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Talia AJ, Shepherd DW, Roshan-Zamir S. Displaced, intra-articular fractures of the calcaneus: Review of non-operative management, open reduction internal fixation and novel minimally invasive techniques. Foot (Edinb) 2025; 62:102160. [PMID: 40157020 DOI: 10.1016/j.foot.2025.102160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Revised: 03/16/2025] [Accepted: 03/23/2025] [Indexed: 04/01/2025]
Abstract
Calcaneal fractures comprise 1-2 % of all fractures and typically occur in younger, working age male patients. These injuries result in a significant burden to the patient in terms of residual pain, inability to work or participate in sports, difficulty with shoe wear and secondary reconstructive surgery such as subtalar arthrodesis. They also result in a significant burden to the healthcare system. Calcaneal fractures can be sub-classified into extra-articular and intra-articular, two-thirds of calcaneal fractures involve the articular facets of the subtalar joint. The treatment of displaced intra-articular calcaneal fractures is controversial, with many authors recommending non-operative treatment. The concerns with this approach include painful malunion, articular surface disruption, heel varus and increased calcaneal width, with a significant rate of secondary reconstructive surgery. Traditional operative approaches for calcaneal fractures allowed the surgeon to restore anatomic parameters, but have been associated with high rates of soft tissue complications, up to 40 % in some series. Newer, less invasive techniques for fixation allow the surgeon to obtain a similar anatomic reduction with reduced tissue compromise. We performed a systematic literature search which identifed forty articles on which this review is based. In this review article we discuss the background of displaced, intra-articular calcaneal fractures and compare the current knowledge base of operative vs. non-operative management. We then compare and contrast the three common surgical approaches used for treatment of these injuries: the extensile lateral approach, the sinus tarsi approach and newer percutaneous/minimally invasive techniques. At the current time, the sinus tarsi approach is the mainstay for treating these fractures, with most authors favouring this over the extensile lateral approach. There is momentum for adoption of newer minimally invasive techniques which show promising results, with reduced soft tissue complications and satisfactory functional outcomes.
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Affiliation(s)
- Adrian J Talia
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Gordon Street, Footscray, Victoria 3011, Australia; Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7HE, UK; Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Victoria 3181, Australia.
| | - David W Shepherd
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Gordon Street, Footscray, Victoria 3011, Australia; Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Victoria 3181, Australia.
| | - Sasha Roshan-Zamir
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Gordon Street, Footscray, Victoria 3011, Australia; Melbourne Orthopaedic Surgeons, 188 Gipps St, East Melbourne, Victoria 3002, Australia.
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Kang D, Raviprasad A, Pierre K, Talati J, Kent T, Batmunh B, Lanier L, Slater RM, Sistrom CL, Mancuso AA, Davis I, Rajderkar DA. Challenges in diagnosis of calcaneal fractures: an examination using the WIDI SIM platform. Emerg Radiol 2024; 31:653-660. [PMID: 38969914 DOI: 10.1007/s10140-024-02267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/01/2024] [Indexed: 07/07/2024]
Abstract
INTRODUCTION The calcaneus is the most commonly fractured tarsal bone. Diagnosis is often challenging due to subtle radiographic changes and requires timely identification to prevent complications, including subtalar arthritis, neurovascular injury, malunion, osteomyelitis, and compartment syndrome. Treatment varies based on fracture type, with non-surgical methods for non-displaced stress fractures and surgical interventions for displaced or intra-articular fractures. METHODS This study utilized the Wisdom in Diagnostic Imaging Simulation (WIDI SIM) platform, an emergency imaging simulation designed to assess radiology resident preparedness for independent call. During an 8-hour simulation, residents were tested on 65 cases across various imaging modalities of varying complexity, including normal studies. A single, unique case of calcaneal fracture was included within the simulation in four separate years of testing. Cases were assessed using a standardized grading rubric by subspecialty radiology faculty, with errors subsequently classified by type. RESULTS A total of 1279 residents were tested in five separate years on the findings of calcaneal fractures of 5 different patients. Analysis revealed a consistent pattern of missed diagnoses across all training years, primarily attributed to observational errors. There was limited improvement with training progression as all training years exhibited similar average performance levels. CONCLUSIONS Calcaneal fractures pose a diagnostic challenge due to their frequent subtle radiographic findings, especially in stress fractures. Simulation-based evaluations using WIDI SIM highlighted challenges in radiology residents' proficiency in diagnosing calcaneal fractures. Addressing these challenges through targeted education and exposure to diverse cases is essential to improve diagnostic accuracy and reduce complications with calcaneal fractures.
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Affiliation(s)
- Dahyun Kang
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Abheek Raviprasad
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA.
| | - Kevin Pierre
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Jay Talati
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas Kent
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Bayar Batmunh
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Linda Lanier
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Roberta M Slater
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Christopher L Sistrom
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Anthony A Mancuso
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Ivan Davis
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
| | - Dhanashree A Rajderkar
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, Gainesville, FL, 32610, USA
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Thor J, Socklingam R, Kon C. Outcomes of Percutaneous Fixation in Intra-articular Calcaneal Fractures. Cureus 2024; 16:e68428. [PMID: 39360078 PMCID: PMC11445687 DOI: 10.7759/cureus.68428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/04/2024] Open
Abstract
Displaced intra-articular calcaneal fractures have been proven to be challenging for orthopaedic surgeons worldwide due to the poor clinical outcomes. Historically, the decision whether for fixation or conservative management depended mostly on the literature of the time, initially favouring conservative management but attitudes slowly shifted to operative intervention. Percutaneous fixation options have been increasingly popular for their ability for fracture reduction without skin and wound complications of the open method. A retrospective study of 17 patients with a total of 18 calcaneal fractures treated in our hospital by a single surgeon from January 2017 to December 2019 was conducted. Fixation was done percutaneously using cannulated screws, with the patients in a lateral position. Intraoperative imaging was done using a mini-image intensifier to visualise fracture reduction, and the O-arm was used in most cases. Using the Sanders classification, there were a total of 4 IIA, 3 IIB, 2 IIC, 2 IIIAB, and 7 IIIAC. Results showed that 16 calcaneal fractures (94%) had good to excellent outcomes with the American Orthopedic Foot and Ankle Society (AOFAS) score and Maryland Foot Score (MFS), while 14 calcaneal fractures (78%) showed good to excellent outcomes with the Kerr calcaneal score. There were no wound complications encountered in our series. However, there was one patient with a k-wire broken intraoperative and left in situ and there were two patients with prominent screws. Despite this, our experience with percutaneous fixation of displaced intra-articular calcaneal fractures has been generally favourable, allowing for good outcomes and satisfactory reduction of the fracture fragments.
