An anatomic repair can be performed. John E. Femino, MD, Tanawat Vaseenon, MD, [], and Edward H. Yian, MD. Calcaneal fractures have long been recognized as a source of significant disability and remain one of the most difficult articular fractures to treat. Care is taken to avoid any dissection of the floor of the SPR. endobj Peroneal longus and brevis both supplied by superficial peroneal nerve. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. A name object indicating whether the document has been modified to include trapping information 3379 This can aid visualization of the articular surface, but we avoid this in most cases because of the importance of this ligament as a primary stabilizer of the subtalar joint. The third measurement was taken where the LCA crossed the posterolateral margin of the SPR. doi:10.1186/s12891-015-0519-0 The extensile lateral approach provides excellent fracture visualization and allows reduction of the displaced fracture fragments, but high complication rate has been described with this approach, so many studies favor the sinus tarsi approach. Text start incision 1 cm below the tip of the lateral malleolus. %%EOF TECHNIQUE STEPS Preoperative Patient Care. Sinus tarsi syndrome is caused by hemorrhage or/and inflammation of the synovial recesses of the sinus tarsi with or without tears of the associated ligaments. The lateral calcaneal artery is responsible for the majority of the blood supply to this area. Mark and make incision . (B) Identification of lateral calcaneal artery deep to deep fibers of superior peroneal retinaculum. Seven patients were chronic smokers (average 1.5 packs per day). Your subtalar joint, the joint under which is important and runs under the neck of the talus in your subtalar joint and it's a little cavity that has some fat, it has some nerve endings and it has some fluid that lubricates the joint. Preoperative computed tomography scans were obtained in all patients. The common identifier for all versions and renditions of a document. There were 12 males and one female with an average age of 45.1 years (range from 26-71 years). The senior author (J.F.) Subtalar Dislocations are hindfoot dislocations that result from high energy trauma. In a similar fashion we found the LCA to be at risk with this extended sinus tarsi approach if at the proximal edge of the floor of the SPR. In these cases, the articular surface damage was deemed to be too severe to warrant ORIF alone. The ePub format is best viewed in the iBooks reader. The sinus tarsi syndrome is a foot pathology, mostly following after a traumatic injury to the ankle. Inflammatory arthritides such as rheumatoid arthritis, gout, or ankylosing arthritis are also associated. This study reviews the radiographic and clinical outcomes of the use of the sinus tarsi approach for operative fixation of these fractures with attention to the rate of infection and restoration of angular . The fracture is typically reduced from anterior to posterior. When the calcaneal insertion is elevated with the entire lateral calcaneal soft tissue flap, it remains in its anatomic relationship to the surrounding soft tissues and later reduces back to the calcaneus. Exposure and reductions are performed under tourniquet control. divide the fascia over the anterior compartment musculature in line with the skin incision, elevate the muscle and the periosteum over the anterolateral face of the tibia using a periosteal elevator to expose the anterolateral cortex, create a 1 by 1 cm square or elliptical window in the center of the anterolateral face, insert a curette into the window and remove the cancellous graft, seal the window with the previously removed bone plug, perform a layered closure of the fascia, subcutaneous tissue and the skin, make sure to place graft within 30 minutes of harvest, create 1 cm incision at the apex of the heel for insertion of the guidepin. Standard approach to sinus tarsi S Tip of fibula S Extend towards base of 4th metatarsal S 5-8 cm S Visualize calcaneal-cuboid joint Tips/Techniques Elevate extensor . Conformance level of PDF/A standard Surgical treatment of intra-articular calcaneal fractures: a review of small incision approaches. You may switch to Article in classic view. amd We were able to define two objective criteria for the syndrome: arthrography of the subt Recent evidence favoring sinus tarsi rather than the extensile lateral approach has shifted opinion . By SungHun.Kim. Diagnosis can be suspected clinically with burning plantar foot pain with a positive Tinel's sign over the tibial nerve. At this