CME OnDemand: 2022 AOFAS Annual Meeting-Anterior Structures at Risk During Antegrade Subtalar Fusion: A Cadaver Study

Pdf Summary

A study compared the percutaneous and mini-open approaches for talocalcaneal arthrodesis, a procedure commonly used for hindfoot pathologies. The primary endpoint was damage to important soft tissue structures in the anterior foot. Three specimens in the percutaneous group and one specimen in the mini-open group had the guidewire touching the anatomical structure of interest. One specimen in the percutaneous group had injured structures. The average distances between the guidewire and uninjured anatomical structures were summarized. Overall, the percutaneous approach had an increased risk of soft tissue injury, while the mini-open approach provided more visualization of the soft tissue structures. The percutaneous technique had the guidewire closer to the superficial peroneal nerve, deep peroneal nerve, dorsalis pedis artery, and dorsalis pedis vein, while the mini-open procedure had the guidewire closer to the extensor hallucis longus muscle/tendon and tibialis anterior muscle/tendon. The dorsal pedis nerve, deep peroneal artery, extensor hallucis longus tendon, and dorsalis pedis vein were damaged or touched in the percutaneous group. However, the average distances to all structures except for the extensor hallucis longus tendon and tibialis anterior tendon were increased in the mini-open approach. The study had limitations such as a small sample size and possible human errors. However, all procedures were performed by fellowship-trained foot and ankle surgeons, and it was the first study comparing soft tissue iatrogenic injury between the anterior mini-open and anterior percutaneous subtalar screw placement.

Asset Subtitle

Ashish Shah, MD, Zachary Littlefield, MD, Sean M. Young, Thomas Sanchez, Turner Sankey, Alexander K. Mihas, Matthew Young, Chad B. Willis, MD

Keywords

talocalcaneal arthrodesis

percutaneous approach

mini-open approach

hindfoot pathologies

soft tissue structures

guidewire

anatomical structures

soft tissue injury

visualization of soft tissue

risk of injury