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Affiliation(s)
- Jessica Thor
- Orthopaedic Surgery, Changi General Hospital, Singapore, SGP
| | - Raj Socklingam
- Orthopaedic Surgery, Changi General Hospital, Singapore, SGP
| | - Charles Kon
- Orthopaedic Surgery, Changi General Hospital, Singapore, SGP
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Schippers P, Engels R, Benning D, Fischer S, Wunderlich F, Afghanyar Y, Arand C, Nienhaus M, Drees P, Gercek E, Küchle R. Functional outcomes after intramedullary nailing (C-Nail®) of severe calcaneal fractures with mean follow-up of 36 months. Eur J Trauma Emerg Surg 2024; 50:1111-1118. [PMID: 38226990 PMCID: PMC11249407 DOI: 10.1007/s00068-023-02433-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/28/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Calcaneal fractures (CFs) are rare but potentially debilitating injuries. Apart from the open, far lateral or sinus tarsi approach, operative treatment can be performed minimally invasive and percutaneously with intramedullary nailing. In this study, we sought to investigate the functional outcome of severe CFs treated with the C-Nail® implant. METHODS Twenty-two CFs (9 × Sanders III and 8 × Sanders IV), operated between 2016 and 2019, were followed up with a mean duration of 36 (± 11) months. The AOFAS score, pre- and postoperative Böhler angles, wound healing disorders, and patient-reported outcome measures (PROMs) like pain levels and return to work/sport levels were assessed. RESULTS The mean AOFAS score was 72.0 (± 9.8). Four patients sustained wound healing disorders, yet no implant-associated surgical revision was required. Fifty percent of patients were pain-free within 1 year. Within 1 year, about 50% of the patients could return to sports, and about 80% of the patients could return to work. PROMs and functional results align with those from other implants reported in the literature. CONCLUSION Intramedullary nailing of severe CFs with the C-Nail® implant can be considered a safe treatment alternative that yields acceptable results at mid-terms.
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Affiliation(s)
- Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, 55131, Mainz, Germany.
| | - Rasmus Engels
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, 55131, Mainz, Germany
- Medical Point Chirurgie Wiesbaden, 65183, Wiesbaden, Germany
| | - Dominik Benning
- Department of Orthopaedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, Plastic Surgery and Burn Medicine, German Armed Forces Central Hospital, Koblenz, Germany
| | - Sebastian Fischer
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, 60389, Frankfurt, Germany
| | - Felix Wunderlich
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, 55131, Mainz, Germany
| | - Yama Afghanyar
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, 55131, Mainz, Germany
| | - Charlotte Arand
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, 55131, Mainz, Germany
| | - Michael Nienhaus
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, 55131, Mainz, Germany
| | - Philipp Drees
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, 55131, Mainz, Germany
| | - Erol Gercek
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, 55131, Mainz, Germany
| | - Raphael Küchle
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, 55131, Mainz, Germany
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Acar E, Fitzpatrick K, Flint K, Weber T. Intra-articular Calcaneal Fractures: A Report of Cases and Comments on Preoperative Management. Niger J Clin Pract 2024; 27:583-591. [PMID: 38842707 DOI: 10.4103/njcp.njcp_480_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/26/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES To present a review of the clinical characteristics, preoperative and surgical management, and outcomes of patients with intra-articular calcaneal fractures who had open reduction and internal fixation (ORIF) and to offer some comments on and research ideas for the preoperative management of patients with these fractures. PATIENTS AND METHODS We studied consecutive patients who had ORIF performed by a single surgeon for closed, intra-articular calcaneal fractures at our level-1 trauma center between 5/29/2012 and 3/20/2018. All inpatients were treated with a preoperative soft tissue management protocol, whereas outpatients were not. Data were obtained about demographic and clinical characteristics, times from injury to surgery, quality of fracture reductions, and complication rates. RESULTS Mean follow-up for the 72 patients with 77 calcaneal fractures was 8.5 (range: 1-43) months, and 21 (27.3%) fractures received inpatient preoperative care with a soft tissue management protocol, while 56 (72.7%) received outpatient preoperative management. More of the fractures treated preoperatively as inpatients versus outpatients were classified as Sanders type III (66.7% vs. 32.1%) and type IV (8.9% vs. 4.8%) fractures and were associated with polytrauma (38.1% vs. 7.1%) and diabetes mellitus (9.5% vs. 5.4%), respectively. For all patients, the mean time from injury to surgery was 12.2 (range: 2.7-19.4) days, and the time was 6.3 days for inpatients and 14.4 days for outpatients, but the quality of fracture reductions and complication rates did not differ between these two groups. CONCLUSIONS Patients with intra-articular calcaneal fractures treated as inpatients and receiving a preoperative soft tissue management protocol had outcomes after ORIF that were not inferior to those experienced by patients treated preoperatively as outpatients, despite a greater proportion of the inpatients having severe fractures, polytrauma, and diabetes mellitus. Dedicated preoperative soft tissue management protocols may be beneficial for patients with calcaneal fractures and warrant further study.
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Affiliation(s)
- E Acar
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
- Department of Orthopaedics and Traumatology, OrthoIndy Hospital (St. Vincent Hospital), Indianapolis, Indiana, United States
| | - K Fitzpatrick
- Department of Orthopaedics and Traumatology, OrthoIndy Hospital (St. Vincent Hospital), Indianapolis, Indiana, United States
| | - K Flint
- Department of Orthopaedics and Traumatology, OrthoIndy Hospital (St. Vincent Hospital), Indianapolis, Indiana, United States
| | - T Weber
- Department of Orthopaedics and Traumatology, OrthoIndy Hospital (St. Vincent Hospital), Indianapolis, Indiana, United States
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Kayali H, Moghamis I, Radi M, Baroudi O, Hantouly A, Toubasi A, Foodoul MA, Alkhayarin M, Ahmed G. The role of patient positioning in surgical fixation of the calcaneus fractures using the lateral extensile approach. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1529-1534. [PMID: 38265742 PMCID: PMC10980634 DOI: 10.1007/s00590-023-03829-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Calcaneus is the most commonly fractured tarsal bone. Open reduction and internal fixation of the displaced intra-articular fractures is considered the gold standard treatment. The lateral extensile approach is the most commonly used approach, and usually, the patients are kept in lateral decubitus position. Recent study has descried calcaneus fracture fixation utilizing the lateral extensile approach with the patient in prone position. The aim of this study was to compare the postoperative radiological outcome, reoperation rate, operative and anesthesia time, infection and the wound complications rate between the two groups. METHODS The data of 49 adult patients with unilateral closed calcaneus fracture underwent open reduction and internal fixation using lateral extensile approach were collected. Postoperative Bohler's, Gissane angles and complications rate were compared between the two groups. RESULTS A total of 49 patients were included. Lateral position was utilized in 26 patients (53.1%), while 23 patients (46.9%) were operated in prone position. Majority of the patients were males 87.8% (43 patients), and the mean age of the patients was 31.12 ± 7.50. The most commonly mechanism of injury was fall from height in (91.8%) of the patients. The mean preoperative Bohler's angle was 9.33 ± 13.07 and increased to 22.69 ± 9.15 postoperatively. The mean preoperative angle of Gissane was 130.45 ± 26.98 whereas it was 124.76 ± 17.20 postoperatively. The mean postoperative Bohler's angle and angle of Gissane were significantly higher among patient who underwent fixation in lateral position (25.88 ± 6.62, 137.15 ± 11.17) when compared to the prone one (19.09 ± 10.35, 110.74 ± 10.81). There was no significant difference between the two groups regarding the reoperation rate (p 0.947), infection (p 0.659, operative time (p 0.688), anesthesia time (p 0.522) and wound complications (p 0.773). CONCLUSION Surgical restoration of the Bohler's and Gissane's angles with the patient placed in the lateral decubitus position remains superior to the prone position with no difference in the complication rate between the two groups.
