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Related Experiment Video

Updated: May 6, 2026

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
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Optimal Guidewire Starting Position for Medial Column Intramedullary Fixation.

Dominick Casciato1, Ross Groeschl2, Robert Mendicino2

  • 1*University of Maryland Medical Center, Baltimore, MD.

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|August 27, 2025
PubMed
Summary
This summary is machine-generated.

This study defines anatomical landmarks for guidewire placement in the first metatarsal during Charcot reconstruction. Precise guidewire insertion optimizes intramedullary fixation and surgical outcomes.

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Area of Science:

  • Orthopedic surgery
  • Podiatric medicine
  • Anatomy

Background:

  • Medial column intramedullary fixation is crucial for Charcot reconstruction.
  • Accurate guidewire placement is essential for optimal endosteal purchase.
  • Current methods lack defined anatomical relationships for guidewire insertion into the first metatarsal.

Purpose of the Study:

  • To identify the anatomical relationship between the first metatarsal's intramedullary canal center and its head and base.
  • To provide data for improving guidewire placement accuracy in foot and ankle surgery.

Main Methods:

  • Dissection and measurement of ten fresh-frozen human first metatarsals.
  • Utilized digital calipers for linear measurements (length, width, height).
  • Employed 3D printed gantry and image analysis software to determine canal center relative to metatarsal dimensions.

Main Results:

  • The intramedullary canal's center was located at approximately 51% of the head's height and 67% of the base's height (from inferior cortex).
  • The center was found at approximately 53% of the head's width and 53% of the base's width (from lateral cortex).
  • Longer metatarsals showed a correlation with a more superior starting position at the base (r = 0.74; P = .02).

Conclusions:

  • Optimal guidewire entry is slightly superior and medial to the first metatarsal head's center.
  • The guidewire should be directed proximally towards the superior third of the metatarsal base.
  • These anatomical findings can refine surgical techniques and guide instrument development for Charcot reconstruction.