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Hk Sharma - One of the best experts on this subject based on the ideXlab platform.
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PROXIMAL TIBIAL FINE WIRE PLACEMENT IN RELATION TO COMMON PERONEAL NERVE: CADAVERIC ANALYSIS
2018Co-Authors: Dearden P, K Lowery, Sherman K, Mahadevan, Hk SharmaAbstract:Background:Potential injury to the common peroneal nerve at the level of the Fibula Head/neck junction during fine wire insertion in stabilization of proximal Fibula, is a recognised complication. This study aims to relate the course of the common peroneal nerve to Fibula Head transfixion wire.Methods:Standard 1.8mm Ilizarov wires were inserted percutaneously in the Fibula Head of cadaveric knees. The course of the common peroneal nerve was dissected calculating wire to nerve distance.Results:The common peroneal nerve was seen to cross the neck of Fibula at a mean distance of 34.8mm from the tip of Fibula (range 21.5–44.3mm). Wire placement was found to be on average, 52% of the maximal AP diameter of the Fibula Head and 64% of the distance from tip of Fibula to the point of nerve crossing Fibula neck.Conclusion:When inserting a Fibula Head transfixion wire, care must be taken not to place wire entry point too distal or posterior on the Fibula Head. Observing a safe zone in the anterior half of the proxim...
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PROXIMAL TIBIAL FINE WIRE PLACEMENT IN RELATION TO COMMON PERONEAL NERVE: CADAVERIC ANALYSIS
Journal of Bone and Joint Surgery-british Volume, 2015Co-Authors: Dearden P, K Lowery, K.p. Sherman, Vishy Mahadevan, Hk SharmaAbstract:Background: Potential injury to the common peroneal nerve at the level of the Fibula Head/neck junction during fine wire insertion in stabilization of proximal Fibula, is a recognised complication. This study aims to relate the course of the common peroneal nerve to Fibula Head transfixion wire. Methods: Standard 1.8mm Ilizarov wires were inserted percutaneously in the Fibula Head of cadaveric knees. The course of the common peroneal nerve was dissected calculating wire to nerve distance. Results: The common peroneal nerve was seen to cross the neck of Fibula at a mean distance of 34.8mm from the tip of Fibula (range 21.5–44.3mm). Wire placement was found to be on average, 52% of the maximal AP diameter of the Fibula Head and 64% of the distance from tip of Fibula to the point of nerve crossing Fibula neck. Conclusion: When inserting a Fibula Head transfixion wire, care must be taken not to place wire entry point too distal or posterior on the Fibula Head. Observing a safe zone in the anterior half of the proximal 20mm of the Fibula Head would avoid injury to the nerve. In cases where palpation of Fibula is difficult, we recommend wire insertion under fluoroscopic guidance.
Henning Roehl - One of the best experts on this subject based on the ideXlab platform.
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Preservation of the PCL when performing cruciate-retaining TKA: Is the tibial tuberosity a reliable predictor of the PCL footprint location?
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2014Co-Authors: Ahmed Jawhar, Hanns-peter Scharf, Aditya Sai Kadavkolan, S. Wasnik, Henning RoehlAbstract:Purpose Reconstruction of the joint line is crucial in total knee arthroplasty (TKA). A routine height of tibial cut to maintain the natural joint line may compromise the preservation of the PCL. Since the PCL footprint is not accessible prior to tibial osteotomy, it seems beneficial to identify a reliable extraarticular anatomic landmark for predicting the PCL footprint and being visible within standard TKA approach. The Fibula Head predicts reliably the location of PCL footprint; however, it is not accessible during TKA. The aim of this study now was to analyze whether the tibial tuberosity can serve as a reliable referencing landmark to estimate the PCL footprint height prior to tibial cut.
