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Soft Tissue Structures at Risk With a Percutaneous Focal Dome Osteotomy: A Cadaver Study
Dominick J Casciato1, Ryan Stone2, Robert Mendicino3
1Fellow, Limb Preservation and Deformity Correction Fellowship, Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD.
Summary
This study maps the optimal placement for percutaneous focal dome osteotomies in ankle realignment. Careful dissection is crucial to protect anterior ankle tendons and neurovascular structures during this minimally invasive procedure.
Area of Science:
- Orthopedic Surgery
- Anatomy
- Biomechanics
Background:
- Percutaneous focal dome osteotomy offers extracapsular ankle realignment with minimal soft tissue dissection.
- This technique allows frontal plane rotation and translation for deformity correction, avoiding a standard anterior incision.
Purpose of the Study:
- To determine the ideal positioning and safe anatomical corridors for percutaneous focal dome osteotomy.
- To assess the proximity of critical anterior ankle structures to planned incision and drilling sites.
Main Methods:
- Focal dome osteotomies were simulated on 10 fresh-frozen cadaver specimens.
- A radial arm device mapped osteotomy sites, and measurements were taken to nearby tendons and neurovascular structures.
- Medial, lateral, and central incisions were evaluated for proximity to the tibialis anterior and extensor hallucis longus tendons.
Main Results:
- The ideal osteotomy position was consistently found below the most proximal posthole using a 2.50 cm radial arm.
- Medial and central incisions were closest to the tibialis anterior tendon (0.43 ± 0.9 mm centrally).
- Lateral incision and half-pin sites were closest to the extensor hallucis longus tendon (1.27 ± 1.5 mm for half-pin). Neurovascular structures were generally further but had concerning variations.
Conclusions:
- Percutaneous focal dome osteotomy is feasible, with specific landmarks identified for optimal placement.
- Protection of the tibialis anterior and extensor hallucis longus tendons is paramount.
- Preoperative mapping and awareness of potential anatomical variations are essential for safe execution.
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