title: Percutaneous pin placement in the medial calcaneus: is anywhere safe?
abstract: OBJECTIVE
  To redefine the medial calcaneal anatomic safe zone for pin placement with respect to reproducible palpable landmarks.
  
  
  METHODS
  Anatomic study.
  
  
  METHODS
  Medical school anatomy laboratory.
  
  
  METHODS
  Thirty-three fresh-frozen adult cadaveric feet were used. Three palpable anatomic landmarks were identified on each ankle and labeled as Point A (posteroinferior medial calcaneus), Point B (inferior medial malleolus), and Point C (navicular tuberosity). The medial neurovascular bundle was carefully dissected, and the medial calcaneal nerve, the most posterior branch of the lateral plantar nerve, the lateral plantar nerve, the medial plantar nerve, and the posterior tibial artery were identified. These structures were recorded at the point at which they transected a line from Point A to B and from Point A to C. Based on the findings of the first thirty-three feet, two pins were placed percutaneously into the medial calcaneus of ten additional feet. Pin 1 was placed one half the distance from Point A to B. Pin 2 was placed one third the distance from Point A to C. The neurovascular structures were then dissected and identified in relation to the pin position.
  
  
  RESULTS
  The medial calcaneal, most posterior branch of the lateral plantar, and lateral plantar nerves are at significant risk for abutting the pins or being directly injured at the margins of these relative safe zones.
  
  
  CONCLUSIONS
  The medial calcaneus provides a small window for safe percutaneous pin placement. Posterior to the halfway point from Point A to B and posterior to the one-third mark from Point A to C remain the relatively safest regions; a more posterior placement in the safe zone is safest. Careful blunt dissection and the use of cannulas may help to avoid neurovascular injury.
authors.affiliation: Boston Medical Center, Boston, Massachusetts 02118, USA.
authors.forename: David
authors.initials: D
authors.lastname: Casey
authors.forename: Timothy
authors.initials: T
authors.lastname: McConnell
authors.forename: Selene
authors.initials: S
authors.lastname: Parekh
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
mesh_terms: D016512:Ankle Injuries / Q000601:surgery; D002102:Cadaver; D002111:Calcaneus / Q000033:anatomy & histology* / Q000601:surgery*; D016267:External Fixators; D005528:Foot / Q000033:anatomy & histology / Q000601:surgery; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D012449:Safety; D012680:Sensitivity and Specificity