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Fibula Head is a useful landmark to predict the location of posterior cruciate ligament footprint prior to total knee arthroplasty
International Orthopaedics, 2014Co-Authors: Ahmed Jawhar, Sandeep Wasnik, Hanns-peter Scharf, Henning RoehlAbstract:Purpose The hypothesis of our study is that a routine tibial cut during cruciate retaining TKA may result in a partial or a total removal of the PCL footprint. Therefore providing a reliable landmark is essential to estimate the probability of PCL damage with a tibial cut and to enable the surgeon to decide pre-operatively whether a cruciate retaining implant design is suitable. Methods In a case series of 175 cruciate retaining TKA, the routinely made standing postoperative AP-view radiographs were evaluated to determine the distance between Fibula Head and tibial cutting plane. In a second case series knee MRI of 223 subjects were consecutively used to measure the vertical distance between tibial attachment of PCL and Fibula Head. The probability of partial or total PCL damage was calculated for different vertical distances between tibial cut and Fibula Head. Results The vertical distance between the tibial cut and the most proximal point of the Fibula Head averaged 6.1 mm ±4.8 mm. The mean vertical distance from Fibula Head to proximal and to distal PCL footprint revealed to be 11.4 mm ±3.7 mm and 5.4 mm ±2.9 mm, respectively. The location of the insertion was not significantly different between subgroups such as age (50 years), gender and side. Based on our results 11 (7 %) knees were considered at high risk of an entire PCL removal after implantation of a cruciate retaining TKA design. Conclusions Currently available routine tibial preparation techniques result in partial or total posterior cruciate ligament detachment. Fibula Head as a landmark aids to predict the PCL location and to estimate its disruption pre- and postoperatively on AP-view radiographs.
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Fibula Head is a useful landmark to predict the location of posterior cruciate ligament footprint prior to total knee arthroplasty.
International orthopaedics, 2013Co-Authors: Ahmed Jawhar, Sandeep Wasnik, Hanns-peter Scharf, Henning RoehlAbstract:Purpose The hypothesis of our study is that a routine tibial cut during cruciate retaining TKA may result in a partial or a total removal of the PCL footprint. Therefore providing a reliable landmark is essential to estimate the probability of PCL damage with a tibial cut and to enable the surgeon to decide pre-operatively whether a cruciate retaining implant design is suitable.
K Lowery - One of the best experts on this subject based on the ideXlab platform.
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PROXIMAL TIBIAL FINE WIRE PLACEMENT IN RELATION TO COMMON PERONEAL NERVE: CADAVERIC ANALYSIS
2018Co-Authors: Dearden P, K Lowery, Sherman K, Mahadevan, Hk SharmaAbstract:Background:Potential injury to the common peroneal nerve at the level of the Fibula Head/neck junction during fine wire insertion in stabilization of proximal Fibula, is a recognised complication. This study aims to relate the course of the common peroneal nerve to Fibula Head transfixion wire.Methods:Standard 1.8mm Ilizarov wires were inserted percutaneously in the Fibula Head of cadaveric knees. The course of the common peroneal nerve was dissected calculating wire to nerve distance.Results:The common peroneal nerve was seen to cross the neck of Fibula at a mean distance of 34.8mm from the tip of Fibula (range 21.5–44.3mm). Wire placement was found to be on average, 52% of the maximal AP diameter of the Fibula Head and 64% of the distance from tip of Fibula to the point of nerve crossing Fibula neck.Conclusion:When inserting a Fibula Head transfixion wire, care must be taken not to place wire entry point too distal or posterior on the Fibula Head. Observing a safe zone in the anterior half of the proxim...
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Fibular Head transfixion wire and its relationship to common peroneal nerve: cadaveric analysis
Strategies in Trauma and Limb Reconstruction, 2015Co-Authors: Paul Dearden, K Lowery, Vishy Mahadevan, Kevin Sherman, Hemant SharmaAbstract:Proximal tibio-Fibular joint is routinely stabilised during leg lengthening, peri-articular fractures and deformity corrections of tibia. Potential injury to the common peroneal nerve at the level of the Fibula Head/neck junction during wire insertion is a recognised complication. Previous studies have mapped the course of the common peroneal nerve and its branches at the level of the Fibular Head, and guidelines are published regarding placement of proximal tibial wires. This study aims to relate the course of the common peroneal nerve to the placement of a lateral insertion Fibula Head transfixion wire. Standard 1.8-mm Ilizarov ‘olive’ wires were inserted in the Fibula Head of 10 un-embalmed cadaveric knees. Wires were inserted percutaneously to the Fibula Head using surface anatomy landmarks and palpation technique. The course of the common peroneal nerve was then dissected. Distances from wire entry point to the course of the common peroneal nerve were measured post-wire insertion. The mean distance of the common peroneal nerve from the anterior aspect of the broadest point of the Fibular Head was 24.5 mm (range 14.2–37.7 mm). Common peroneal nerve was seen to cross the neck of Fibula at a mean distance of 34.8 mm from the tip of Fibula (range 21.5–44.3 mm). Wire placement was found to be on average, 52 % of the maximal AP diameter of the Fibula Head and 64 % of the distance from tip of Fibula to the point of nerve crossing Fibula neck. When inserting a Fibula Head transfixion wire, care must be taken not to place wire entry point too distal or posterior on the Fibula Head. Observing a safe zone in the anterior half of the proximal 20 mm of the Fibula Head would avoid injury to the nerve. In cases where palpation of Fibula is difficult due to patient habitus, we recommend consideration of the use of fluoroscopic guidance during wire transfixion of the proximal tibio-Fibular articulation to avoid wire insertion too distally and subsequent potential nerve injury.
