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Avoidance of injury to the posterior neurovascular bundle during total ankle arthroplasty – A simple technical tip
Foot and Ankle Surgery ( IF 2.5 ) Pub Date : 2022-04-29 , DOI: 10.1016/j.fas.2022.04.003
Eamonn Ramhamadany 1 , Toby Jennison 1 , Howard G Davies 1 , Kris Buedts 2 , Chris M Blundell 1
Affiliation  

Iatrogenic nerve injury to the tibial nerve is a serious but avoidable complication of total ankle replacements and may be under-reported as it may go unrecognised or thought to be due to tarsal tunnel syndrome. The tibial nerve is particularly vulnerable during the saw cuts at the posteromedial corner without appropriate protection. Prior to drilling the tibial and talar pins of the adjustment block for the Infinity ankle replacement we perform a 2 cm incision behind the medial malleolus. The tibialis posterior tendon sheath is identified and incised. A periosteal elevator is used to develop a plane between the back of the tibia and the tibialis posterior tendon and then exchanged for a mini Hohmann retractor protecting the neurovascular bundle. This allows us to drill the pins and saw cuts safely. The Hohmann retractor can be felt at the tip of the saw blade providing reassurance that the blade is not too deep. Our technique has not previously been reported in the literature. It acts as a simple reproducible way of avoiding injury to structures at the back of the ankle joint.



中文翻译:

在全踝关节置换术中避免损伤后神经血管束——一个简单的技术提示

胫神经的医源性神经损伤是全踝关节置换术的一种严重但可避免的并发症,并且可能被低估,因为它可能未被识别或被认为是由于跗管综合症引起的。在没有适当保护的情况下,胫神经在后内侧角处的锯切过程中特别脆弱。在为 Infinity 踝关节置换术的调节块钻胫骨和距骨针之前,我们在内踝后方做一个 2 cm 的切口. 识别并切开胫骨后肌腱鞘。使用骨膜升降器在胫骨后部和胫骨后肌腱之间建立一个平面,然后换成保护神经血管束的迷你霍曼牵开器。这使我们能够安全地钻销和锯切。可以在锯片的尖端感觉到 Hohmann 收缩器,确保锯片不会太深。我们的技术以前没有在文献中报道过。它作为一种简单可重复的方法来避免损伤踝关节后部的结构。

更新日期:2022-04-29
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