title: Circular frame fixation for calcaneal fractures risks injury to the medial neurovascular structures: A cadaveric description.
abstract: OBJECTIVE
  There is a risk of iatrogenic injury to the soft tissues of the calcaneus and this study assesses the risk of injury to these structures in circular frame calcaneal fracture fixation.
  
  
  METHODS
  After olive tip wires were inserted, an L-shaped incision on the lateral and medial aspects of 5 formalin fixed cadaveric feet was performed to expose the underlying soft tissues. The calcaneus was divided into zones corresponding to high, medium and low risk using a grading system.
  
  
  RESULTS
  Structures at high risk included the posterior tibial artery, posterior tibial vein and posterior tibial nerve on the medial aspect. Soft tissue structures on the lateral side that were shown to be at lower risk of injury were the small saphenous vein and the sural nerve and the tendons of fibularis longus and fibularis brevis.
  
  
  CONCLUSIONS
  The lateral surface of the calcaneus provides a lower risk area for external fixation. The risk of injury to significant soft tissues using a circular frame fixation approach has been shown to be greater on the medial aspect.
  
  
  CONCLUSIONS
  This study highlights the relevant anatomical relations in circular frame fixation for calcaneal fractures to minimise damage to these structures.
authors: Laboratory of Human Anatomy, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, Univeristy of Glasgow, UK.
authors: Tom
authors: T
authors: Esparon
authors: Laboratory of Human Anatomy, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, Univeristy of Glasgow, UK.
authors: Callum M
authors: CM
authors: Thomson
authors: Laboratory of Human Anatomy, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, Univeristy of Glasgow, UK. Electronic address: Paul.Rea@glasgow.ac.uk.
authors: Paul M
authors: PM
authors: Rea
authors: Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, UK.
authors: Bilal
authors: B
authors: Jamal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D002111:Calcaneus / Q000033:anatomy & histology / Q000601:surgery*; D016267:External Fixators / Q000009:adverse effects; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D059348:Peripheral Nerve Injuries / Q000517:prevention & control*; D012307:Risk Factors; D017695:Soft Tissue Injuries / Q000517:prevention & control*; D013979:Tibial Nerve / Q000293:injuries*
keywords: Calcaneus; External fixation; Heel fractures; Ilizarov; Safe-Zone; Surgical procedures