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PROXIMAL TIBIAL FINE WIRE PLACEMENT IN RELATION TO COMMON PERONEAL NERVE: CADAVERIC ANALYSIS
Journal of Bone and Joint Surgery-british Volume, 2015Co-Authors: Dearden P, K Lowery, K.p. Sherman, Vishy Mahadevan, Hk SharmaAbstract:Background: Potential injury to the common peroneal nerve at the level of the Fibula Head/neck junction during fine wire insertion in stabilization of proximal Fibula, is a recognised complication. This study aims to relate the course of the common peroneal nerve to Fibula Head transfixion wire. Methods: Standard 1.8mm Ilizarov wires were inserted percutaneously in the Fibula Head of cadaveric knees. The course of the common peroneal nerve was dissected calculating wire to nerve distance. Results: The common peroneal nerve was seen to cross the neck of Fibula at a mean distance of 34.8mm from the tip of Fibula (range 21.5–44.3mm). Wire placement was found to be on average, 52% of the maximal AP diameter of the Fibula Head and 64% of the distance from tip of Fibula to the point of nerve crossing Fibula neck. Conclusion: When inserting a Fibula Head transfixion wire, care must be taken not to place wire entry point too distal or posterior on the Fibula Head. Observing a safe zone in the anterior half of the proximal 20mm of the Fibula Head would avoid injury to the nerve. In cases where palpation of Fibula is difficult, we recommend wire insertion under fluoroscopic guidance.
Dearden P - One of the best experts on this subject based on the ideXlab platform.
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PROXIMAL TIBIAL FINE WIRE PLACEMENT IN RELATION TO COMMON PERONEAL NERVE: CADAVERIC ANALYSIS
2018Co-Authors: Dearden P, K Lowery, Sherman K, Mahadevan, Hk SharmaAbstract:Background:Potential injury to the common peroneal nerve at the level of the Fibula Head/neck junction during fine wire insertion in stabilization of proximal Fibula, is a recognised complication. This study aims to relate the course of the common peroneal nerve to Fibula Head transfixion wire.Methods:Standard 1.8mm Ilizarov wires were inserted percutaneously in the Fibula Head of cadaveric knees. The course of the common peroneal nerve was dissected calculating wire to nerve distance.Results:The common peroneal nerve was seen to cross the neck of Fibula at a mean distance of 34.8mm from the tip of Fibula (range 21.5–44.3mm). Wire placement was found to be on average, 52% of the maximal AP diameter of the Fibula Head and 64% of the distance from tip of Fibula to the point of nerve crossing Fibula neck.Conclusion:When inserting a Fibula Head transfixion wire, care must be taken not to place wire entry point too distal or posterior on the Fibula Head. Observing a safe zone in the anterior half of the proxim...