point, excellent direct visualization of the articular surface of the posterior facet is possible. XMP Basic Postoperative measurement of Bohler's angle averaged 29 (range 25-36) degrees and Gissane's angle averaged 131 (range 122-150) degrees (Figure 1). Satisfactory articular reduction is gained and confirmed clinically and fluoroscopically with lateral, axial heel and Broden's views. The LCA was seen to consistently emerge from the posterior lateral edge of the fibula proximally and course distally behind the deep portion of the peroneal tendon sheath superior to the SPR. use the Harris heel and lateral views to drive guidepin through the tuberosity, across the subtalar joint and into the talar neck. 1 0 obj The incision is deepened by mobilizing the sinus tarsi fat pad dorsally. GH>UrLDcc"G_HJ2FRCt).st[N. *Department of Orthopaedics and Rehabilitations, University of Iowa Hospitals and Clinics, Iowa City, IA, **Barrington Orthopaedic Specialist, Hoffman Estates, IL. In all specimens, the LCA traversed directly posterior to the lateral border of the deep portion of the SPR. 12 0 obj Operative and non-operative management have both been suggested for the acute treatment of calcaneal fractures, however it is generally accepted that in most cases operative treatment of displaced calcaneal fractures is warranted in order to avoid the negative consequences of malunion.2,6 Operative management can consist of reduction through an extensile open incision, limited incision or percutaneous techniques. Calcaneus,Intra-articular fracture,Sinus tarsi approach,Extensile lateral approach 2 0 obj The description of the relationship of the LCA to the SPR provides an identifiable landmark for this extended sinus tarsi approach. Specimens were frozen overnight after allowing the dye to disseminate and consolidate. <> This provided good exposure of the posterior facet, and unlike Palmer who used structural bone graft to support the articular reduction, they used internal fixation, consisting of interfragmentary compression screws. found that smoking, diabetes, and open fractures all increase the risk of significant wound complications and are cumulative.13. This creates a smooth lateral surface which is less likely to create impingement on the peroneal tendons. internal endobj XMP Media Management Schema It could be tempting, however, to carry the deep dissection farther proximally as it would provide even wider access to this area. allows direct visualization of the posterior facet, anterolateral fragment, and lateral wall . The sinus tarsi approach offers an alternative to the extensile lateral approach for open reduction and internal fixation of the calcaneus that may improve soft tissue-related complications and still provide . Recent evidence favoring sinus tarsi rather than the extensile lateral approach has shifted opinion . The Sinus Tarsi approach is the surgical approach for the incision. The authors obtained satisfactory reductions and minimal wound complications. The authors have used an extended sinus tarsi approach to include placement of plate percutaneously beneath the lateral calcaneal skin flap through a sinus tarsi approach, and to treat adjacent fractures and soft tissue injuries. Three measurements were made to define the location and orientation of the LCA relative to the superior border of the deep portion of the SPR. No wound complications occurred in smokers. Insertion of a broad elevator can enhance the retraction by placing the soft tissues under tension thus facilitating sharp elevation off of the lateral wall of the calcaneus. He and others have found this approach to be useful and reasonably safe. H|U}Ty{w URI At the midline of the peroneal sheath, the average distance from the LCA to the SPR was 2.0 (range from 0 to 4) millimeters. ; licensee BioMed Central. doi:10.1186/s12891-015-0519-0 0000000120 00000 n default Ebraheim NA, Elgafy H, Sabry FF, et al. r Sinus Tarsi () X lateral malleolus & medial malleolus . Next a lateral plate is placed beneath the internally elevated soft tissue flap, and directly fixed to the anterior calcaneus and the articular fragments. The LCA was found to emerge from the posterior fibular border an average of 10.6 (range from 2 to 23) millimeters proximal to the superior border of the deep fibers of the SPR. At the tip of the fibula, the incision is directed toward the base of the fourth metatarsal. 