Anatomical Study of the Cuboid and Its Ligamentous Attachments and Its Implications for a Cuboid Osteotomy

Background: Lateral column lengthening (LCL) for flexible flatfoot is an effective surgery with powerful correction of deformity because it tightens only the lateral third of the long plantar ligament (LPL). However, LCL has been associated with joint damage at the osteotomy site and loss of foot flexibility owing to joint fixation. We focused on the cuboid and investigate a novel anatomical LCL osteotomy site that effectively tightens the LPL without damaging any joints. Methods: We studied 24 feet of 12 cadavers (mean age, 80.8 years). The lengths of the LPL and short plantar ligament, locations of the attachments, and shape and location of the cuneocuboid joint on the medial side of the cuboid were studied. ImageJ software was used to measure the osteotomy angle. Results: The lateral cuboid attachment of the LPL on average was located 4.6 mm from the calcaneocuboid joint, and the cuneocuboid joint on average was located 6.7 mm from the cuboid-metatarsal joint on the medial surface of the cuboid. The direct line connecting the anterior cuneocuboid joint and the oblique crest of the cuboid on average was at a 10.3-degree inclination posterior to the cuboid-metatarsal joint. Conclusion: A straight line must be selected between a point 4 mm from the calcaneocuboid joint laterally and 6 mm from the cuboid-metatarsal joint medially at a 10-degree posterior tilt to the cuboid-metatarsal joint to perform a cuboid osteotomy LCL without damaging the articular surface. Clinical Relevance: We investigated a potential novel cuboid osteotomy method for LCL.

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Effect of Calcaneal Lengthening on Relationships among the Hindfoot, Midfoot, and Forefoot

Foot & Ankle ◽

10.1177/107110079301400305 ◽

1993 ◽

Vol 14 (3) ◽

pp. 136-141 ◽

Cited By ~ 304

Author(s):

Bruce J. Sangeorzan ◽

Vincent Mosca ◽

Sigvard T. Hansen

Keyword(s):

Pitch Angle ◽

Articular Surface ◽

Angular Measurement ◽

Pes Planus ◽

Lateral Column ◽

Medial Side ◽

Significant Correction ◽

Before And After ◽

Calcaneal Lengthening ◽

The Relationship

To better understand the bony component of pes planus and the means by which the Evans calcaneal lengthening corrects them, we studied the standing radiographs of seven adult patients who had undergone calcaneal lengthening to treat symptomatic pes planus. Weightbearing AP and lateral views done preoperatively and postoperatively were used for the study. For each set of films, the following parameters were measured: on the lateral view; overall length of the calcaneus, lateral talometatarsal angle, lateral talocalcaneal angle, and the calcaneal pitch angle; and on the dorsoplanar view, the talometatarsal and talocalcaneal angle. In addition, the relative coverage of the talus by the navicular was described by an angular measurement based on the relationship of the center of the talus to the center of the navicular. The average improvements in lateral talocalcaneal angle (a reflection of hind-foot valgus) was 6.4° when the long axis of the calcaneus was used and 6.8° when the inferior surface of the calcaneus was used for the measurement. The lateral talometatarsal angle improved an average 11.3° (from an average of 19.7° to 8.4°). The dorsoplantar talometatarsal angle (a measure of forefoot adduction/abduction) improved 15.8° (preoperative average 26.8°, postoperative average 11°). The calcaneal pitch angle improved an average 10.8° (preoperative average 3.2°, postoperative average 14°). The relationship between the talus and navicular was defined by an angular measurement based on the center of each articular surface before and after correction using this measurement. An average improvement of 26° occurred in the alignment of these two articular surfaces. This study confirms Evans' belief that significant correction can be obtained by lateral column lengthening, that the relationship between navicular and talus can be restored without fusion, and that the forefoot position corrects without operative intervention to the medial side of the foot. This study also provides numerical guidelines for the surgeon planning surgical correction of symptomatic pes planus, and since bony relationships can be observed before and after correction, some insight may be gained into tarsal morphology of pes planus.

