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Calcaneal pins



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