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Affiliation(s)
- Hammam Kayali
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Isam Moghamis
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Radi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Omar Baroudi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Toubasi
- School of Medicine, University of Jordan, Amman, Jordan
| | - Mazen A Foodoul
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Alkhayarin
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
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Ren W, Zhang K, Zhao Z, Zhang X, Lin F, Li Y, Bao K, Yang J, Chang J, Li J. Biomechanical characteristics of Sanders type II and III calcaneal fractures fixed by open reduction and internal fixation and percutaneous minimally invasive fixation. J Orthop Surg Res 2024; 19:166. [PMID: 38443993 PMCID: PMC10916136 DOI: 10.1186/s13018-024-04606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND This work investigated the differences in the biomechanical properties of open reduction and internal fixation (ORIF) and percutaneous minimally invasive fixation (PMIF) for the fixation of calcaneal fractures (Sanders type II and III calcaneal fractures as examples) through finite element analysis. METHODS Based on CT images of the human foot and ankle, according to the principle of three-point fixation, namely the sustentaculum tali, the anterior process and the calcaneal tuberosity were fixed. Three-dimensional finite element models of Sanders type II and III calcaneal fractures fixed by ORIF and PMIF were established. The proximal surfaces of the tibia, fibula and soft tissue were constrained, and ground reaction force and Achilles tendon force loads were added to simulate balanced standing. RESULTS The maximum stress was 80.54, 211.59 and 113.88 MPa for the calcaneus, screws and plates in the ORIF group and 70.02 and 209.46 MPa for the calcaneus and screws in the PMIF group, respectively; the maximum displacement was 0.26, 0.21 and 0.12 mm for the calcaneus, screws and plates in the ORIF group and 0.20 and 0.14 mm for the calcaneus and screws in the PMIF group, respectively. The values obtained from the simulation were within the permissible stress and elastic deformation range of the materials used in the model, and there was no significant stress concentration. The maximum stress and displacement of the calcaneus and implants were slightly lower in the PMIF group than in the ORIF group when fixing Sanders type II and III calcaneal fractures. CONCLUSIONS This study may provide a reference for optimising the design of implants, the development of individualised preoperative plans and the choice of clinical surgical approach.
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Affiliation(s)
- Wu Ren
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China
| | - Kailu Zhang
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China
| | - Ziya Zhao
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China
| | - Xueling Zhang
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China
| | - Fei Lin
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Yawei Li
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Ke Bao
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Jun Yang
- Hunan Normal University, Changsha, 410000, Hunan, China
| | - Jinlong Chang
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China.
| | - Jia Li
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China.
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Liu Z, Hou G, Zhang W, Lin J, Yin J, Chen H, Huang G, Li A. Calcaneal tuberosity avulsion fractures - A review. Injury 2024; 55:111207. [PMID: 37984015 DOI: 10.1016/j.injury.2023.111207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/30/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
Calcaneal tuberosity avulsion fracture, an extra-articular injury, is a rare fracture caused internally by Achilles tendon driven following intense contraction of gastrocnemius-soleus complex, and externally by low-energy (possibly high-energy). Moreover, the risk of injuries of the skin and Achilles tendon around calcaneal tuberosity is closely related to Lee classification and Carnero-Martín de Soto Classification of calcaneal tuberosity avulsion fracture. Although the diagnosis confirmed by X-ray, digital imaging and computed tomography (CT), magnetic resonance imaging (MRI) should also be used to evaluate soft tissue. In recent years, the understanding of this fracture has witnessed the development of different internal fixation devices and surgical procedures. These advances have been further elaborated scientifically in terms of their ability to provide stable fracture reduction ad resistance to Achilles tendon forces. In order to obtain a comprehensive knowledge of the disease, this article reviewed the new understanding of the anatomy, typing, risk factors, and treatment modalities of calcaneal tuberosity avulsion fracture in recent years.
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Affiliation(s)
- Zhiyi Liu
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
| | - Guodong Hou
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Wencong Zhang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Junyan Lin
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Jinrong Yin
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Huan Chen
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Guowei Huang
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Aiguo Li
- Department of Orthopedics, Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.
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Chirayath A, Dhaniwala N, Kawde K. A Comprehensive Review on Managing Fracture Calcaneum by Surgical and Non-surgical Modalities. Cureus 2024; 16:e54786. [PMID: 38529440 PMCID: PMC10961470 DOI: 10.7759/cureus.54786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/23/2024] [Indexed: 03/27/2024] Open
Abstract
This comprehensive review delves into the multifaceted landscape of calcaneal fractures, thoroughly examining their aetiology, clinical presentation, and diverse management strategies. Encompassing surgical and non-surgical approaches, the review scrutinises critical aspects such as patient compliance, rehabilitation protocols, and long-term follow-up considerations. Surgical modalities, propelled by recent innovations like minimally invasive techniques and advanced fixation materials, are juxtaposed with non-surgical interventions, emphasising the pivotal role of patient education and adherence to optimise outcomes. The synthesis of critical findings underscores the need for individualised care and multidisciplinary collaboration in clinical practice. Moreover, the review outlines recommendations for healthcare practitioners and identifies promising areas for future research, including biomechanical studies and telerehabilitation. This comprehensive exploration aims to contribute to the ongoing evolution of calcaneal fracture management, ultimately enhancing patient care and outcomes in this complex orthopaedic realm.