0 5 in cases of patients at higher risk for wound complications such as smokers or those with concomitant injuries that could be treated from a lateral approach. It affords placement of a lateral plate subcutaneously by using retrograde subperiosteal elevation of the lateral calcaneal skin flap. . X . In addition, a limited sinus tarsi incision without elevation of the lateral calcaneal skin flap does not allow for plate fixation, a notable advantage of the extensile lateral approach, particularly in gaining reduction of the body of the calcaneus. xxviii, p. Rogers LF. already built in. Fluoroscopy can be utilized, but a small right angle hemostat can also be used to localize the holes for the percutaneous screws by visualizing the holes in the plate directly with retraction of the lateral soft tissues. Sinus Tarsi. 0000000000 65535 f The incision lies in a plane between the superficial peroneal nerve and the sural nerve. The potential for serious wound complications is a major concern, particularly breakdown of the lateral calcaneal skin flap with the extensile lateral approach. Folk JW, Starr AJ, Early JS. CONCLUSION: In displaced intra-articular calcaneal fractures, a minimally invasive sinus tarsi approach is associated with a lower . There has historically been debate over the best approach for treating these fractures.1,4 The goal of operative treatment of calcaneal fractures is to obtain the best possible reduction of the articular surfaces and restoration of the architecture of the non-articular portions of the bone, and to hold this reduction with stable internal fixation.5,6 These goals must be balanced with the need to minimize the operative risks, especially the risk of wound healing complications. Two patients developed wound complications. Acrobat Distiller 10.1.5 (Windows); modified using iText 5.3.5 2000-2012 1T3XT BVBA (AGPL-version) One patient had a calcaneal anterior process fracture with calcaneal-cuboid subluxation fused with a large staple. Trapped Components of the sinus tarsi syndrome include lateral hindfoot pain, tenderness to palpation over the sinus tarsi, a sensation of instability . Of those patients who did not undergo primary subtalar arthrodesis, postoperative radiographs with Broden's views revealed articular reduction within two millimeters. Diagnosis is made clinically and confirmed with orthogonal radiographs of the foot. A clinical series of 13 patients (including 7 chronic smokers and 1 with diabetes and vascular disease) with closed displaced intra-articular calcaneal fractures (Sanders types II and III) were treated by open reduction and internal fixation via this approach. the display of certain parts of an article in other eReaders. Concerns remain however regarding the best approach for reducing and maintaining reduction of these complex fractures, while minimizing the risk of surgical complications. Sixteen lower extremity cadaver specimens were obtained through the University of Michigan Medical School Anatomic Donations program. Fixation was obtained using the following plates with screws: An Ace/Depuy titanium calcaneal perimeter plate in six patients, a Synthes calcaneal or cervical H-plate in five patients, and a Synthes 2.7 mm reconstruction plate in one patient. 2015, :. internal Hall MC, Pennal GF. The extended lateral approach to the hindfoot. http://www.aiim.org/pdfa/ns/id/ The wide exposure allows the surgeon to place a lateral plate which gives rigid control of the body reduction with lag screw fixation through the plate into the medial sustentacular fragment. Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures. It healed uneventfully after surgical debridement, closure and subsequent local care. Four patients underwent ORIF with concurrent primary subtalar arthrodesis. One patient sustained a lateral wound dehiscence due to a hematoma. Zwipp H, Tscherne H, Wulker N. [Osteosynthesis of dislocated intraarticular calcaneus fractures]. The treatment of displaced calcaneal fractures remains controversial. Benirschke SK, Sangeorzan BJ. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course. ligament and reflection of the . Good to excellent clinical results have been published in patients undergoing open reduction and internal fixation with the extensile lateral approach, however high wound complication rates are reported.13,23,24 They include superficial epithelial necrosis, full-thickness skin sloughing, deep purulent infections and osteomyelitis. Treatment with our self-designed combined plate through a sinus tarsi approach may be safe and effective for type II and type III calcaneal fractures. Comparison of two surgical approaches for displaced intra-articular calcaneal fractures: sinus tarsi versus extensile lateral approach. internal