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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.

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