Foot Inclusion for External Fixators

- Indications:
    - temporary fixation of foot to eliminate ankle & soft tissue motion at frx site may be needed w/ open frx treated w/ external fixators;
    - patient w/ concurrent head injury or severe soft tissue wounds involving muscles that control ankle or foot motion;
    - foot inclusion prevents plantar skin break down & equinus deformities;

- Calcaneal Pin Insertion

- Insertion of Talar Pins:
    - pins are usually inserted from the medial side to avoid N/V structures;
    - mark a line joining the points from the medial malleolus to the navicular;
    - insertion of pins anterior to this line should safely avoid the N/V bundle;
    - using flouroscopy, insert a horizontally directed pin into the talar neck, just proximal to the head and midway between the dorsal and plantar surfaces of the talus;
           - the pin should be perpendicular to the talar neck as seen on the AP view;

- Insertion Technique for Ilizarov:
    - half ring must be elongated w/ plates to accommodate obliquely inserted transfixation wires;
    - at the distal edge of the plate, another half ring is attached at right angles to the floor;
    - hindfoot:
          - is stabilized w/ 2 to 3 crossed transfixation pins placed thru posterior calcaneal tuberosity;
          - see: calcaneal pin insertion:
    - midfoot and forefoot:
          - two 4 mm half pins inserted into subcutaneous border of first metatarsal;
          - fifth metatarsal can be used similarly;
          - alternatively, a single transfixation pin can be placed transversely thru the midfoot between dorsal & plantar neurovascular & tendinous structures;
          - or, transfixation wires can be inserted thru the necks of the first and fifth metatarsal necks, passing underneath the central metatarsals;
          - or, the surgeon's hand can be used to flatten out the forefoot arch, when then allows a tranfixation wire to be directed across all 5 metatarsals;
    - Frame:
          - two half rings are used to construct the foot frame;
          - the half rings are the same size as the tibial rings

Percutaneous pin placement in the medial calcaneus: is anywhere safe?

The Safety of Forefoot Metatarsal Pins in External Fixation of the Lower Extremity

The "safe zone" in medial percutaneous calcaneal pin placement.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, August 2, 2012 12:25 pm