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Anterior Approach Total Ankle Arthroplasty: Superficial Peroneal Nerve Branches at Risk.
J Foot Ankle Surg. 2016 May-Jun; 55(3):476-9.JF

Abstract

In ankle arthroplasty, little attention has been given to intraoperative nerve injury and its postoperative sequelae. The aim of the present anatomic study was to determine the relationship of the superficial peroneal nerve to the standard anterior approach for total ankle arthroplasty. The superficial peroneal nerve was dissected in 10 below-the-knee cadaver specimens. The medial and intermediate dorsal cutaneous branches were identified. A needle was placed at the ankle joint. The following measurements were recorded: bifurcation into the medial and intermediate dorsal cutaneous branches, reference needle to the branches of the medial and intermediate superficial peroneal nerve, and the crossing branches of the medial dorsal cutaneous nerve. Two specimens (20%) had a medial dorsal cutaneous branch cross from medially to laterally. Eight specimens (80%) had a crossing branch of the medial dorsal cutaneous branch within 5 cm of the incision. No intermediate dorsal cutaneous branches were within the incision. The results from the present cadaver study suggest that during an anterior ankle approach, aberrant branches of the superficial peroneal nerve could require transection in 20% of patients at the joint level and ≤80% of patients with distal extension >35 mm from the ankle joint. The risk of injury to branches of the superficial peroneal nerve is substantial. The risk of nerve injury can be decreased with meticulous operative technique, smaller incisions, and the avoidance of aggressive retraction.

Authors+Show Affiliations

Attending Physician, The CORE Institute, Phoenix, AZ.Attending Physician, Orthopedics Northwest, Yakima, WA.Attending Physician, Orthopedic Foot and Ankle Center, Westerville, OH. Electronic address: ofacresearch@orthofootankle.com.Attending Physician, Orthopedic Foot and Ankle Center, Westerville, OH.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26884263

Citation

McAlister, Jeffrey E., et al. "Anterior Approach Total Ankle Arthroplasty: Superficial Peroneal Nerve Branches at Risk." The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, vol. 55, no. 3, 2016, pp. 476-9.
McAlister JE, DeMill SL, Hyer CF, et al. Anterior Approach Total Ankle Arthroplasty: Superficial Peroneal Nerve Branches at Risk. J Foot Ankle Surg. 2016;55(3):476-9.
McAlister, J. E., DeMill, S. L., Hyer, C. F., & Berlet, G. C. (2016). Anterior Approach Total Ankle Arthroplasty: Superficial Peroneal Nerve Branches at Risk. The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, 55(3), 476-9. https://doi.org/10.1053/j.jfas.2015.12.013
McAlister JE, et al. Anterior Approach Total Ankle Arthroplasty: Superficial Peroneal Nerve Branches at Risk. J Foot Ankle Surg. 2016 May-Jun;55(3):476-9. PubMed PMID: 26884263.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anterior Approach Total Ankle Arthroplasty: Superficial Peroneal Nerve Branches at Risk. AU - McAlister,Jeffrey E, AU - DeMill,Shyler L, AU - Hyer,Christopher F, AU - Berlet,Gregory C, Y1 - 2016/02/13/ PY - 2014/10/15/received PY - 2016/2/18/entrez PY - 2016/2/18/pubmed PY - 2017/6/14/medline KW - ankle arthroplasty KW - complications KW - neuritis KW - superficial peroneal nerve SP - 476 EP - 9 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 - 55 IS - 3 N2 - In ankle arthroplasty, little attention has been given to intraoperative nerve injury and its postoperative sequelae. The aim of the present anatomic study was to determine the relationship of the superficial peroneal nerve to the standard anterior approach for total ankle arthroplasty. The superficial peroneal nerve was dissected in 10 below-the-knee cadaver specimens. The medial and intermediate dorsal cutaneous branches were identified. A needle was placed at the ankle joint. The following measurements were recorded: bifurcation into the medial and intermediate dorsal cutaneous branches, reference needle to the branches of the medial and intermediate superficial peroneal nerve, and the crossing branches of the medial dorsal cutaneous nerve. Two specimens (20%) had a medial dorsal cutaneous branch cross from medially to laterally. Eight specimens (80%) had a crossing branch of the medial dorsal cutaneous branch within 5 cm of the incision. No intermediate dorsal cutaneous branches were within the incision. The results from the present cadaver study suggest that during an anterior ankle approach, aberrant branches of the superficial peroneal nerve could require transection in 20% of patients at the joint level and ≤80% of patients with distal extension >35 mm from the ankle joint. The risk of injury to branches of the superficial peroneal nerve is substantial. The risk of nerve injury can be decreased with meticulous operative technique, smaller incisions, and the avoidance of aggressive retraction. SN - 1542-2224 UR - https://www.unboundmedicine.com/medline/citation/26884263/Anterior_Approach_Total_Ankle_Arthroplasty:_Superficial_Peroneal_Nerve_Branches_at_Risk_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1067-2516(15)00585-2 DB - PRIME DP - Unbound Medicine ER -