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Affiliation(s)
- Aditya Chirayath
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nareshkumar Dhaniwala
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kevin Kawde
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wang C. Hollow screw fixation of type II avulsion fractures of the calcaneal tuberosity using the finite element analysis. Medicine (Baltimore) 2023; 102:e33816. [PMID: 37335730 PMCID: PMC10194749 DOI: 10.1097/md.0000000000033816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/28/2023] [Indexed: 06/21/2023] Open
Abstract
We aimed to establish a model of type II avulsion fractures of the calcaneal tuberosity treated with 2 hollow screws implanted in different directions and to analyze the biomechanical properties of the model using the finite element method. The Dicom data of the calcaneal bone obtained after computed tomography scan were inputted into Mimics 21.0 software and Geomagic Studio software to generate a 3D finite element digital model of the calcaneal bone. The model was then imported into SOLIDWORKS 2020 software. Based on the Beavis theory, the calcaneal bone was cut to build a type II avulsion fracture model of the calcaneal tuberosity; the calcaneal fracture was then simulated by internal fixation using hollow screws. Two screws were used to fix the calcaneal bone from the calcaneal tuberosity in different ways, resulting in 3 different calcaneal models (Model 1 involved 2 screws for fixing the fracture vertically; Model 2 had 2 screws for fixing the fracture cross-wise; and Model 3 had 2 screws for fixing the fracture parallelly). Three internal fixation models were loaded under the same conditions, and lines finite element analysis was then performed to calculate the stress distribution of the generated internal fixation models. Under the same loading conditions, compared with Models 2 and 3, Model 1 exhibited smaller maximum displacement values of the heel bone, maximum equivalent force values of the screws, and more dispersed stresses. Avulsion fractures of the calcaneal tuberosity can be treated using 2 screws to fix the fracture vertically (Model 1), which is more biomechanically relevant.
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Affiliation(s)
- Chengwei Wang
- Department of Orthopedics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
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Delmon R, Vendeuvre T, Pries P, Aubert K, Germaneau A, Severyns M. Percutaneous balloon calcaneoplasty versus open reduction and internal fixation (ORIF) for intraarticular SANDERS 2B calcaneal fracture: Comparison of primary stability using a finite element method. Injury 2023:S0020-1383(23)00272-3. [PMID: 36997362 DOI: 10.1016/j.injury.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/25/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Fractures of the calcaneus are common, with 65% being intra-articular, which can lead to a major impairment of the patient's quality of life. Open reduction and internal fixation with locking plates can be considered as gold-standard technique but has a high rate of post-operative complications. Minimally invasive calcaneoplasty combined with minimally invasive screw osteosynthesis is largely drawn from the management of depressed lumbar or tibial plateau fractures. The hypothesis of this study is that calcaneoplasty associated with minimally invasive percutaneous screw osteosynthesis presents biomechanical characteristics comparable with conventional osteosynthesis. MATERIALS AND METHODS Eight hind feet were collected. A SANDERS 2B fracture was reproduced on each specimen, while four calcanei were reduced by a balloon calcaneoplasty method and fixed with a lateral screw, four others were manually reduced and fixed with conventional osteosynthesis. Each calcaneus was then segmented for 3D finite element modeling. A vertical load was applied to the joint surface in order to measure the displacement fields and the stress distribution according to the type of osteosynthesis. RESULTS Analyses of the intra-articular displacement fields showed lower overall displacements in calcaneal joints treated with calcaneoplasty and lateral screw fixation. Better stress distribution was found in the calcaneoplasty group with lower equivalent joint stresses. These results could be explained by the role of the PMMA cement as a strut, enabling better load transfer. CONCLUSION Balloon Calcaneoplasty combined with lateral screw osteosynthesis has biomechanical characteristics at least comparable to locking plate fixation in the treatment of SANDERS 2B calcaneal joint fractures in terms of displacement fields and stress distribution under the premise of anatomical reduction.
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Affiliation(s)
- Romain Delmon
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France
| | - Tanguy Vendeuvre
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France; Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Pierre Pries
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France
| | - Kevin Aubert
- Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Arnaud Germaneau
- Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Mathieu Severyns
- Orthopedic and traumatology department, Clinique Porte Océane, Les Sables d'Olonne, France.
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Shams A, Gamal O, Mesregah MK. Minimally Invasive Reduction of Intraarticular Calcaneal Fractures With Percutaneous Fixation Using Cannulated Screws Versus Kirschner Wires: A Retrospective Comparative Study. Foot Ankle Spec 2023; 16:28-35. [PMID: 33511858 DOI: 10.1177/1938640020987750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several minimally invasive techniques were developed for management of intraarticular calcaneal fractures. This study aimed to compare the functional and radiological outcomes of 2 minimally invasive reduction and fixation techniques using cannulated screws or Kirschner wires (K-wires) for fixation. METHODS This study was a retrospective comparative review of patients with displaced intraarticular calcaneal fractures, who were treated with cannulated screws or K-wires techniques. Clinical and radiological data were collected and compared between both groups. Functional outcomes and patient satisfaction using the Maryland Foot Score (MFS) and the visual analogue scale (VAS) of pain, in addition to the complications, were compared between both groups. RESULTS In total, 70 patients were included in the study: 34 in the cannulated screws group, with a mean age of 35.2 ± 4 years, and 36 in the K-wires groups, with a mean age of 33.4 ± 3 years. The operative time was shorter in the K-wires group (40.5 ± 5.6 minutes) compared to the cannulated screw group (49.5 ± 4.5 minutes), P < .001. There were no statistically significant differences between both groups regarding the radiological parameters, including Bohler's angle, angle of Gissane, calcaneal width, height, or length. The mean MFS, mean VAS, and complications were not different between the 2 groups. CONCLUSION Treatment of displaced intraarticular calcaneal fractures with minimally invasive reduction and fixation using either cannulated screws or K-wires can achieve similar excellent functional and radiological outcomes, with high patient satisfaction. The use of K-wires has the advantage of reduced operative time than cannulated screws. LEVELS OF EVIDENCE Level III: Retrospective comparative study.