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PROXIMAL TIBIAL FINE WIRE PLACEMENT IN RELATION TO COMMON PERONEAL NERVE: CADAVERIC ANALYSIS
Journal of Bone and Joint Surgery-british Volume, 2015Co-Authors: Dearden P, K Lowery, K.p. Sherman, Vishy Mahadevan, Hk SharmaAbstract:Background: Potential injury to the common peroneal nerve at the level of the Fibula Head/neck junction during fine wire insertion in stabilization of proximal Fibula, is a recognised complication. This study aims to relate the course of the common peroneal nerve to Fibula Head transfixion wire. Methods: Standard 1.8mm Ilizarov wires were inserted percutaneously in the Fibula Head of cadaveric knees. The course of the common peroneal nerve was dissected calculating wire to nerve distance. Results: The common peroneal nerve was seen to cross the neck of Fibula at a mean distance of 34.8mm from the tip of Fibula (range 21.5–44.3mm). Wire placement was found to be on average, 52% of the maximal AP diameter of the Fibula Head and 64% of the distance from tip of Fibula to the point of nerve crossing Fibula neck. Conclusion: When inserting a Fibula Head transfixion wire, care must be taken not to place wire entry point too distal or posterior on the Fibula Head. Observing a safe zone in the anterior half of the proximal 20mm of the Fibula Head would avoid injury to the nerve. In cases where palpation of Fibula is difficult, we recommend wire insertion under fluoroscopic guidance.
Ahmed Jawhar - One of the best experts on this subject based on the ideXlab platform.
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Preservation of the PCL when performing cruciate-retaining TKA: Is the tibial tuberosity a reliable predictor of the PCL footprint location?
Knee surgery sports traumatology arthroscopy : official journal of the ESSKA, 2014Co-Authors: Ahmed Jawhar, Hanns-peter Scharf, Aditya Sai Kadavkolan, S. Wasnik, Henning RoehlAbstract:Purpose Reconstruction of the joint line is crucial in total knee arthroplasty (TKA). A routine height of tibial cut to maintain the natural joint line may compromise the preservation of the PCL. Since the PCL footprint is not accessible prior to tibial osteotomy, it seems beneficial to identify a reliable extraarticular anatomic landmark for predicting the PCL footprint and being visible within standard TKA approach. The Fibula Head predicts reliably the location of PCL footprint; however, it is not accessible during TKA. The aim of this study now was to analyze whether the tibial tuberosity can serve as a reliable referencing landmark to estimate the PCL footprint height prior to tibial cut.
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Fibula Head is a useful landmark to predict the location of posterior cruciate ligament footprint prior to total knee arthroplasty
International Orthopaedics, 2014Co-Authors: Ahmed Jawhar, Sandeep Wasnik, Hanns-peter Scharf, Henning RoehlAbstract:Purpose The hypothesis of our study is that a routine tibial cut during cruciate retaining TKA may result in a partial or a total removal of the PCL footprint. Therefore providing a reliable landmark is essential to estimate the probability of PCL damage with a tibial cut and to enable the surgeon to decide pre-operatively whether a cruciate retaining implant design is suitable. Methods In a case series of 175 cruciate retaining TKA, the routinely made standing postoperative AP-view radiographs were evaluated to determine the distance between Fibula Head and tibial cutting plane. In a second case series knee MRI of 223 subjects were consecutively used to measure the vertical distance between tibial attachment of PCL and Fibula Head. The probability of partial or total PCL damage was calculated for different vertical distances between tibial cut and Fibula Head. Results The vertical distance between the tibial cut and the most proximal point of the Fibula Head averaged 6.1 mm ±4.8 mm. The mean vertical distance from Fibula Head to proximal and to distal PCL footprint revealed to be 11.4 mm ±3.7 mm and 5.4 mm ±2.9 mm, respectively. The location of the insertion was not significantly different between subgroups such as age (50 years), gender and side. Based on our results 11 (7 %) knees were considered at high risk of an entire PCL removal after implantation of a cruciate retaining TKA design. Conclusions Currently available routine tibial preparation techniques result in partial or total posterior cruciate ligament detachment. Fibula Head as a landmark aids to predict the PCL location and to estimate its disruption pre- and postoperatively on AP-view radiographs.
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Fibula Head is a useful landmark to predict the location of posterior cruciate ligament footprint prior to total knee arthroplasty.
International orthopaedics, 2013Co-Authors: Ahmed Jawhar, Sandeep Wasnik, Hanns-peter Scharf, Henning RoehlAbstract:Purpose The hypothesis of our study is that a routine tibial cut during cruciate retaining TKA may result in a partial or a total removal of the PCL footprint. Therefore providing a reliable landmark is essential to estimate the probability of PCL damage with a tibial cut and to enable the surgeon to decide pre-operatively whether a cruciate retaining implant design is suitable.