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Posterior approach for medial column beam screw in midfoot Charcot reconstruction: technique and structures at risk.
J Foot Ankle Surg. 2015 May-Jun; 54(3):433-6.JF

Abstract

Charcot neuroarthropathy is frequently recognized as a major cause of morbidity in patients with neuropathic diabetes mellitus. Recently, intramedullary beam screw fixation has been used for midfoot Charcot reconstructions. Ten below-the-knee cadaveric specimens were used to demonstrate an antegrade, posterior approach for placement of a medial column beam screw, with specific attention to the proximity of the anatomic structures at risk. Six structures at risk were identified, including the sural nerve, ankle joint, flexor hallucis longus tendon, Achilles tendon, neurovascular bundle, and peroneal tendon sheath. The sural nerve was the most commonly injured structure, injured in 50% of the limbs. The Achilles and flexor hallucis longus tendons were injured in 20% and the ankle joint in 10% of the limbs. The neurovascular bundle and peroneal tendon sheath were located over 1 cm from the reference guidewire and were considered safe structures in this approach. Our results have demonstrated an alternative posterior approach to the delivery of an intramedullary medial column beam screw, instead of a retrograde technique beginning in the metatarsal heads. Our results have also made clear the need to be aware of the potential for damage to the sural nerve, Achilles tendon, flexor hallucis longus tendon, and ankle joint.

Authors+Show Affiliations

Fellowship-Trained Foot and Ankle Surgeon, Suburban Orthopaedics, Bartlett, IL.Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Westerville, OH. Electronic address: ofacresearch@orthofootankle.com.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25456342

Citation

Peterson, Kyle S., and Christopher F. Hyer. "Posterior Approach for Medial Column Beam Screw in Midfoot Charcot Reconstruction: Technique and Structures at Risk." The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, vol. 54, no. 3, 2015, pp. 433-6.
Peterson KS, Hyer CF. Posterior approach for medial column beam screw in midfoot Charcot reconstruction: technique and structures at risk. J Foot Ankle Surg. 2015;54(3):433-6.
Peterson, K. S., & Hyer, C. F. (2015). Posterior approach for medial column beam screw in midfoot Charcot reconstruction: technique and structures at risk. The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, 54(3), 433-6. https://doi.org/10.1053/j.jfas.2014.10.006
Peterson KS, Hyer CF. Posterior Approach for Medial Column Beam Screw in Midfoot Charcot Reconstruction: Technique and Structures at Risk. J Foot Ankle Surg. 2015 May-Jun;54(3):433-6. PubMed PMID: 25456342.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Posterior approach for medial column beam screw in midfoot Charcot reconstruction: technique and structures at risk. AU - Peterson,Kyle S, AU - Hyer,Christopher F, Y1 - 2014/11/11/ PY - 2014/08/22/received PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2016/3/29/medline KW - Charcot foot KW - diabetes mellitus KW - flexor tendon KW - intramedullary beam KW - neuroarthropathy KW - sural nerve KW - surgical complication SP - 433 EP - 6 JF - The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons JO - J Foot Ankle Surg VL - 54 IS - 3 N2 - Charcot neuroarthropathy is frequently recognized as a major cause of morbidity in patients with neuropathic diabetes mellitus. Recently, intramedullary beam screw fixation has been used for midfoot Charcot reconstructions. Ten below-the-knee cadaveric specimens were used to demonstrate an antegrade, posterior approach for placement of a medial column beam screw, with specific attention to the proximity of the anatomic structures at risk. Six structures at risk were identified, including the sural nerve, ankle joint, flexor hallucis longus tendon, Achilles tendon, neurovascular bundle, and peroneal tendon sheath. The sural nerve was the most commonly injured structure, injured in 50% of the limbs. The Achilles and flexor hallucis longus tendons were injured in 20% and the ankle joint in 10% of the limbs. The neurovascular bundle and peroneal tendon sheath were located over 1 cm from the reference guidewire and were considered safe structures in this approach. Our results have demonstrated an alternative posterior approach to the delivery of an intramedullary medial column beam screw, instead of a retrograde technique beginning in the metatarsal heads. Our results have also made clear the need to be aware of the potential for damage to the sural nerve, Achilles tendon, flexor hallucis longus tendon, and ankle joint. SN - 1542-2224 UR - https://www.unboundmedicine.com/medline/citation/25456342/Posterior_approach_for_medial_column_beam_screw_in_midfoot_Charcot_reconstruction:_technique_and_structures_at_risk_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1067-2516(14)00532-8 DB - PRIME DP - Unbound Medicine ER -