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Affiliation(s)
- Ahmed Shams
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Osama Gamal
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt.,Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Park HJ, You KH, Huang B, Yoon JH, Kim HN. Can 3-Dimensional Printing for Calcaneal Fracture Surgery Decrease Operation Time and Improve Quality of Fracture Reduction? J Foot Ankle Surg 2022; 62:21-26. [PMID: 35418345 DOI: 10.1053/j.jfas.2022.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 02/03/2023]
Abstract
We investigated whether 3-dimensional (3D) printed models can decrease operation time and improve the quality of reduction for calcaneal fractures. The study involved 48 patients with unilateral intra-articular calcaneal fractures, who were retrospectively case-matched according to Sander's classification, age, and sex. Group A (24 patients) was operated using 3D printed models as a preoperative and intraoperative tool, and group B (24 patients) was operated using standard techniques without 3D printed model. Operation time was significantly shorter for group A, compared to group B (82.3 ± 13.2 vs 91.4 ± 16.0, p = .036). The differences between the radiological parameters of operated calcaneus, compared to the normal side was similar between the 2 groups (Böhler angle, 5.3° ± 3.9° vs 4.2° ± 4.7°, p = .45, Gissane angle, 5.9° ± 12.5° vs 8.4° ± 11.0°, p = .54). The number of screws projecting more than 5 mm from the cortex was lower in group A than in group B (7/187, 4% vs 16/208, 8%, p = .11). The number of screw holes of the plate cut intraoperatively was significantly lower for group A compared to group B (1 vs 138). Although group A started weightbearing 3 to 4 weeks earlier than group B, the radiological parameters were similar between groups that early weightbearing was possible for group A using the 3D printed models (Böhler angle, - 1.5° ± 0.8° vs - 1.8° ± 1.2°, p = .28, Gissane angle, 2.5° ± 2.6° vs 3.5° ± 4.3°, p = .39). The operation time was shorter while using the 3D printed models, compared to that of the standard technique without using the 3D printed model. The radiological parameters were not statistically different, and the quality of fracture reduction seemed similar. However, with the use of 3D printed models, early weightbearing was possible without significant subsidence of reduced fragments or failure of fracture reduction, comparable to non-weightbearing cases.
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Affiliation(s)
- Hyun-Jin Park
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ki-Han You
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Bingzhe Huang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Joon Hyeok Yoon
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
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Stefanov A, Ivanov S, Zderic I, Baltov A, Rashkov M, Gehweiler D, Richards G, Gueorguiev B, Enchev D. Comminuted intraarticular calcaneal fractures: Multiplanar VA locked plating and interlocked nailing incorporate longitudinal strut and provide superior stability - a biomechanical cadaveric study. Injury 2022; 53:3543-3552. [PMID: 35810043 DOI: 10.1016/j.injury.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023]
Abstract
Treatment of comminuted intraarticular calcaneal fractures remains controversial and challenging. The aim of this study was to investigate the biomechanical performance of three different methods for fixation of such fractures. Comminuted calcaneal fractures, including Sanders III AB fracture of the posterior facet and Kinner II B fracture of the calcaneocuboid joint (CCJ) articular calcaneal surface, were created in 18 human cadaveric lower legs by osteotomizing. The ankle joint, medial soft tissues and midtarsal bones along with their ligaments were preserved. The specimens were randomized to three groups for fixation with either (1) 2.7 mm variable-angle locking lateral calcaneal plate (Group 1), (2) 2.7 mm variable-angle locking anterolateral calcaneal plate in combination with one 4.5 mm and one 6.5 mm cannulated screws (Group 2), or (3) interlocking calcaneal nail with 3.5 mm screws in combination with three separate 4.0 mm cannulated screws (Group 3). All specimens were biomechanically tested to failure under axial loading in midstance foot position. Each test commenced with a quasi-static compression ramp from 50 to 200 N, followed by progressively increasing cyclic loading at 2 Hz. Starting from 200 N, the peak load of each cycle increased at a rate of 0.2 N/cycle. Interfragmentary movements were captured by motion tracking. In addition, mediolateral X-rays were taken every 250 cycles with a triggered C-arm. Böhler angle after 5000 cycles (1200 N peak load) increased significantly more in Group 1 compared to both other groups (P ≤ 0.020). Varus deformation of 10° between the calcaneal tuberosity and the lateral calcaneal fragments was reached at significantly lower number of cycles in Group 1 compared the other groups (P ≤ 0.017). Both cycles to 10° plantar gapping between the anterior process and the calcaneal tuberosity fragments, and 2 mm displacement at the CCJ articular calcaneal surface revealed no significant differences among the groups (P ≥ 0.773). From a biomechanical perspective, treatment of comminuted intraarticular calcaneal fractures using anterolateral variable-angle locking plate with additional longitudinal screws or interlocked nail in combination with separate transversal screws provides superior stability as opposed to lateral variable-angle locked plating only.
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Affiliation(s)
- A Stefanov
- AO Research Institute Davos, Davos, Switzerland; University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria.
| | - S Ivanov
- AO Research Institute Davos, Davos, Switzerland; Medical University of Varna, Varna, Bulgaria
| | - I Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - A Baltov
- University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - M Rashkov
- University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - D Gehweiler
- AO Research Institute Davos, Davos, Switzerland
| | - G Richards
- AO Research Institute Davos, Davos, Switzerland
| | | | - D Enchev
- University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
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Bischofreiter M, Litzlbauer W, Breulmann F, Kindermann H, Rodemund C, Mattiassich G. Return-to-sports after minimally invasive stabilization of intra-articular calcaneal fractures. SPORTVERLETZUNG-SPORTSCHADEN 2022; 36:100-110. [PMID: 35345053 DOI: 10.1055/a-1688-3720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Evaluation of different factors in patient quality of life after minimally invasive stabilization of intra-articular calcaneal fractures, including the return-to-sports rate. PATIENTS AND METHODS Patients with minimally invasive stabilization of intra-articular calcaneal fractures were collected from the database of a Level I trauma center and evaluated in a retrospective and explorative way. The clinical and radiological examination have been done immediately after the operation, after 2 and 6 weeks postoperative and after a minimum follow-up of 2 years. Clinical and radiological examination was performed by applying the American Orthopedic Foot and Ankle Society hindfoot scale score (AOFAS), 36-item Short Form Health Survey (SF-36), the Tegner Activity Scale, the Foot and Ankle Outcome Score (FAOS) and with a questionnaire about pre- and postoperative engagement in sport and recreational activities. RESULTS Fourty-nine patients with an isolated uni-lateral fracture of the calcaneus who fulfilled all inclusion criteria were assessed. Fourty-two of them were male and 24 were under the age of 50 years. No statistically significant differences were noted between Sanders I/II and Sanders III/IV in terms of SF-36, AOFAS, FAOS or Tegner-scale. A less satisfying result was noticed in Sanders III/IV patients. General health, pain in FAOS, physical functioning and pain in SF-36 were strongly dependent on Tegner score values. Twenty-nine percent of our study population changed sport activities after injury, whereas 22 percent stopped all kinds of sports. Consequently, our overall return-to-sport rate was 78 percent. CONCLUSION Clinical results including different scores and quality of life parameters in our study population were satisfying. About 80 percent of patients could return to sports, but there are still many patients that were not able to perform sports and physical activities on the same level as before.
