Percutaneous Harvest of Calcaneal Bone Autograft: Quantification of Volume and Definition of Anatomical Safe Zone.

Bone grafting is commonly used in reconstructive foot and ankle surgery. The calcaneus provides an excellent site for graft harvest due to its rich vascularity and access to corticocancellous or strictly cancellous bone. The relatively thin soft tissue envelope makes dissection easy compared to more proximal autograft sites. In this investigation we quantified cancellous autograft volume from the calcaneus while simultaneously defining anatomical safe zones and identifying anatomical structures at risk. Nine matched-pair (18 total) fresh-frozen cadaveric below-knee limbs were utilized. All limbs were thawed at room temperature prior to the procedure. Calcaneal autograft was harvested following the senior author's (D.J.E.) technique. Bone graft was packed and quantified by podiatric medical students (B.R. and J.T.). An independent investigator (K.S.) meticulously dissected the lateral calcaneal soft tissue envelope to determine rates of neurovascular compromise. Anatomical safe zones were defined by measurements of the harvest site compared to vital anatomical structures. Cancellous autograft averaging 0.85 cc was obtained through an average cortical opening of 0.77 cm. The stab incision is approximately 2.2 cm anterior to the posterior aspect of the calcaneus and 1.6 cm superior to the inferior aspect of the calcaneus. This incision is an average 1.8 cm from the main branch of the sural nerve. No neurovascular damage was found. This study details percutaneous harvest of calcaneal autograft for use in forefoot or midfoot surgeries with an emphasis on feasibility of this additional procedure. The technique proposed is valuable based on simplicity, wide anatomic safe zone, and potential improvement of surgical outcomes.

Novel Branching Pattern of the Common Fibular Nerve: Emergence of the Superficial Fibular Nerve Within the Anterior Crural Compartment.

Distal to its origination from the sciatic nerve, the common fibular (peroneal) nerve divides into the superficial and deep fibular (peroneal) nerves. Whereas the deep fibular nerve continues its course into the anterior compartment, the superficial fibular nerve (SFN) usually arises near the fibular neck and projects distally within the lateral crural compartment before entering the superficial fascia proximal to the ankle. In this report, we describe a unilateral case where the SFN arises within the anterior crural compartment and remains there for the remainder of its course deep to the deep fascia of the leg. Surgeons should be aware of anomalies such as this, for example, when performing fasciotomies to avoid inadvertently damaging an anomalously placed SFN.

The fibularis digiti quinti tendon: A cadaveric study with anthropological and clinical considerations.

In addition to the fibularis longus and brevis muscles, a number of anomalous muscles or tendons can arise from the lateral compartment of the leg. The authors describe a bilateral and robust fibularis digiti quinti (FDQ) tendon present in the foot of a 99-year-old female cadaver, present the incidence of this tendon in a cohort of 26 cadavers dissected by podiatric-medical students for a lower-extremity anatomy course, and discuss the anthropological and clinical significance of the findings. In these specimen, the FDQ tendon arose from the fibularis brevis tendon proximal to the lateral malleolus, but did not separate completely from the fibularis brevis tendon until passing through the inferior fibular retinaculum. On the lateral dorsum of the foot, the FDQ passed through a third fibular retinaculum formed by the fibularis tertius tendon, and inserted onto the extensor sling of the fifth digit. This case specimen is designated as an example of the fully present category. Of the 52 limbs dissected, 17 limbs (33%) showed a fully present FDQ, while 20 limbs (38%) exhibited an FDQ in a rudimentary form. Thus, 71% of the limbs showed some presence of the FDQ. Because human bipedality requires less dexterity than that of nonhuman primates in the routine use of their hindlimbs, the authors interpret the high variability of the FDQ, including its absence in many feet, as a relaxation of natural selection maintaining this trait since the divergence of humans from African apes.

Absence of the fourth tendon of the flexor digitorum brevis muscle: a cadaveric study.

UNLABELLED: This study was undertaken to help confirm the percentages concerning the presence or absence of the flexor digitorum brevis muscle tendon to the fifth toe. We also hope to be able to determine the presence based on gender and nationality. It is known to be absent occasionally; however, there is no definitive study dedicated to its prevalence. Using a pool of 60 cadavers, 97 total feet were included in our analysis. Of these feet, 47 (48%) lacked a flexor digitorum brevis tendon to the fifth toe at all. Furthermore, 25 (26%) had notably small tendons to the fifth toe. The final 25 (26%) had what the researchers deemed present tendons. This information could be helpful in surgical planning, including tendon transfer techniques, and biomechanical evaluations. Further research would need to be conducted as this was a cadaveric study. LEVELS OF EVIDENCE: Cadaver/anatomy research, Level V.

Clinical implications of peroneal artery variation.

Vascular anatomy has a strong influence on the choice of surgical approach. Anomalies of vascular patterns may explain uncharacteristic physical or clinical findings. We present a case of an anomalous peroneal artery not previously described. The anomalous anatomic pattern is the peroneal artery replacing the posterior tibial artery in the medial ankle and providing the primary blood supply to the plantar foot.