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Remodeling of the Calcaneocuboid Joint in the Flatfoot

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000278 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Arthur Manoli

Keyword(s):

Soft Tissue ◽

Articular Surface ◽

Stage Ii ◽

Posterior Tibial Tendon ◽

Consecutive Series ◽

Soft Tissue Reconstruction ◽

Lateral Column ◽

Calcaneocuboid Joint ◽

Lateral Column Lengthening ◽

Lateral Portion

Category: Hindfoot Introduction/Purpose: Although the flatfoot has been successfully treated with a lateral column lengthening (LCL) for over half of a century, there has been controversy recently about whether the lateral column is actually short in a flatfoot, especially the acquired type. Some ask, “How can the normal, hard bones actually change and shorten?” And, if it is not short, perhaps the lengthening procedure is producing a non-physiologic state with abnormal anatomy. Would the flatfoot patient be better served with other procedures that don’t include a lateral column lengthening? Level of Evidence: Therapeutic Level IV. Methods: After observing a very dramatically changed calcaneocuboid (CC) joint when performing a double calcaneal osteotomy with a medial soft tissue reconstruction for a Johnson-Strom Stage II posterior tibial tendon insufficiency, it was decided to carefully observe, photograph, and record any changes in the CC joint at surgery in a consecutive series of 21 patients who were operated on who had this disorder(Figure 1). In total, there were fourteen double heel osteotomies, with medial soft tissue reconstructions for Johnson-Strom Stage II deformities, five triple arthrodeses for Stage III deformities, and two lateral column lengthenings with an ankle arthrodesis for a Stage IV deformity. All of the patients had a triple hemisection heel cord lengthening for hindfoot equinus. Results: Every patient studied had some changes to the CC joint which were generally related to the amount of deformity present. At a minimum, the calcaneal side of the joint drifted proximally, laterally and dorsally, with bone being laid down on the outside of the calcaneus, resulting in the joint being larger. There was drifting and abduction of the lateral portion of the articular surface of the joint. In some joints the lateral portion looked like a distinct but confluent facet. Often times, a marginal osteophyte was present laterally and dorsally in the widened area of the calcaneus and “kissing” osteophytes were seen on the cuboid. All of these remodeling changes resulted in the calcaneal side of the joint being short, and facing laterally and dorsally. Conclusion: These findings give evidence to the rationale for performing of a LCL proximal to the calcaneocuboid joint to treat the acquired flatfoot. When performing a LCL one should attempt to restore length to the calcaneal side of the joint, and to redirect it medially and plantarward. We do not remove the marginal spurs, rather they are maintained to provide an area to insert a retrograde fixation screw. If the patient has lateral column pain after the bone graft has incorporated, the screw and spurs are removed.

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The use of locking plates in complex midfoot fractures

Annals of The Royal College of Surgeons of England ◽

10.1308/003588412x13373405386736 ◽

2012 ◽

Vol 94 (8) ◽

pp. 593-596 ◽

Cited By ~ 11

Author(s):

E Bayley ◽

N Duncan ◽

A Taylor

Keyword(s):

Articular Surface ◽

Open Reduction Internal Fixation ◽

Locking Plates ◽

Lateral Column ◽

Improved Outcomes ◽

Fracture Dislocations ◽

Angle Stable ◽

Post Traumatic ◽

Neurological Injuries

INTRODUCTION Complex fracture dislocations of the midfoot are uncommon. Improved outcomes have been demonstrated where it has been possible to restore and maintain the length and alignment of the medial column as well as the congruity of the articular surfaces. We present our experience with the use of angle-stable locking plates in the stabilisation of complex midfoot fracture dislocations. METHODS Twelve patients were identified on a prospective trauma database between 2003 and 2009. All fractures involved the medial column with four associated fracture subluxations of the lateral column also. Patients underwent open reduction internal fixation (ORIF) with restoration of the medial column axis, reduction of the articular surface congruity and stabilisation with angle-stable locking plates. RESULTS There were no post-operative infections or neurological injuries. Ten of the twelve patients required metalwork removal. There were no implant failures prior to removal of the metalwork. At a mean follow-up of 12.4 months (range: 4–32 months), 11 patients had minimal symptoms of swelling, discomfort or stiffness in the midfoot. This did not restrict their daily activities. One patient developed post-traumatic arthritis and collapse of the medial longitudinal arch. Two patients declined removal of the metalwork. CONCLUSIONS Angle-stable locking plates provide satisfactory stabilisation following ORIF of complex midfoot fracture dislocations. Most patients will require removal of the metalwork. Following removal of metalwork, the majority of patients will maintain the length, alignment and stability of the midfoot.

