon ◽  
Peroneal Nerve Palsy ◽  
Peroneus Longus ◽  
Posterior Tibial ◽  
Anterior Tibial

The Bridle procedure consists of a posterior tibial tendon transfer through the interosseous membrane to the dorsum of the foot with a dual anastomosis to the tendon of the anterior tibial and a rerouted peroneus longus in front of the lateral malleolus. This procedure is performed to restore loss of dorsiflexion and to balance the foot, preventing a secondary varus or valgus deformity. The procedure was performed in 10 patients with 11 feet with paralysis of dorsiflexion of the foot. All are brace-free. The results are better in patients with peroneal nerve palsy secondary to trauma.

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