Percutaneous Corticotomy Using a Shannon Burr in Tibial Cortex Transverse Transport: An Innovative Approach to Reducing Local Complications

Introduction: Tibial cortex transverse transport (TTT) is a limb-salvage alternative for patients with infrapatellar critical limb ischemia who are ineligible for revascularization. Conventional corticotomy, performed via sequential drill holes and osteotomes, is associated with local tibial complication rates between 23% and 30%. Objective: To evaluate local complications at the tibial site after performing a percutaneous corticotomy using a side-cutting Shannon burr. Method: A prospective, observational, and analytical case series (STROBE guidelines), including consecutive patients with chronic infrapatellar critical limb ischemia who underwent TTT with percutaneous corticotomy. The primary outcomes were bone comminution with pin loosening, local skin necrosis, deep infection of the osteotomized fragment, and nonunion at the sixth postoperative month. Results: Seventeen patients were included (41.2% female; mean age 66.6 +- 9.9 years), of whom 16 (94.1%) had diabetes. There were no episodes of bone comminution with pin loosening (0%), and bone healing occurred in 17/17 cases (100%). Two cases of deep fragment infection (11.8%) and one case of local skin necrosis (5.9%) were recorded, the latter concomitant with infection. The overall local complication rate was 11.8%. Conclusion: Percutaneous corticotomy using a Shannon burr proved feasible and reduced mechanical complications at the tibial site compared to historical standards, with no episodes of comminution, pin loosening, or nonunion. The remaining complications were infectious in nature, suggesting that refinement of the instrumentation addresses the mechanical component of local morbidity but does not resolve the infectious component.