Patients managed with a sinus tarsi approach were less likely to suffer complications (OR = 2.98, 95% CI = 1.62-5.49, p = 0.0005) and had a shorter duration of surgery (OR = 44.29, 95% CI = 2.94-85.64, p = 0.04). Once the fixation is complete and final fluoroscopic or x-ray images obtained, the wound is thoroughly irrigated and the EDB and sinus tarsi fat pad reduced and sutured with absorbable sutures. Copyright 2022 Lineage Medical, Inc. All rights reserved. studied the vascularity of the lateral calcaneal flap and concluded that the lateral calcaneal artery was found to be responsible for the majority of the blood supply to the corner of the flap.12 They found that it emerged from the deep fascia of the leg 15 mm proximal to the tip of the lateral malleolus and 33 mm posterior to the posterior edge of the fibula and 11.5 mm anterior to the anterior edge of the Achilles tendon. Tarsal Tunnel Syndrome is a compressive neuropathy of the tibial nerve at the level of the tarsal tunnel which can lead to pain and paresthesias of the plantar foot. 0000000210 00000 n The sinus tarsi syndrome is predominately a clinical diagnosis deduced through the use of physical examination and history. extend posteriorly over the sinus tarsi (soft tissue depression just anterior to lateral malleolus) incise obliquely to point 2.5 cm below tip of lateral malleolus. Letournel E. Open treatment of acute calcaneal fractures. The floor of the peroneal tendon sheath above the superficial peroneal retinaculum was transected longitudinally and the underlying posterior peroneal artery branch, or lateral calcaneal artery (LCA) was identified (Figure 3). ; licensee BioMed Central. Epidemiology. A word or short phrase that identifies a document as a member of a user-defined collection. <>/Font 8 0 R>>/Thumb 9 0 R/MediaBox[0 0 595.276 793.701]/B[10 0 R 11 0 R]/Annots[12 0 R 13 0 R 14 0 R 15 0 R 16 0 R 17 0 R 18 0 R 19 0 R 20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R]/Rotate 0>> In nearly all cases, an associated contracture of the heel cord is present. sinus tarsi approach . 2015-04-09T10:26:07+02:00 1 Overall incidence is unknown, but it is generally considered uncommon and without consistent gender predilection. One patient had diabetes and vascular disease, with lateral calcaneal fracture dislocation impacted into the lateral ankle gutter. 2, 3. 1 2015-04-09T10:26:07+02:00 Both lateral and medial approaches have been described, but the lateral approach allows direct exposure of the articular surface, while the medial approach is limited to reduction of the body. Usually post-traumatic, it is characterised by pain over the lateral opening of the sinus tarsi and a feeling of instability of the ankle. Borrelli J, Jr., Lashgari C. Vascularity of the lateral calcaneal flap: a cadaveric injection study. The incision can be extended to allow access to the distal tibia and fibula, talus and the lateral column of the foot. would like to thank his fellowship director and mentor, Elly Trepman M.D. It can later be re-approximated with a single stitch if desired. Incision. After the second case in the series, which was complicated by a wound hematoma, a small closed suction drain was placed into the wound and brought out dis-tally. Radiology of skeletal trauma; p. 2. v. (xii, 1406, 1430 p.). The anterior flap was mobilized to the ankle to facilitate the photographic demonstration of the anatomy. Screw fixation into the body of the calcaneus is gained by percutaneous screw placement posteriorly. application/pdf Arbortext Advanced Print Publisher 9.1.440/W Unicode URI fibrous debris and fat removed from sinus tarsi small elevator or lamina spreader placed under posterior facet fragment to aid in reduction K-wires inserted for provisional fixation aimed towards the sustentaculum Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intraar-ticular calcaneal fractures. Essex-Lopresti P. The mechanism, reduction technique, and results in fractures of the os calcis. xmpMM The CFL can be repaired if desired. Noble J, McQuillan WM. All patients begin motion once the incision is well healed and the sutures are removed, which is usually 2 V2 - 3 weeks postoperatively. Figure 58-8 superior view inferior view ( . Some characteristics are pain at the lateral side of the ankle and a feeling of instability. You may notice problems with The vascular anatomy of the lateral calcaneal artery related to this approach was also studied with 16 cadaver legs. It may also occur if the person has a pes planus or an (over)-pronated foot, which can cause compression in the sinus