- 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.
