Clinical Orthopaedics and Related Research

, Volume 466, Issue 12, pp 3003–3010

Tibial Lengthening: Extraarticular Calcaneotibial Screw to Prevent Ankle Equinus

  • Mohan V. Belthur
  • Dror Paley
  • Gaurav Jindal
  • Rolf D. Burghardt
  • Stacy C. Specht
  • John E. Herzenberg
Symposium: Advances in Limb Lengthening and Reconstruction

DOI: 10.1007/s11999-008-0489-8

Cite this article as:
Belthur, M.V., Paley, D., Jindal, G. et al. Clin Orthop Relat Res (2008) 466: 3003. doi:10.1007/s11999-008-0489-8

Abstract

Between 2003 and 2006, we used an extraarticular, cannulated, fully threaded posterior calcaneotibial screw to prevent equinus contracture in 10 patients (four male and six female patients, 14 limbs) undergoing tibial lengthening with the intramedullary skeletal kinetic distractor. Diagnoses were fibular hemimelia (two), mesomelic dwarfism (two), posteromedial bow (one), hemihypertrophy (one), poliomyelitis (one), achondroplasia (one), posttraumatic limb-length discrepancy (one), and hypochondroplasia (one). Average age was 24.5 years (range, 15–54 years). The screw (length, typically 125 mm; diameter, 7 mm) was inserted with the ankle in 10° dorsiflexion. Gastrocnemius soleus recession was performed in two patients to achieve 10° dorsiflexion. Average lengthening was 4.9 cm (range, 3–7 cm). Screws were removed after a mean 3.3 months (range, 2–6 months). Preoperative ankle range of motion was regained within 6 months of screw removal. No neurovascular complications were encountered, and no patients experienced equinus contracture. We also conducted a cadaveric study in which one surgeon inserted screws in eight cadaveric legs under image intensifier control. The flexor hallucis longus muscle belly was the closest anatomic structure noted during dissection. The screw should be inserted obliquely from upper lateral edge of the calcaneus and aimed lateral in the tibia to avoid the flexor hallucis longus muscle.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Mohan V. Belthur
    • 1
  • Dror Paley
    • 2
  • Gaurav Jindal
    • 3
  • Rolf D. Burghardt
    • 4
  • Stacy C. Specht
    • 2
  • John E. Herzenberg
    • 2
  1. 1.SPARSH HospitalBangaloreIndia
  2. 2.Rubin Institute for Advanced OrthopedicsSinai Hospital of BaltimoreBaltimoreUSA
  3. 3.Children’s Healthcare of Atlanta at Scottish RiteAtlantaUSA
  4. 4.Department for Trauma SurgeryKlinikum Rechts der Isar der Technischen Universität MünchenMünchenGermany