tarsi. However, the presumed diagnosis can be corroborated through the use of imaging studies, predominately magnetic resonance imaging. Palmer originally described a laterally based approach through the sinus tarsi for direct visualization of the articular surface for reduction. uuid:290c41fa-7bb3-4810-88a4-2264eda0c929 Various internal fixation techniques have been described, but a laterally based plate is commonly accepted to give the most rigid fixation.7,8 Since displaced calcaneus fractures present with various degrees of comminution and soft tissue trauma, it is advantageous for the calcaneal fracture surgeon to have a variety of methods of treatment to balance minimizing risks of wound complications against obtaining the best reduction possible.9. It is possible that joint instability may result and could add to the chance of post-traumatic arthritis. 1 0 obj<> endobj 2 0 obj<> endobj 3 0 obj<> endobj 5 0 obj null endobj 6 0 obj<>/ProcSet[/PDF/Text]/ExtGState<>>>>> endobj 7 0 obj<> endobj 8 0 obj<> endobj 9 0 obj<> endobj 10 0 obj<>stream OriginalDocumentID 2015-03-27T10:56:32+08:00 make a second 1 cm incision just medial to the anterior tibialis tendon, use the Harris heel and lateral views to drive guidepin through the dorsomedial aspect of the talar neck across the subtalar joint into the posterior calcaneal tuberosity, insert a 6.5 or 8 mm large fragment cannulated lag screws after minimal countersinking, repeat the procedure for the second guidepin except use a small fragment cannulated screw, depth of this screw is best judged by axial view of the calcaneus, obtain final fluoroscopic images to ensure proper screw position, use 3-0 nylon horizontal mattress sutures for skin, use 2-0 vicryl for the subcutaneous layer, place in well padded non-weightbearing short leg plaster cast, split cast in recovery room to allow for post op swelling. Foot Conditions are the most common deformity seen in Cerebral Palsy which are caused by lower extremity spasticity and can take several forms including equinus, hallux valgus, equinocavovarus, and equinoplanovalgus. began using in 1999 based on the technique described by Gupta et al. 2015, :. Diagnosis is made clinically with presence of spasticity/contracture of the gastrocsoleus complex in equinus, presence of a . Comparison of two surgical approaches for displaced intra-articular calcaneal fractures: sinus tarsi versus extensile lateral approach trailer The intermediate root of the inferior extensor retinaculum (IER) can be released too to gain better exposure of the fracture line passing obliquely through the angle of Gissane. This approach is subfibular and slightly anterior and keeps the peroneal tendons inferiorly. Note wire passed subcutaneously indicating extent of subperiosteal elevation. The average length of follow-up time was 19 (range from 2-41) months, excluding one patient who underwent subsequent below-knee amputation six weeks post-operatively. Anatomical basis and surgical implications. Orthobullets Team % TECHNIQUE VIDEO 0 % TECHNIQUE STEPS 0. By avoiding dissection through the deep portion of the SPR, the lateral calcaneal artery can be protected, thus preserving the blood supply to the lateral calcaneal skin flap. UUID based identifier for specific incarnation of a document Eleven patients healed their soft tissues uneventfully by three weeks. The surgeon must be vigilant to identify the rare rigid flatfoot. Tilting the bed into Trendelenberg position and allowing the foot to invert over a cloth bump aids in visualizing the subtalar joint. A clinical series of 13 patients (including 7 chronic smokers and 1 with diabetes and vascular disease) with closed . The first was the distance from the superior margin of the floor of the SPR, at the fibular attachment, to the point where the LCA emerged from the posterior margin of the fibula. Posterior facet of calcaneus is exposed after release of the CFL. This provides for reduction of the body fragment medially, even when extensive comminution of the lateral wall is present.2,6 This exposure relies on developing a lateral calcaneal flap that is supplied by the LCA which is the terminal branch of the peroneal artery.12 One drawback of this approach is the potentially catastrophic wound complications that can result in the need for a soft tissue flap, or rarely below-the-knee amputation.13 Gupta et al. Post-operative lateral and hindfoot alignment views demonstrating restoration of the calcaneus. Results: Median Bhler and Gissane angle were improved to 26.5 degree (4.6 to 45), 115.5 degree (101.2 to 127.4) The drain in our series was removed 24-48 hours postoperatively and wounds were examined on the second postoperative day. Results using a prognostic computed tomography scan classification. converted After allowing the specimens to thaw, the extensile sinus tarsi approach was performed. Used to organize documents in a file browser. 