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Affiliation(s)
- Martin Bischofreiter
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz + Department of Orthopedic Surgery, Clinic Diakonissen Schladming
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Wang J, Qin S, Wang T, Liu J, Wang Z. Comparison of the Curative Effect of Percutaneous Reduction with Plastic Calcaneal Forceps Combined with Medial External Fixation in the Treatment of Intra-Articular Calcaneal Fractures. Orthop Surg 2021; 13:2344-2354. [PMID: 34767310 PMCID: PMC8654646 DOI: 10.1111/os.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/28/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the clinical efficacy of percutaneous minimally invasive reduction combined with external fixation and a tarsal sinus approach to treat Sanders type II and III intra‐articular calcaneal fractures. Methods The clinical data of 64 patients with Sanders type II and III calcaneal fractures admitted to our hospital from January 2010 to January 2016 were retrospectively analyzed; data includedage, sex, body mass index. According to the surgical method, they were divided into the percutaneous minimally invasive reduction with internal and external fixation group (30 cases) and the tarsal sinus approach group (34 cases).The two groups of patients were compared in terms of the time tosurgery, length of hospital stay, intraoperative blood loss, operative duration, complications, radiographic features, including the heel bone length, width, height, Bohlerangle, Gissane angle, and calcaneal varus angle, and clinical efficacy indicators, including the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS) pain score, health survey profile (SF‐36) score and Maryland ankle function score. Results Patients in both groups were followed up for 12 to 50 months, with an average of 24.8 months.Bony union was achieved in all cases. The time to surgery, length of hospitalstay, intraoperative blood loss and incidence of incision‐related complications were significantly lower in the percutaneous minimally invasive medial external fixation group than in the tarsal sinus group (P < 0.01). At the last follow‐up, the calcaneal length, width, and height, Bohler angle, Gissane angle, and varus angle were significantly increased in both groups (P < 0.01), the calcaneal width was significantly lower after than before surgery (P < 0.01), and there were no statistically significant differences between the two groups (P > 0.05). As measures of clinical efficacy, the AOFAS, VAS, SF‐36 and Maryland scores were 85.28 ± 8.21, 0.84 ± 1.21, 82.95 ± 3.25 and 83.56 ± 3.32, respectively, at the last follow‐up in the percutaneous minimally invasive medial external fixation group and 83.32 ± 7.69, 1.85 ± 1.32, 80.71 ± 5.42, and 81.85 ± 2.41 in the tarsal sinus group, respectively, with no significant differences between the two groups (P > 0.05). Conclusion Under the condition of a good command of surgical indications and surgical skills, the use of plastic calcaneal forceps for percutaneous minimally invasive reduction combined with medial external fixation for the treatment of Sanders type II and III intra‐articular calcaneal fractures can achieve similar clinical effects as the tarsal sinus approach. However, the use of plastic calcaneal forceps for percutaneous minimally invasive reduction combined with internal and external fixation has advantages, such as fewer complications, less bloodloss, and a shorter operation, and thus has good safety and is worthy of clinical promotion.
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Affiliation(s)
- Jianchuan Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Song Qin
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Tienan Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jibin Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Zongpu Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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Varol A, Oc Y, Kilinc BE. An evaluation of the efficacy of the locked plate with bone grafting in Sanders type III and IV intra-articular calcaneus fractures. SAGE Open Med 2021; 9:20503121211040954. [PMID: 34434558 PMCID: PMC8381430 DOI: 10.1177/20503121211040954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/30/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: To demonstrate the efficacy of locking plate osteosynthesis performed by an
L-shaped lateral approach in patients with Sanders type III and IV
intra-articular calcaneal fractures with posterior facet displacement. Methods: Fifty-three patients with Sanders type III or IV unilateral calcaneal
fractures treated with locking plates and additional bone grafting were
included in the study. Böhler and Gissane angles, and heel height values
were measured on the radiological examinations. Clinical results of the
patients were evaluated using the American Orthopaedic Foot and Ankle
Society and Maryland evaluation criteria. The presence of arthrosis was
investigated with Broden’s view. Preoperative and postoperative values were
evaluated. Results: The mean Gissane angle was 119.32°, the mean Böhler angle was 9.47° and the
mean heel height was 40.82 mm on radiographs at initial presentation of the
patients. The mean Gissane angle was 114.63°, the mean Böhler angle was
23.33° and the mean heel height was 47.84 mm on the early postoperative
radiographs of the patients. In patients, a mean 4.69° recovery was achieved
in the Gissane angle, 13.86° in Böhler angle and 7.02 mm in heel height. On
the most recent follow-up, Böhler angle was 21.49°, Gissane was 114.88° and
the mean heel height was 46.95 mm. The mean American Orthopaedic Foot and
Ankle Society score and Maryland score were 86.91 and 86.53, respectively,
on the last follow-up. Conclusion: Internal fixation and grephonage using low-profile locking plates provides
good functional results to patients since it facilitates anatomic
restoration of the subtalar joint and correction of calcaneal height, width
and varus/valgus heel.
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Affiliation(s)
- Ali Varol
- Department of Orthopaedics and
Traumatology, Health Science University, Istanbul Fatih Sultan Mehmet Training and
Research Hospital, Istanbul, Turkey
| | - Yunus Oc
- Department of Orthopaedics and
Traumatology, Beykent University Faculty of Medicine, Istanbul, Turkey
| | - Bekir Eray Kilinc
- Department of Orthopaedics and
Traumatology, Health Science University, Istanbul Fatih Sultan Mehmet Training and
Research Hospital, Istanbul, Turkey
- Bekir Eray Kilinc, Department of
Orthopaedics and Traumatology, Health Science University, Istanbul Fatih Sultan
Mehmet Training and Research Hospital, Icerenkoy District Zubeyde Hanim Street
No: 1 B-43 PC:34752, Atasehir, Istanbul, Turkey.
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Gao D, Wong TM, Fang C, Leung FK, Li X, Jia B, Wang Y, Yu B. Arthroscopic-assisted percutaneous fixation of intra-articular calcaneal fractures using an intraoperative distraction device. J Orthop Surg (Hong Kong) 2021; 29:2309499020979095. [PMID: 33410380 DOI: 10.1177/2309499020979095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the quality of reduction and clinical outcomes by using Percutaneous Distractor and Subtalar Arthroscopy Closed Reduction followed by Internal Fixation (PDSA-CRIF) in the intra-articular calcaneal fracture. METHODS A consecutive case series of 453 patients with 507 displaced intra-articular calcaneal fractures was recruited in this retrospective study. We performed PDSA-CRIF to treat intra-articular calcaneal fractures. The quality of reduction was assessed by early postoperative Computed Tomography (CT) scans and measurement of serial Bohler's angles during follow-ups. Clinical outcomes were evaluated by Visual Analogue Scale (VAS) and the American Foot & Ankle Society ankle-hind foot scale (AOFAS) scoring system. RESULTS Fifty-nine patients (68 fractures) who had complete clinical data and follow-up of at least 12-months (mean: 14 months, range: 12-59 months) were finally included. Anatomical and near-anatomical reduction in subtalar articular surface which had less than 2 mm gap or step-off was found in 93% fractures. Unsatisfactory reduction was found in 7%. CONCLUSION Arthroscopic-assisted percutaneous fixation using a distraction device is effective in achieving positive short-term results in the displaced intra-articular calcaneal fractures. A multicenter, large sample, randomized control trial is needed to fully evaluate the long-term effects of PDSA-CRIF in comparison to other methods.
