Percutaneous Posterior to Anterior Screw Fixation of the Talar Neck

Category: Trauma Introduction/Purpose: Fractures of the talar neck and body can be fixed with percutaneously placed screws directed from anterior to posterior or posterior to anterior. The latter has been found to be biomechanically and anatomically superior. Percutaneous pin and screw placement poses anatomic risks for posterolateral and posteromedial neurovascular and tendinous structures. The objective of this study was to enumerate the number of trials for proper placement of two parallel screws and to determine the injury rate to neurovascular and tendinous structures. Methods: Eleven fresh frozen cadaver limbs were used. 2.0 mm guide wires from the Stryker (Selzach, Switzerland) 5.0-mm headless cannulated set were percutaneously placed (under fluoroscopic guidance) into the distal posterolateral aspect of the ankle. All surgical procedures were performed by a fellowship-trained foot and ankle surgeon. Malpositioned pins were left intact to allow later assessment of soft tissue injury. The number of guide wires needed to achieve an acceptable positioning of the implant was noted. Acceptable positioning was defined as in line with the talar neck axis in both AP and lateral fluoroscopic views. After a layered dissection from the skin to the tibia, we evaluated neurovascular and tendinous injuries, and measured the shortest distance between the closest guide pin and the soft tissue structures, using a precision digital caliper. Results: The mean number of guide wires needed to achieve acceptable positioning for 2 parallel screws was 2.91 ± 0.70 (range, 2 - 5). The mean distances between the closest guide pin and the soft tissue structures of interest were: Achilles tendon, 0.53 ± 0.94 mm; flexor hallucis longus tendon, 6.62 ± 3.24 mm; peroneal tendons, 7.51 ± 2.92 mm; and posteromedial neurovascular bundle, 11.73 ± 3.48 mm. The sural bundle was injured in all the specimens, with 8/11 (72.7%) in direct contact with the guide pin and 3/11 (17.3%) having been transected. The peroneal tendons were transected in 1/11 (9%) of the specimens. The Achilles tendon was in contact with the guide pin in 6/11 (54.5%) specimens and transected in 2/11 (18.2%) specimens. Conclusion: The placement of posterior to anterior percutaneous screws for talar neck fixation is technically demanding and multiple guide pins are needed. Our cadaveric study showed that important tendinous and neurovascular structures are in close proximity with the guide pins and that the sural bundle was injured in 100% of the cases. We advise performing a formal small posterolateral approach for proper visualization and retraction of structures at risk. Regardless, adequate patient education about the high risk of injury from this procedure is crucial.

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Comparing Soft Tissue Injury Rate Using the Functional Movement Screen in Division I Football Players

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000485308.93167.37 ◽

2016 ◽

Vol 48 ◽

pp. 101

Author(s):

Kurt W. McDowell ◽

Alan B. Miller ◽

Ryan J. Johnson ◽

Ben M. Fox ◽

Ben Krueger ◽

...

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Injury Rate ◽

Division I ◽

Football Players ◽

Functional Movement Screen ◽

Functional Movement ◽

Division I Football

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Checkrein Deformity of the Hallux and Second Toe after Soft-Tissue Injury

Case Reports in Orthopedics ◽

10.1155/2021/8459586 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

J. R. Rodriguez-Collell ◽

D. Mifsut-Miedes

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Plantar Flexion ◽

Soft Tissue Injury ◽

Rehabilitation Program ◽

Flexor Hallucis Longus ◽

Bone Injury ◽

Mri Study ◽

Tissue Trauma ◽

Second Toe

We report the case of a patient who developed a checkrein deformity of the hallux and of the second toe following a direct soft tissue trauma to his right leg, with no associated fracture. This dynamic deformity caused the patient significant trouble walking and prevented him from playing any sport as in the stance phase of gait the toes were forced into maximum plantar flexion and ended up trapped under the foot. An MRI study did not show any bone injury or tendinous tethering. So the cause could be a subclinical compartment syndrome. Treatment consisted of a z-plasty and application of a pulvertaft suture to the flexor hallucis longus. Following a short rehabilitation program (2 weeks), the patient made a full recovery.

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Bilateral Gastrocnemius Flap For Harlequin Defects Around The Knee

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v6i1.272 ◽

2020 ◽

Vol 6 (1) ◽

pp. 248-253

Author(s):

Tarun Chabra ◽

Venkatramani Hari ◽

Sabapathy SR

Keyword(s):

Soft Tissue ◽

Proximal Tibia ◽

Tissue Injury ◽

Soft Tissue Injury ◽

High Energy ◽

Tissue Loss ◽

Lateral Side ◽

Gastrocnemius Flap ◽

Schatzker Type ◽

The Mean

Background : Tibial plateau fractures (especially bicondylar Schatzker type 5 and type 6) are a result of high energy trauma. Along with bony component, soft tissue injury is a major determinant in the treatment and final outcome. Bicondylar fractures needs bicolumnar fixation and as such require separate approaches: postero-medial and lateral incisions. The soft tissue of the proximal tibia swells significantly after the injury, coupled with extensive soft tissue dissection during fixation this can lead to subsequent wound breakdown and infection along either side of the proximal tibia which resembles “harlequin eyes”. This study describes outcome of management of post operative soft tissue complications following bicolumnar fixation of proximal tibia with medial and lateral gastrocnemius flap. Method : Three patients who had bilateral soft tissue necrosis at surgical incision sites treated with debridement and bilateral gastrocnemius flaps between January 2016 and December 2017 were included in this study. The mean age was 38 years (range 18–50 years) and the mean duration of follow-up was 10 months. Outcome assessments included the condition of the flap and fracture healing time. Result : All fractures united after surgery. There were no soft tissue complications and all flaps healed well. The mean bony union time was 6 months. Conclusion: Our technique of covering soft tissue loss at surgical site on medial and lateral side of proximal tibia with bilateral gastrocnemius flap in the same setting is a reliable and safe surgical method for these conditions.

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Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

10.21203/rs.3.rs-41966/v1 ◽

2020 ◽

Author(s):

Jiazhao Yang ◽

Wanbo Zhu ◽

Qirong Dong

Keyword(s):

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

High Energy ◽

Study Data ◽

Fracture Site ◽

Tibial Fractures ◽

Early Complications ◽

The Mean ◽

Staged Treatment

Abstract Background and Objective: Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment. However, early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed. This study aimed to analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.Materials and Methods: A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a level-1 trauma center from 2014 to 2018 were enrolled in this retrospective study. Data regarding the demographic information, Tscherne soft tissue injury, fracture site, entry point placement, and duration of traction were recorded. Procedure-related complications such as movement and sensation disorder, vessel injury, discharge, infection, loosening, and iatrogenic fracture were analyzed.Results: The mean patient age was 42.5 (18–71) years and the mean duration of traction was 7.5 (0–26) days. In total, 19 (4.7%) patients presented with procedure-related complications, including technique-associated complications in 6 patients and nursing-associated complications in 13. Differences in the incidence of complications with respect to sex, affected side, soft tissue injury classification, and fracture sites were not observed. However, the number of complications due to hammer insertions was significantly fewer than those due to drill insertions (2.9% vs. 7.4%).Conclusion: The application of preoperative external traction fixation had been proved to be an ideal alternative treatment for high energy tibial fractures. In this study, we found the incidence of early complications of the fixation is low, and it is not significantly associated with the severity of soft tissue injury and fracture site. Although relatively rough and more likely to cause pain, complications of hammer insertions were significantly fewer than drill insertions. The possible reason was higher probability of heat damage and loosening by drilling.

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