Abstract
INTRODUCTION
A simple technique has been developed to quickly 1 and accurately identify the center of the posterior third of the calcaneus when harvesting autogenous cancellous bone graft. This location is posterior and inferior to the sural nerve 2,3 and is situated directly within the dense rim of trabecular bone at the posterior third of the calcaneus. 1,4 The calcaneus is an ideal source of small to moderate amounts of autogenous bone graft material in most patients. 2 –4
OPERATIVE TECHNIQUE
The surgeon places his thumb on the insertion of the Achilles tendon at the posterior-superior aspect of the calcaneal tuber and the index finger on the origin of the plantar fascia at the inferior aspect of the calcaneal tuber as if using his hand to signal “Okay.” This creates three-quarters of a circle between his index finger, thenar eminence, and thumb, with the remaining one-quarter of the circle being an imaginary line connecting the distal aspects of the index finger and thumb. At a point midway between the distal aspects of the index finger and thumb along the imaginary line, a 1-cm incision is placed through the skin only (Figure 1, A). A hemostat is used to dissect to the lateral wall of the calcaneus to clear the soft tissue to bone and view any crossing branches of the sural nerve. An 8-mm round-core biopsy trephine is then inserted at a 90-degree angle to the lateral wall of the calcaneus (Figure 1, B). The trephine is passed through the lateral wall and into the posterior aspect of the body of the calcaneus until it abuts the medial cortex. This is verified by palpating the medial wall of the calcaneus with the nondominant hand. With gentle, gradually increasing circular motions, the trephine is retrieved from the wound (Figure 1, C). If additional cancellous bone graft is necessary, the trephine is passed through the same hole at different angles 3 rather than new adjacent holes 2 so that less structural injury to the lateral aspect of the calcaneus occurs. The bone graft donor site fully heals in a few weeks without the need for supplemental bone graft substitute implantation within the osseous void created (Figure 2). 2 –4 The skin edges of the incision are approximated with a single vertical mattress suture and supported with adhesive strips of the surgeons preference.
The thumb is located at the insertion of the Achilles tendon and the index finger is located at the origin of the plantar fascia, creating a circular “okay” sign. At a point midway between the tips of the index finger and thumb, along the imaginary circular line, a 1-cm incision is made and blunt dissection down to the lateral wall of the calcaneus is performed with a hemostat
Immediate