2015-03-27T12:05:11+08:00 InstanceID After this episode, a medium hemovac drain was placed intra-operatively in all remaining patients with no subsequent wound healing complications. . Team Orthobullets (D) Trauma http://ns.adobe.com/pdf/1.3/ In conclusion, the extended sinus tarsi approach provides good exposure to the calcaneus for reduction and fixation and also provides exposure for concomitant treatment of injuries to the lateral ankle and talus. uuid:8b07b946-4f2d-4d62-b004-46a4051d37d6 Various approaches have been developed to try and balance the need for direct reduction of the articular surface while minimizing the potential for wound complications. The goal of treatment is to achieve anatomic reduction of the articular surface of the subtalar joint and reduction of the tuberosity. The plate is not contoured and the lateral wall fragment typically reduces into the body of the calcaneus with lagging of the plate to the stable medial fragment. With the anterior calcaneus and sinus tarsi exposed, the peroneal tendons below the SPR are retracted with a freer elevator placed along the lateral wall of the calcaneus and sharp dissection is used to perform retrograde subperiosteal elevation of the soft tissues off of the lateral calcaneus and proceeding to the tuberosity. We retrospectively reviewed thirteen patients who had undergone open reduction and lateral plate fixation without bone graft of closed displaced intraarticular calcaneus fractures using an extensile sinus tarsi approach. Indications for flatfoot surgery are strict: failure of prolonged nonsurgical attempts to relieve pain that interferes with normal activities and occurs under the medial midfoot and/or in the sinus tarsi. We are experimenting with display styles that make it easier to read articles in PMC. for introducing him to the modified Palmer approach, which formed the basis of this extended technique. All patients were evaluated both clinically and radiologically. Integer In a retrospective study by Abidi and Conti et al., risk factors included single layered closure, high body mass index, extended time between injury and surgery, and smoking.23 Folk et al. The authors have used an extended sinus tarsi approach to include placement of plate percutaneously beneath the lateral calcaneal skin flap through a sinus tarsi approach, and to treat adjacent fractures and soft tissue injuries. bone work. Sinus tarsi approach This approach was chosen at the discretion of the senior author (J.F.) True Care is taken to make sure that the elevator is not placed into the fracture, but lateral to the lateral wall fragment. The peroneal tendons are retracted laterally between the superior peroneal retinaculum and IPR and the inferior peroneal retinaculum is released off of the bone to expose the lateral calcaneal wall down to the anterior process. make a 1 cm incision distal to the distal aspect of the tibial tubercle and 1 cm lateral to the anterior tibial crest. Six patients underwent concurrent peroneal sheath and/or tendon reconstruction, six patients underwent concomitant lateral ankle ligament reconstruction, two patients underwent concurrent open reduction and internal fixation (ORIF) of a talar neck and head fracture respectively, and two patients underwent concurrent ORIF of fibular fractures. internal supine with bump under buttock. Our cadaveric study shows that this inherently protects the LCA, which passes deep to and just along the proximal border of the SPR. (A) 1; Crucial angle of Gissane (B) 2; Calcaneal width 3; Tibio-Calcaneal angle. Stephenson JR. Surgical treatment of dis placed intraarticular fractures of the calcaneus. for higher risk patients or those with concomitant fractures that could be addressed simultaneously. After transection and removal of the peroneal tendons within the tendon sheath, the superior border of the deep fibers of the superior peroneal retinaculum was identified (Figure 2). The fracture is mobilized, comminution and interposed soft tissues are debrided and provisional reduction of the articular surface and body is held with K-wires. endstream 1 0 obj<> endobj 2 0 obj<> endobj 3 0 obj<> endobj 4 0 obj<>stream 32, 34 . Past anatomic studies supported the conclusion that division of the LCA can lead