- Discussion:
- are placed from the medial side to avoid damage to the posterior tibial neurovascular pedicle;
- posterior tibial pulse should be palpated with one hand during the initial placement;
- safe zone is outlined by a vertical line tangential to the posterior border of the medial malleolus
and a horiztontal line at the level of the postero-superior edge of the calcaneal tuberosity;
- the safe zone lies in the postero-inferior quadrant of these lines;
- exit should be chosen so that the pin is perpendicular to tibia;
- ideally, it will not exit too close to the fibula, as this can again damage the peroneal tendons, as well
as the sural nerve, lesser saphenous vein, and
peroneal artery;
- according to
Tournetta, et al., the medial calcaneus provides a small window for safe percutaneous pin placement.
