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Siddiqui AA, Troyer WD, Bango J, Mustafa MS, Buckner JF, Shi GG, Haupt ET. Lateralizing calcaneal osteotomy performed with a percutaneous burr results in a significantly lower increase in tarsal tunnel pressure. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1865-1870. [PMID: 38431895 DOI: 10.1007/s00590-024-03865-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Tarsal tunnel syndrome is well documented following lateralizing calcaneal osteotomy to manage varus hindfoot deformity. Traditionally, calcaneal osteotomy is performed with an oscillating saw. No studies have investigated the effect of alternative surgical techniques on postoperative tarsal tunnel pressure. The purpose of this study was to investigate the difference in tarsal tunnel pressures following lateralizing calcaneal osteotomy performed using a high-torque, low-speed "minimally invasive surgery" (MIS) Shannon burr versus an oscillating saw. METHODS Lateralizing calcaneal osteotomy was performed on 10 below-knee cadaveric specimens. This was conducted on 5 specimens each using an oscillating saw (Saw group) or MIS burr (Burr group). The calcaneal tuberosity was translated 1 cm laterally and transfixed using 2 Kirschner wires. Tarsal tunnel pressure was measured before and after osteotomy via ultrasound-guided percutaneous needle barometer. Mean pre/post-osteotomy pressures were compared between groups. Differences were analyzed using Student's t test. RESULTS The mean pre-procedure tarsal tunnel pressure was 25.8 ± 5.1 mm Hg in the Saw group and 26.4 ± 4.3 mm Hg in the Burr group (p = 0.85). The mean post-procedure pressure was 63.4 ± 5.1 in the Saw group and 47.8 ± 4.3 in the Burr group (p = 0.01). Change in tarsal tunnel pressure was significantly lower in the Burr group (21.4 ± 4.5) compared to the Saw group (37.6 ± 12.5) (p = 0.03). The increase in tarsal tunnel pressure was 43% lower in the Burr group. CONCLUSION In this cadaveric study, tarsal tunnel pressure increase after lateralizing calcaneal osteotomy was significantly lower when using a burr versus a saw. This is likely because the increased width ("kerf") of the 3 mm MIS burr, compared to the submillimeter saw blade width, causes calcaneal shortening. Given the smaller increase in tarsal tunnel pressure, using the MIS burr for lateralizing calcaneal osteotomy may decrease the risk of postoperative tarsal tunnel syndrome. Future research in vivo should explore this.
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Affiliation(s)
- Ali A Siddiqui
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA.
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - Wesley D Troyer
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Jugert Bango
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Moawiah S Mustafa
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Jeannie F Buckner
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Glenn G Shi
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Edward T Haupt
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
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Beischl S, Harrasser N, Toepfer A, Scheele C, Smits Sererna R, Walther M, Lenze F, Hörterer H. Feasibility and safety of minimally invasive calcaneal osteotomy (MICO) through a medial approach: a case-control study. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:39-46. [PMID: 38078936 PMCID: PMC10781868 DOI: 10.1007/s00132-023-04460-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Minimally invasive calcaneal osteotomy (MICO) is already an established surgical procedure for correcting hindfoot deformities using a lateral approach. So far, no description of a medial approach for MICO has been published. MATERIAL AND METHODS Between August 2022 and March 2023, 32 consecutive patients (MICO with medial approach, MMICO: n = 15; MICO with lateral approach, LMICO: n = 17) underwent MICO as part of complex reconstructive surgery of the foot and ankle with concomitant procedures. The amount of correction in the axial view of the calcaneus and consolidation rates were evaluated radiographically. Subjective satisfaction, stiffness of the subtalar joint, and pain level (numeric rating scale, NRS) at the level of the heel were assessed clinically. The last follow-up was at 6 months. RESULTS All osteotomies consolidated within 6 months after surgery. Displacement of the tuber was 9 mm on average in either group. Relevant subtalar joint stiffness was detected in 5 MMICO and 6 LMICO patients. No relevant differences between the groups were detected for wound healing problems, nerve damage, heel pain or patient satisfaction. CONCLUSION In this study lateral and medial approaches for MICO were performed. Similar degrees of correction and low complication rates were found in both groups. The medial approach for MICO is safe and can be beneficial regarding patient positioning and arrangement of the C‑arm.
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Affiliation(s)
- S Beischl
- Clinic of Orthopaedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - N Harrasser
- Clinic of Orthopaedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - A Toepfer
- Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacher Straße 95, 9007, St. Gallen, Switzerland
| | - C Scheele
- Clinic of Orthopaedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - R Smits Sererna
- Clinic of Orthopaedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - M Walther
- Center for Foot and Ankle Surgery, Schön Clinic Munich Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547, Munich, Germany
| | - F Lenze
- Clinic of Orthopaedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - H Hörterer
- Center for Foot and Ankle Surgery, Schön Clinic Munich Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
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