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Affiliation(s)
- Di Gao
- Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Orthopedics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Tak Man Wong
- Department of Orthopedics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Christian Fang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Frankie Kl Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Xiang Li
- Department of Orthopedics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Bin Jia
- Department of Orthopedics, Shenzhen Pingle Orthopedics Hospital, Shenzhen, China
| | - Yu Wang
- Department of Orthopaedics, Chifeng Municipal Hospital, Inner Mongolia, China.,Chifeng Clinical Medical School of Inner Mongolia Medical University, Inner Mongolia, China
| | - Bin Yu
- Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Gültekin A, Acar E, Uğur L, Yıldız A, Serarslan U. The importance of Böhler's angle in calcaneus geometry: A finite element model study. Jt Dis Relat Surg 2021; 32:420-427. [PMID: 34145820 PMCID: PMC8343831 DOI: 10.52312/jdrs.2021.81251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/14/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Calcaneal fractures are the most common tarsal fractures following a foot-ankle trauma. The Böhler's angle is an important measurable angle before, during, and after surgery. In this study, we aimed to investigate correlation between Böhler's angle, calcaneal strength, and subtalar joint stress using a finite element analysis (FEA). PATIENTS AND METHODS Between January 2016 and December 2016, computed tomography (CT) scans were used with MIMICS® software for FEA. The ankle and foot of a 23-year-old male person with a height of 180 cm and weighing 80 kg was modeled as reference. Raw coronal CT images were obtained in Digital Imaging and Communications in Medicine format with the resolution of 512X512 pixels and 0.3-mm slice intervals in 135 kV. The structures including tibia, fibula and 26 other bones (talus, calcaneus, cuboid, navicular, three cuneiforms, five metatarsals, and 14 components of phalanges), cartilage and ligamentous tissues were modeled to form ankle joint. After determining Böhler's angle as 35 degrees for the reference model, a fracture line was created on calcaneus. Calcaneus was remodeled with the Böhler's angle of 45, 40, 30, 25, 20, 10, and 0 degrees respectively. All models were transferred to ANSYS software for FEA and the loads on the lower extremities with normal posture were applied on models. RESULTS Analysis of all models based in the reference model revealed that maximum tension values on calcaneus increased, while the Böhler's angle decreased, indicating a statistically significant difference. The decreased Böhler's angle indicated statistically significantly higher maximum tension values (p=0.04). Action force in subtalar joint was evaluated by comparing with the forces in reference model. The increased Böhler's angle was found to be associated with statistically significantly decreased amount of load on subtalar joint. The decreased Böhler's angle was related to the statistically significantly increased amount of load on subtalar joint. CONCLUSION Our study results suggest that decreased Böhler's angle increases the possibility of subtalar arthrosis, although overcorrection of the Böhler's angle seems not to increase the risk of subtalar arthrosis.
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Affiliation(s)
| | - Erdinç Acar
- Ankara Şehir Hastanesi Ortopedi ve Travmatoloji Kliniği, El ve Üst Ekstremite Cerrahisi Bölümü, 06800 Çankaya, Ankara, Türkiye.
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Maccagnano G, Noia G, Cassano GD, Sarni AL, Quitadamo R, Stigliani C, Liuzza F, Vitiello R, Pesce V. Quality of Life and Clinical Evaluation of Calcaneoplasty with a Balloon System for Calcaneal Fracture at 5 Years of Follow-Up. Adv Orthop 2021; 2021:5530620. [PMID: 34211787 PMCID: PMC8208879 DOI: 10.1155/2021/5530620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/02/2021] [Indexed: 02/05/2023] Open
Abstract
Calcaneal fractures are a challenging clinical problem. Management of this type of injury remains controversial, especially in the context of intra-articular fractures. Surgical treatment with open reduction and internal synthesis (ORIF) is considered the standard treatment for CF, but it is associated with many complications. Several minimally invasive techniques such as balloon-assisted reduction, pin fixation, and tricalcium phosphate augmentation have been proposed to avoid the frequent and recurrent postoperative problems related to these fractures. We retrospectively examined 20 patients (mean age was 54.5), all undergoing minimally invasive calcaneoplasty surgery at our Department of Orthopaedics and Traumatology between 2012 and 2016. X-ray and CT scan were performed preoperatively and at 5 years of follow-up (57.9 ± 6 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was used for clinical examination, and the Short-Form (36) Health Survey (SF-36) score and Visual Analogue Scale (VAS) were used to assess the Health-Related Quality of Life (HRQoL). All 20 patients were available at the final follow-up. The mean AOFAS score was 82.25/100. The VAS results attest an overall average of 2.7/10 (0-9). The average of the parameters "Physical Health" and "Mental Health" was, respectively, 81.25 and 83.55. In terms of postoperative complications, we observed no cases of superficial or deep infections. Clinical response after balloon-assisted reduction, pin fixation, and tricalcium phosphate augmentation has shown a comparable or better outcome according to the AOFAS and VAS score. Quality-of-life scores, obtained according to the SF-36 questionnaire, are considered high. From both a clinical and quality-of-life point of view, our study highlights that there is not gender distinction. Further comparative studies with a higher number of patients are needed which assess the quality of life in the various techniques used to treat calcaneal fractures.
