Anatomical Structures at Risk After Medial Column Nailing.

Area of Science:

• Orthopedic Surgery
• Anatomy
• Biomedical Engineering

Background:

• Medial column nails offer strong fixation for Charcot's neuroarthropathy reconstruction.
• Percutaneous screw placement may risk injury to surrounding soft tissues.

Purpose of the Study:

• To identify anatomical structures at risk during medial column nail interlocking screw placement.
• To inform surgical technique and minimize iatrogenic injury.

Main Methods:

• Ten cadaveric limbs underwent medial column nail insertion.
• Kirschner wires simulated interlocking screws at proximal, middle, and distal locations.
• Distances from wires to anatomical structures were measured and risk levels assigned.

Main Results:

• Proximally, deltoid ligament, posterior tibial tendon, and saphenous vein were at risk.
• The medial dorsal cutaneous nerve and medial marginal vein were at risk at the middle screw.
• The medial dorsal cutaneous nerve was at high risk at the distal screw.

Conclusions:

• Percutaneous interlocking screws for medial column nails present significant risks to neurovascular and musculotendinous structures.
• Surgeons must be aware of anatomical relationships to mitigate injury during Charcot foot reconstruction.