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The patient-specific implant created with 3D printing technology in treatment of a severe open distal humerus fracture with complete loss of the lateral column

Journal of Orthopaedic Surgery ◽

10.1177/2309499020960251 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902096025

Author(s):

Suriya Luenam ◽

Arkaphat Kosiyatrakul ◽

Kantapat Phakdeewisetkul ◽

Chedtha Puncreobutr

Keyword(s):

Articular Surface ◽

Lateral Collateral Ligament ◽

Humeral Fracture ◽

Distal Humerus ◽

Patient Specific ◽

Iliac Crest Bone Graft ◽

Favorable Result ◽

Printing Technology ◽

Lateral Column ◽

Distal Humeral Fracture

The open distal humeral fracture associated with the major loss of the articular surface and bony structure is a challenging problem for orthopedic surgeons. In this case report, we describe a case of complete missing lateral column of the distal humerus with severe articular destruction of capitellum and lateral trochlear ridge which was treated with the patient-specific implant created with three-dimensional printing technology. Apart from anatomic replacement of the articular surface, the lateral collateral ligament complex and extensor muscle which are the key soft tissue stabilizers of elbow were repaired by reattaching their bony origins to the impacted iliac crest bone graft inside the implant. Due to the favorable result at 2-year follow-up, this modality is a potentially viable surgical option in treating of the severe open distal humeral fracture associated with entire lateral condylar damage.

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Biomechanical Analysis of the Calcaneocuboid Joint Pressure After Sequential Lengthening of the Lateral Column

Foot & Ankle International ◽

10.1177/1071100712464211 ◽

2013 ◽

Vol 34 (2) ◽

pp. 261-266 ◽

Cited By ~ 17

Author(s):

Jiang Xia ◽

Peng Zhang ◽

Yun-Feng Yang ◽

Jia-Qian Zhou ◽

Qian-Ming Li ◽

...

Keyword(s):

Biomechanical Analysis ◽

Lateral Column ◽

Calcaneocuboid Joint

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Radiologic results of additional single screw fixation with lateral locking plate after hybrid closed-wedge high tibial osteotomy

Knee Surgery and Related Research ◽

10.1186/s43019-020-00085-w ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Nobuyuki Hiraoka ◽

Shuji Nakagawa ◽

Eigo Otakara ◽

Hiroaki Inoue ◽

Kenji Takahashi ◽

...

Keyword(s):

Locking Plate ◽

Callus Formation ◽

Bone Union ◽

Osteotomy Site ◽

Tibial Osteotomy ◽

Cancellous Screw ◽

Medial Compartment Osteoarthritis ◽

Medial Side ◽

Closed Wedge ◽

Wedge High Tibial Osteotomy

Abstract Background Hybrid closed-wedge high tibial osteotomy (hybrid CWHTO) is an effective surgical treatment for medial compartment osteoarthritis of the knee. Our study investigated whether the combination of a lateral locking plate and a single medial screw promoted bone union after hybrid CWHTO. Methods The study cohort consisted of 30 patients (15 men and 15 women) who underwent hybrid CWHTO for medial compartment osteoarthritis or spontaneous osteonecrosis of the knee. Sixteen knees were fixed with a lateral locking plate (LP group), and 17 were fixed with both a lateral locking plate and a cannulated cancellous screw on the medial side of the tibia (LPS group). The times to bone union, radiolucency, and callus formation at the osteotomy site were evaluated radiographically. Results The mean postoperative time to radiographic confirmation of bone union was 5.5 ± 2.6 months in the LP group and 3.4 ± 1.5 months in the LPS group. Radiolucency at the osteotomy site and excess callus formation on the posterior side of the tibia were lower in the LPS group than in the LP group. Conclusions This modified hybrid CWHTO combining a lateral locking plate and a cannulated cancellous screw on the medial side of the tibia improves the stability of the osteotomy site and shortens the period of bone union.

