title: Calcaneal traction pin placement simplified: a cadaveric study.
abstract: BACKGROUND
  The tibial neurovascular bundle and sural nerve are at risk with errant pin placement during transcalcaneal pin placement. The purpose of this study was to determine a relative safe zone using a single osseous landmark to establish a technique applicable in the presence of trauma. We describe the neural anatomy anatomically and radiographically, giving surgeons a reliable and relatively safe technique for transcalcaneal pin placement.
  
  
  METHODS
  Twenty-four cadavers were dissected for the major medial neurovascular structures and the sural nerve. The closest distance from the neurovascular structures to the posterior inferior calcaneus was measured.
  
  
  RESULTS
  The mean distance from the posterior inferior calcaneus to the closest major medial neurovascular structure was 3.4 cm (SD ± 0.36; range, 2.6 to 4.1 cm). The mean distance to the sural nerve was 3.4 cm (SD ± 0.54; range, 2.3 to 4.6 cm). According to the 95% confidence intervals, a relative safe zone of 3.1 cm as a radius from the posterior inferior calcaneus was determined.
  
  
  CONCLUSIONS
  A relatively safe zone of 3.1 cm based on 95% confidence intervals as described as a radius from the posterior inferior calcaneus can be used for transcalcaneal pin placement in most cases without injury to the medial neurovascular bundle or sural nerve. However anatomic variation may result in the neurovascular bundle being within this zone.
  
  
  CONCLUSIONS
  We describe a surgical technique for reliable placement of a transcalcaneal pin within this relative safe zone and a safe distance from the closest neurovascular structure.
authors: Harvard Medical School, Department of Orthopaedic Surgery, Massachusetts Beneral Hospital, Boston, MA, USA. johnkwonmd@gmail.com
authors: John Y
authors: JY
authors: Kwon
authors: J Kent
authors: JK
authors: Ellington
authors: Daniel
authors: D
authors: Marsland
authors: Sanjeev
authors: S
authors: Gupta
mesh_terms: D001858:Bone Nails; D002102:Cadaver; D002111:Calcaneus / Q000294:innervation* / Q000601:surgery*; D005260:Female; D005528:Foot / Q000294:innervation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014143:Traction