title: Anatomical evaluation of different approaches for tibiotalocalcaneal arthrodesis.
abstract: BACKGROUND
  The transfibular approach is commonly used for tibiotalocalcaneal arthrodesis. However, the medial and the posterolateral approaches are available as alternatives. The present study was performed to assess the effects of the 3 approaches on the neurovascular structures encountered and to quantify the extent of cartilage in the different joint compartments that could be surgically debrided.
  
  
  METHODS
  This cadaver study was performed in 6 pairs of formalin-fixed legs (mean donor age: 80 years; 4 females, 2 males). For each approach, 4 specimens were selected. The neurovascular structures at risk and the debrided portions of the articular cartilage were compared.
  
  
  RESULTS
  Arterial structures were least compromised by the transfibular approach. The posterolateral approach was particularly likely to damage the lateral malleolar branches of the peroneal artery. Venous structures were at risk mainly from the medial approach, which was also the most risk-bearing of the 3 approaches in terms of nerve damage. The proportions of cartilage-debrided joint surfaces of the tibia in the ankle joint, and of the talus and the calcaneus in the subtalar joint, did not differ notably. The proportions of debrided surfaces of the talus in the ankle joint differed notably among the 3 approaches.
  
  
  CONCLUSIONS
  The medial approach could be a valid alternative to the lateral transfibular approach for tibiotalocalcaneal arthrodesis. Care should be taken, however, to prevent damage to the saphenous nerve and other neurological structures.
  
  
  CONCLUSIONS
  Access morbidity and feasibility of adequate cartilage debridement are relevant to the clinical outcome of hindfoot arthrodesis.
authors: Department of Trauma, Hand and Reconstructive Surgery, Friedrich-Schiller-University Jena, Jena, Germany.
authors: Sascha
authors: S
authors: Rausch
authors: Clemens
authors: C
authors: Loracher
authors: Rosemarie
authors: R
authors: Fröber
authors: Boyko
authors: B
authors: Gueorguiev
authors: Andreas
authors: A
authors: Wagner
authors: Florian
authors: F
authors: Gras
authors: Paul
authors: P
authors: Simons
authors: Kajetan
authors: K
authors: Klos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000601:surgery; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods*; D002102:Cadaver; D002111:Calcaneus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013628:Talus / Q000601:surgery*; D013977:Tibia / Q000601:surgery*
keywords: joint cartilage debridement; medial approach; neurovascular structures; posterolateral approach; transfibular approach