to ischemia of the lateral calcaneal skin flap. calcaneus decorticated, joint manipulated into varus. Trauma is the most common cause following one single or a series of ankle sprains. continue incision distally until the base of the fourth metatarsal is reached, use cautery to cauterize any crossing vessels for hemostasis, identify the origin of the extensor digitorum brevis and the sinus tarsi fat pad, leave a small cuff of tissue proximally for reattachment of the flap, this allows better exposure of the joint surfaces and the middle and anterior facet, use a rongeur to remove any remaining soft tissues, use a straight curette or chisel to remove cartilage from the lateral half of the inferior talus and superior aspect of the calcaneal facets, insert a lamina spreader and remove the remaining medial articular cartilage, use curettes and osteotomes to create bleeding subchondral bone, use a 2.0 mm drill to create small perforations in bone, if bone graft is inserted reattach tendon after insertion of graft. MODIFICATION OF THE SINUS TARSI APPROACH FOR OPEN REDUCTION AND PLATE FIXATION OF INTRA-ARTICULAR CALCANEUS FRACTURES: THE LIMITS OF PROXIMAL EXTENSION BASED UPON THE VASCULAR ANATOMY OF THE LATERAL CALCANEAL ARTERY, Correspondence to: John E. Femino, MD Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, JPP 01022, Iowa City, IA 52242-1088 phone: 319-384-5844 fax: 319-384-8634, (A) Deep dissection of lateral ankle and hindfoot. external 2015 Yeo et al. 1. Extensive intraarticular fractures of the foot. Shuler FD, Conti SF, Gruen GS, Abidi NA. Note wire passed subcutaneously indicating extent of subperiosteal elevation that can be performed for lateral plate fixation. 2015 Yeo et al. (A) Deep dissection of lateral ankle and hindfoot. Weber M, Lehmann O, Sagesser D, Krause F. Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. The surgeries were all performed by the senior author (J.F.) The technique will be reviewed, and the advantages and disadvantages will be discussed. The protection of the lateral calcaneal artery is important to the success of the approach, as with the extensile lateral incision, and we also present a cadaver study to highlight the anatomy of the LCA relative to this surgical approach. Mller ME, Allgwer M, Arbeitsgemeinschaft fr Osteosynthesefragen . A . The extensor digitorum brevis (EDB) muscle is sharply elevated off of the anterior process with the lateral root of the IER, and reflected dorsally and distally. The interosseous talo-calcaneal ligament (ITCL) could be transected, which allows the medial articular fragment to be better visualized by tipping into varus. <. Extensile lateral approach xmp The lateral calcaneal artery (LCA) passed within 2 mm of the superior border of floor of the Superior Peroneal Retinaculum (SPR) at the midline of the peroneal sheath. Magnetic resonance imaging is an indispensable tool in the evaluation of musculoskeletal . This paper is a review of the sinus tarsi approach for operative fixation of calcaneal fractures. Due to the shorter incision, and more proximal location of the incision, wound complications are less common [ 2 ]. In addition, a limited sinus tarsi incision without elevation of the lateral calcaneal skin flap does not allow for plate fixation, a notable advantage of the extensile lateral approach, particularly in gaining reduction of the body of the calcaneus. The patient had normal pain sensation and was given the option of surgery due to the severe injury to both the ankle and subtalar joints. 2016 Dec 23;11(1):164. doi: 10.1186/s13018-016-0497-4. Femino JE, Vaseenon T. The direct lateral approach to the distal tibia and fibula: a single incision technique for distal tibial and pilon fractures. Orthobullets Team Pediatrics - Cavovarus Foot in Pediatrics & Adults Flashcards (2) Cards . uuid:8b07b946-4f2d-4d62-b004-46a4051d37d6 pdfaid This approach provides excellent direct exposure of the calcaneal body as with the medial approach while also providing direct exposure of the articular surface. http://ns.adobe.com/xap/1.0/ Adjacent fractures were treated through the same incision. Text The anterior process is reduced to the sustentaculum fragment, the lateral articular fragment(s) are reduced and pinned and the tuberosity is loosely reduced and provisionally pinned from posteriorly with pins into the sustentaculum or anterior process. In this manner, both nerves can be left untouched within the subcutaneous fat. They remain non-weight bearing for 10-12 weeks. 0000000075 00000 n Incidence. 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