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Calcaneal Osteotomy Safe Zone to Prevent Neurological Damage: Fact or Fiction?

Publication ,  Journal Article
Wills, B; Lee, SR; Hudson, PW; SahraNavard, B; de Cesar Netto, C; Naranje, S; Shah, A
Published in: Foot Ankle Spec
February 2019

BACKGROUND: Calcaneal osteotomy is a commonly used surgical option for the correction of hindfoot malalignment. A previous cadaveric study described a neurological "safe zone" for calcaneal osteotomy. We performed a retrospective chart review to evaluate the presence of neurological injuries following calcaneal osteotomies and the location of the osteotomy in relation to the reported safe zone. METHODS: In this retrospective study, we reviewed charts of patients who underwent calcaneal osteotomy at our institution from 2011 to 2015. All immediate postoperative radiographs were examined and the shortest distance between the calcaneal osteotomy line and a reference line connecting the posterior superior apex of the calcaneal tuberosity to the origin of the plantar fascia was measured. If the osteotomy line was positioned within an area 11.2 mm anterior to the reference line, it was considered to be inside the neurological safe zone. We correlated the positioning of the osteotomy with the presence of postoperative neurological complications. RESULTS: We identified 179 calcaneal osteotomy cases. Of the 174 (97.2%) nerve injury-free cases, 62.6% (109/174) were performed inside the defined "safe zone" while 37.4% (65/174) outside. A total of 5 (2.8%) nerve complications were identified: 3 (60%) were inside the safe zone and 2 (40%) outside the safe zone. Osteotomies outside the safe zone had a 1.114 relative risk of nerve injury with a 95% CI of 0.191 to 6.500 and showed no statistically significant difference ( P = .9042). CONCLUSION: Our findings suggest that the clinical "safe zone" in calcaneal osteotomies may not actually exist, likely because of wide anatomical variation of the implicated nerves, as described in prior studies. Patients should be properly counseled preoperatively on the low, but seemingly fixed, risk of nerve injury before undergoing calcaneal osteotomy. LEVELS OF EVIDENCE: Level III: Retrospective comparative study.

Duke Scholars

Published In

Foot Ankle Spec

DOI

EISSN

1938-7636

Publication Date

February 2019

Volume

12

Issue

1

Start / End Page

34 / 38

Location

United States

Related Subject Headings

  • Young Adult
  • Retrospective Studies
  • Postoperative Complications
  • Peripheral Nerve Injuries
  • Osteotomy
  • Middle Aged
  • Margins of Excision
  • Male
  • Iatrogenic Disease
  • Humans
 

Citation

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Wills, B., Lee, S. R., Hudson, P. W., SahraNavard, B., de Cesar Netto, C., Naranje, S., & Shah, A. (2019). Calcaneal Osteotomy Safe Zone to Prevent Neurological Damage: Fact or Fiction? Foot Ankle Spec, 12(1), 34–38. https://doi.org/10.1177/1938640018762556
Wills, Bradley, Sung Ro Lee, Parke William Hudson, Bahman SahraNavard, Cesar de Cesar Netto, Sameer Naranje, and Ashish Shah. “Calcaneal Osteotomy Safe Zone to Prevent Neurological Damage: Fact or Fiction?Foot Ankle Spec 12, no. 1 (February 2019): 34–38. https://doi.org/10.1177/1938640018762556.
Wills B, Lee SR, Hudson PW, SahraNavard B, de Cesar Netto C, Naranje S, et al. Calcaneal Osteotomy Safe Zone to Prevent Neurological Damage: Fact or Fiction? Foot Ankle Spec. 2019 Feb;12(1):34–8.
Wills, Bradley, et al. “Calcaneal Osteotomy Safe Zone to Prevent Neurological Damage: Fact or Fiction?Foot Ankle Spec, vol. 12, no. 1, Feb. 2019, pp. 34–38. Pubmed, doi:10.1177/1938640018762556.
Wills B, Lee SR, Hudson PW, SahraNavard B, de Cesar Netto C, Naranje S, Shah A. Calcaneal Osteotomy Safe Zone to Prevent Neurological Damage: Fact or Fiction? Foot Ankle Spec. 2019 Feb;12(1):34–38.
Journal cover image

Published In

Foot Ankle Spec

DOI

EISSN

1938-7636

Publication Date

February 2019

Volume

12

Issue

1

Start / End Page

34 / 38

Location

United States

Related Subject Headings

  • Young Adult
  • Retrospective Studies
  • Postoperative Complications
  • Peripheral Nerve Injuries
  • Osteotomy
  • Middle Aged
  • Margins of Excision
  • Male
  • Iatrogenic Disease
  • Humans