The sural nerve & the calcaneus: A radiographic and anatomical study.

BACKGROUND

The sinus tarsi approach (STA) is a commonly used minimally invasive surgical approach for the fixation of joint depression-type calcaneus fractures. As the sural nerve (SN) is particularly at risk during the STA, understanding the SN's course in relation to bony landmarks on fluoroscopic imaging is crucial.

METHODS

Dissection of 19 post-mortem humans were performed to expose the SN. The SN's course was mapped relative to radiographic bony landmarks, anatomical plates for fracture fixation, and the STA incision location.

RESULTS

The SN typically enters the cranial part of the calcaneus midway between the posterior talocalcaneal (PTC) joint and the calcaneal tuberosity. The posterior tail of the calcaneal plates were always placed under the main branch of the SN.

CONCLUSION

The study highlighted that the SN is always at risk during minimally invasive plate fixation for calcaneal fractures. Intra-operative fluoroscopy could be beneficial for minimizing nerve damage and enhancing surgical outcomes.

LEVEL OF EVIDENCE: IV.