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Late Abduction Deformity of the Midfoot Following the “Medial Double” (Diple) Procedure for Hindfoot Valgus Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00293 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0029

Author(s):

Arthur Manoli

Keyword(s):

Valgus Deformity ◽

High Rate ◽

Joint Involvement ◽

Bone Block ◽

Lateral Side ◽

Triple Arthrodesis ◽

Lateral Column ◽

Calcaneocuboid Joint ◽

Lateral Incision ◽

Hindfoot Deformity

Category: Hindfoot Introduction/Purpose: There has been considerable interest in recent years in performing a combined talonavicular and subtalar arthrodesis instead of a standard triple arthrodesis for a rigid hindfoot deformity. The ”medial double” (diple) avoids fusing the calcaneocuboid joint with its lateral incision, common bone block graft and high rate of complications. Although the results of the “medial double” are generally satisfactory, there are no reports of late midfoot abduction deformity, although it was predicted by Evans in 1975. Methods: A 79 year-old-male with long-standing skin psoriasis with joint involvement presented with severe bilateral flatfoot deformities. The left hindfoot was arthritic, deformed and painful. Despite a conservative course of orthotics and ankle braces, the pain persisted. Because there was a psoriatic plaque over the lateral side of the foot, it was decided to perform a ”medial double” arthrodesis with screw fixation, a plantarflexing 1st tarsometatarsal joint fusion for medial column stabilization, and a heel cord lengthening Results: Skin and bony healing were uneventful. Over the subsequent three years a progressive abduction deformity developed through the naviculocuneiform joints and the unfused calcaneocuboid joint. The patient had only occasional pain in the midfoot and wore wide shoewear to accommodate the deformity. Conclusion: A late abduction deformity can develop through the midfoot in patients who have the ‘medial double” procedure for hindfoot valgus. The cuboid settles proximally against the short distal calcaneus, and the naviculocuneiform joints sublux laterally. In patients with hindfoot valgus with severe lateral column shortening secondary to calcaneocuboid joint remodeling, it may be better to perform an actual triple arthrodesis with a bone graft in the calcaneocuboid joint instead of a “medial double.” Alternatively, one could add a naviculocuneiform arthrodesis to the ”medial double” arthrodesis to prevent this complication.

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Radiographic Union of Evans Osteotomy Without Fixation

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00358 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0035

Author(s):

Megan R. Miles ◽

Brian P. Gallagher ◽

Katherine L. Mistretta ◽

Nigel N. Hsu ◽

Haijun Wang ◽

...

Keyword(s):

Allogenic Bone ◽

Lateral Column ◽

First Metatarsal ◽

Calcaneocuboid Joint ◽

Calcaneal Osteotomy ◽

Metatarsal Angle ◽

Flexible Flatfoot ◽

Lateral Column Lengthening ◽

Allogenic Bone Graft

Category: Hindfoot; Other Introduction/Purpose: The Evans osteotomy is a lateral column lengthening procedure of the calcaneus that is commonly used to correct flexible flatfoot deformities. There is no consensus on whether fixation is needed to avoid nonunion and calcaneocuboid subluxation when performing this osteotomy. We assessed the nonunion rate and correlated extent of subluxation with graft size in an unfixed Evans osteotomy with an allograft wedge and no pinning of the calcaneocuboid joint at any point in the largest series of the procedure to date. Surgeries were performed in patients undergoing flexible flatfoot reconstruction. Methods: We retrospectively reviewed 120 consecutive patients who had undergone 145 unfixed Evans osteotomies by a single surgeon with allogenic bone graft for flatfoot reconstruction between January 2013 and October 2017, with a mean follow-up of 62.5 (range 9.4-266.7) weeks. The calcaneocuboid joint was not pinned during the procedure. Data were collected using clinical and radiographical examination during regular follow-up. Results: A total of 137 feet (94.5%) underwent a double calcaneal osteotomy with an associated medial displacement calcaneal osteotomy (MDCO). There was one nonunion (0.69%). The mean time to union was 10.8 (range, 6.7-17.9) weeks. There was significant improvement in all radiographic parameters postoperatively, including calcaneal pitch, talonavicular uncoverage, anteroposterior and lateral talo-first metatarsal angle, lateral column length, and naviculocuboid overlap (p<0.05). Minor postoperative calcaneocuboid joint subluxation (1.51 +- 2.3 mm) occurred in 72 of 118 feet (61.0%) and had no correlation with wedge size (r=0.06; 95% CI, -0.13, 0.24; p=0.6). Conclusion: An unfixed Evans osteotomy for symptomatic flatfoot deformity resulted in a significant improvement in the radiographic alignment of the foot with an exceptionally rare nonunion rate. Detectable calcaneocuboid subluxation was common but minimal in extent and was not correlated with wedge size in this series in which wedges were less than 12 mm in the maximum dimension. This report represents the largest series of the Evans procedure to date.

