Can sural nerve injury be avoided in the sinus tarsi approach for calcaneal fracture? A cadaveric study

被引:21
作者
Park, Jeong-Hyun [1 ]
Chun, Dong-Il [2 ]
Park, Kwang-Rak [1 ]
Park, Gun-Hyun [3 ]
Park, Suyeon [4 ]
Yang, Jinseo [5 ]
Cho, Jaeho [3 ]
机构
[1] Kangwon Natl Univ, Grad Sch Med, Dept Anat & Cell Biol, Kangwon, South Korea
[2] Soonchunhyang Univ, Seoul Hosp, Dept Orthoped Surg, Seoul, South Korea
[3] Hallym Univ, Chuncheon Sacred Heart Hosp, Dept Orthopaed Surg, 77 Sakju Ro, Chuncheon Si 200704, Gangwon Do, South Korea
[4] Soonchunhyang Univ Hosp, Coll Med, Dept Biostat, Seoul, South Korea
[5] Hallym Univ, Chuncheon Sacred Heart Hosp, Dept Neurosurg, Chunchon, South Korea
关键词
cadaver; calcaneus; complication; fracture; sinus tarsi approach; sural nerve; DISPLACED INTRAARTICULAR FRACTURES; OPEN REDUCTION; INTERNAL-FIXATION; WOUND COMPLICATIONS; EMPHASIS;
D O I
10.1097/MD.0000000000017611
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
There is no consensus regarding the references to determine the exact location of the skin incision to minimize iatrogenic sural nerve injury in the sinus tarsi approach for calcaneal fracture. The purpose of this cadaveric study was to describe the anatomical course of the sural nerve in relation to easily identifiable landmarks during the sinus tarsi approach and to provide a more practical reference for surgeons to avoid sural nerve injury. Twenty-four foot and ankle specimens were dissected. The bony landmarks used in the following reference points were the tip of the lateral malleolus (point A), lateral border of the Achilles tendon on the collinear line with point A (point B), posteroinferior apex of the calcaneus (point C), inferior margin of the calcaneus on the plumb line through point A (point D), and tip of the fifth metatarsal base (point E). After careful dissection, the distances of the sural nerve to points A and B in the horizontal direction (lines D1 and D2), points A and C in the diagonal direction (lines D3 and D4), points A and D in the vertical direction (lines D5 and D6), and points A and E in the diagonal direction (lines D7 and D8) were measured. The median ratio of D1 to D1+D2, D3 to D3+D4, D5 to D5+D6, and D7 to D7+D8 were 0.37 (range, 0.26-0.50), 0.23 (range, 016-0.33), 0.35 (range, 0.25-0.45), and 0.32 (range, 0.20-0.45), respectively. The distance ratios from this study can be helpful to avoid sural nerve injury during the sinus tarsi approach for calcaneal fractures. Established standard incision may have to be modified to minimize sural nerve injury.
引用
收藏
页数:5
相关论文
共 22 条
[1]   Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures [J].
Abidi, NA ;
Dhawan, S ;
Gruen, GS ;
Vogt, MT ;
Conti, SF .
FOOT & ANKLE INTERNATIONAL, 1998, 19 (12) :856-861
[2]   Wound complications following operative fixation of calcaneal fractures [J].
Al-Mudhaffar, M ;
Prasad, CVR ;
Mofidi, A .
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 2000, 31 (06) :461-464
[3]   Wound healing complications in closed and open calcaneal fractures [J].
Benirschke, SK ;
Kramer, PA .
JOURNAL OF ORTHOPAEDIC TRAUMA, 2004, 18 (01) :1-6
[4]  
Buckley R E, 1992, J Orthop Trauma, V6, P216, DOI 10.1097/00005131-199206000-00014
[5]   Early wound complications of operative treatment of calcaneus fractures: Analysis of 190 fractures [J].
Folk, JW ;
Starr, AJ ;
Early, JS .
JOURNAL OF ORTHOPAEDIC TRAUMA, 1999, 13 (05) :369-372
[6]   Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach [J].
Harvey, EJ ;
Grujic, L ;
Early, JS ;
Benirschke, SK ;
Sangeorzan, BJ .
FOOT & ANKLE INTERNATIONAL, 2001, 22 (11) :868-873
[7]   Treatment of Displaced Calcaneus Fractures Using a Minimally Invasive Sinus Tarsi Approach [J].
Hospodar, Paul ;
Guzman, Camilo ;
Johnson, Paul ;
Uhl, Richard .
ORTHOPEDICS, 2008, 31 (11) :1112-1117
[8]   The anatomic features of the sural nerve with an emphasis on its clinical importance [J].
Ikiz, ZAA ;
Üçerler, H ;
Bilge, O .
FOOT & ANKLE INTERNATIONAL, 2005, 26 (07) :560-567
[9]   Variations in sural nerve formation pattern and distribution on the dorsum of the foot [J].
Jeon, Su Kyoung ;
Paik, Doo-Jin ;
Hwang, Young-Il .
CLINICAL ANATOMY, 2017, 30 (04) :525-532
[10]   Minimally Invasive Technique Versus an Extensile Lateral Approach for Intra-Articular Calcaneal Fractures [J].
Kline, Alex J. ;
Anderson, Robert B. ;
Davis, W. Hodges ;
Jones, Carroll P. ;
Cohen, Bruce E. .
FOOT & ANKLE INTERNATIONAL, 2013, 34 (06) :773-780