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COMPARATIVE ANATOMICAL STUDY AND INCIDENCE OF OS PERONEUM IN PERONEUS LONGUS TENDON AND ITS CLINICAL SIGNIFICANCE. Estudio anatómico comparativo e incidencia del os peroneum en el tendón de peroneo largo y su significación clínica

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v6.n1.14093 ◽

2016 ◽

Vol 6 (1) ◽

pp. 15-19

Author(s):

Poonam Verma ◽

Anterpeet Arora

Keyword(s):

Incidence Rate ◽

Clinical Significance ◽

Anatomical Study ◽

Peroneus Longus Tendon ◽

Longus Tendon ◽

Peroneus Longus ◽

Calcaneocuboid Joint ◽

Cuboid Bone ◽

Os Peroneum ◽

High Incidence Rate

Introducción: El objetivo de nuestro estudio fue evaluar la tasa de incidencia del os peroneo (OP) en el tendón del peroneo lateral largo (PLT) y su importancia clínica. Métodos: La disección de 60 cadáveres embalsamados (56 hombres y 4 mujeres) del grupo de mediana edad se hizo para tener acceso a la tasa de incidencia del os peroneo en PLT. Resultados: En nuestro estudio se observó que la tasa de incidencia del os peroneo fue de 86,6% (52 extremidades). La ubicación del os peroneo es también un tema de controversia. La mayoría de los autores afirman que se relaciona con el hueso cuboides y de vez en cuando se ve inferior al calcáneo distal a la articulación calcáneo-cuboidea. Pero en el presente estudio el os- peroneo estuvo en relación al hueso cuboides en 40 extremidades (76.9%) y distal a articulación calcaneocuboidea en el resto de las 12 extremidades (23.1%). Conclusión: Este estudio sugiere que existe una alta tasa de incidencia de un OP en cadaveres. Esto puede ser como consecuencia de la técnica utilizada para localizar el mismo. La importancia clínica ha sido mencionada en relación con la ubicación del os peroneo, que puede ser confundido con fracturas estiloides y de Jones. Introduction: The aim of our study was to assess the incidence rate of the os peroneum (OP) in the peroneus longus tendon (PLT) and its clinical significance. Methods: Dissection of 60 embalmed cadavers (56 male and 4 female) of middle age group was done to access the incidence rate of os peroneum in peroneus longus tendon. Results: In our study the incidence rate of os peroneum was 86.6% (52 limbs). The location of os peroneum is also a subject of dispute. Most authors stated that it is related to the cuboid bone and occasionally it is seen inferior to the calcaneum distal to the calcaneocuboid joint. But in the present study os peroneum was in relation to cuboid bone in 40 limbs (76.9%) and distal to calcaneocuboid joint in 12 limbs (23.1%). Conclusion: This study suggests that there is a high incidence rate of the os peroneum in the peroneus longus tendon in cadavers. This may be a consequence of the technique used to locate it. The os peroneum can be mistaken for a styloid or Jones fractures.

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Calcaneocuboid Joint Pressures with Lateral Column Lengthening (Evans) Procedure

Foot & Ankle International ◽

10.1177/107110079701800403 ◽

1997 ◽

Vol 18 (4) ◽

pp. 199-205 ◽

Cited By ~ 101

Author(s):

Paul S. Cooper ◽

Michael D. Nowak ◽

James Shaer

Keyword(s):

Real Time ◽

Pediatric Population ◽

Lateral Column ◽

Calcaneocuboid Joint ◽

Lateral Column Lengthening

Calcaneocuboid joint pressures were evaluated with eight cadaver specimens. Real-time pressures were recorded using a TekScan 4200 sensor pad at lengths of 0, 5, and 10 mm in both unloaded and 350-newton loaded models. Recorded pressures exceeded 2.3 M Pa in the loaded model at 10 mm lateral column lengthening. Although an acceptable procedure in the pediatric population, application of the Evans lateral column lengthening procedure for management of adult acquired flatfoot may generate excessive pressures leading to joint arthrosis. Lengthening by calcaneocuboid distraction arthrodesis may avoid this problem.

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