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Affiliation(s)
- Giuseppe Maccagnano
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Giovanni Noia
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Giuseppe Danilo Cassano
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, Faculty of Medicine and Surgery, University of Bari, Policlinico di Bari, Bari, Italy
| | - Antonio Luciano Sarni
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Raffaele Quitadamo
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Costantino Stigliani
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Francesco Liuzza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Vito Pesce
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
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21
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Zhang L, Chen Y, Wang X, Hua H, Sheng J, Chen J, Guo Z. [Simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:323-329. [PMID: 33719241 DOI: 10.7507/1002-1892.202010064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique. Methods Between January 2014 and August 2020, 6 cases of traumatic calcaneal osteomyelitis with defect deformities were treated by simultaneous treatment of near-arc bone transport by Ilizarov technique. The patients were all male; aged from 40 to 61 years (mean, 49.3 years). The disease duration was 2-72 months, with an average of 16.1 months. All patients were traumatic calcaneal osteomyelitis, including 4 cases of falling from height, 1 case of traffic accident injury, and 1 case of crushing injury. The infection affected the talar-heel joint in 4 cases, and the talar-heel joint was fused or partially fused in 2 cases. After the external fixator was removed, the Maryland foot scoring system was used to evaluate the foot function, and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot function scoring system was used to evaluate the ankle-hindfoot function, and were compared with the preoperative scores. Results All patients were followed up 1.5-26.0 months, with an average of 16.3 months. All incisions healed by first intention, no recurrence of infection occurred, and no surgical intervention such as second-stage bone grafting and fusion was performed. Five cases of calcaneal osteomyelitis with defect deformity underwent one-stage osteotomy and slipped, 1 case of the original bone mass after debridement after infection of calcaneal fractures slipped directly. The bone sliding time was 28-62 days, with an average of 38.7 days; the sliding distance was 3.1-5.2 cm, with an average of 3.6 cm. In 1 patient, due to the short follow-up time, the calcaneal slip bone had not healed, the external fixator had not been removed (not involved in clinical scoring), but the foot shape, reexamination of X-ray films and with frame walking were satisfactory. The time with external fixator was 6-8 months, with an average of 6.5 months in the other 5 cases. After removing the external fixator, the foot returned to three-point weight-bearing, and the longitudinal arch was recovered to varying degrees, and there was no obvious varus valgus. The Maryland score after removal of the external fixator was 80.8±4.7, which was significantly higher than that before operation (33.6±4.3) ( t=-35.782, P=0.000), 3 cases were excellent and 2 cases were good; the median AOFAS ankle-hindfoot score was 84, the interquartile range was (79, 86), which was significantly improved when compared with the preoperative score [the median score was 33.5, the interquartile range was (21.3, 37.5)] ( Z=-2.023, P=0.043), 4 cases were excellent and 1 case was good. Among them, pain, walking distance, getting rid of walking aids, going up and down stairs, deformity, etc. were significantly improved when compared with preoperative ones. Mobility such as subtalar and hock joints were poor or disappeared. Conclusion Simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique can optimize the operation method, reduce the number of operations, and try to simulate the original shape of the calcaneus. It is an effective, economical, and novel treatment method.
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Affiliation(s)
- Lei Zhang
- No.1 Department of Osteomyelitis, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China
| | - Yusheng Chen
- Department of VIP, the Second Affiliated Hospital of Henan University of Science and Technology, Luoyang Henan, 471000, P.R.China
| | - Xinwei Wang
- No.1 Department of Osteomyelitis, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China
| | - Haotian Hua
- No.1 Department of Osteomyelitis, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China
| | - Jingya Sheng
- No.1 Department of Osteomyelitis, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China
| | - Jiangfei Chen
- No.1 Department of Osteomyelitis, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China
| | - Zairan Guo
- No.1 Department of Osteomyelitis, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China
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22
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Aghnia Farda N, Lai JY, Wang JC, Lee PY, Liu JW, Hsieh IH. Sanders classification of calcaneal fractures in CT images with deep learning and differential data augmentation techniques. Injury 2021; 52:616-624. [PMID: 32962829 DOI: 10.1016/j.injury.2020.09.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Classification of the type of calcaneal fracture on CT images is essential in driving treatment. However, human-based classification can be challenging due to anatomical complexities and CT image constraints. The use of computer-aided classification system in standard practice is additionally hindered by the availability of training images. The aims of this study is to 1) propose a deep learning network combined with data augmentation technique to classify calcaneal fractures on CT images into the Sanders system, and 2) assess the efficiency of such approach with differential training methods. METHODS In this study, the Principle component analysis (PCA) network was selected for the deep learning neural network architecture for its superior performance. CT calcaneal images were processed through PCA filters, binary hashing, and a block-wise histogram. The Augmentor pipeline including rotation, distortion, and flips was applied to generate artificial calcaneus fractured images. Two types of training approaches and five data sample sizes were investigated to evaluate the performance of the proposed system with and without data augmentation. RESULTS Compared to the original performance, use of augmented images during training improved network performance accuracy by almost twofold in classifying Sanders fracture types for all dataset sizes. A fivefold increase in the number of augmented training images improved network classification accuracy by 35%. The proposed deep CNN model achieved 72% accuracy in classifying CT calcaneal images into the four Sanders categories when trained with sufficient augmented artificial images. CONCLUSION The proposed deep-learning algorithm coupled with data augmentation provides a feasible and efficient approach to the use of computer-aided system in assisting physicians in evaluating calcaneal fracture types.
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Affiliation(s)
- Nurya Aghnia Farda
- Department of Computer Science and Information Engineering, National Central University, Jhongli County, Taoyuan City, Taiwan
| | - Jiing-Yih Lai
- Department of Mechanical Engineering, National Central University, Jhongli County, Taoyuan City, Taiwan
| | - Jia-Ching Wang
- Department of Computer Science and Information Engineering, National Central University, Jhongli County, Taoyuan City, Taiwan; Pervasive Artificial Intelligence (PAIR) Labs, Taipei City, Taiwan
| | - Pei-Yuan Lee
- Orthopedic Department, Show Chwan Memorial Hospital, Changhua City, Taiwan
| | - Jia-Wei Liu
- Institute of Cognitive Neuroscience, National Central University, No. 300, Jhongda Rd., Jhongli County, Taoyuan City 32001, Taiwan
| | - I-Hui Hsieh
- Institute of Cognitive Neuroscience, National Central University, No. 300, Jhongda Rd., Jhongli County, Taoyuan City 32001, Taiwan.
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23
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Tian H, Guo W, Zhou J, Wang X, Zhu Z. Bone graft versus non-bone graft for treatment of calcaneal fractures: A protocol for meta-analysis. Medicine (Baltimore) 2021; 100:e24261. [PMID: 33466211 PMCID: PMC7808454 DOI: 10.1097/md.0000000000024261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/07/2020] [Accepted: 12/13/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Calcaneal fractures are a prevalent form of injury caused by high-energy trauma. This study aimed at investigating whether bone graft and non-bone graft are essential for the internal fixation of calcaneal fractures. A meta-analysis of relevant clinical studies evaluated radiographic parameters, functional outcomes, and complications that offer practical recommendations on the suitability of bone grafts for the management of Calcaneal fractures. METHODS AND ANALYSIS This study performed a comprehensive search on PubMed, EMBASE, and Cochrane electronic to retrieve related clinical studies. The studies incorporated in our meta-analysis were identified after doing a preliminarily screening, reading of the full-text articles, and eliminating repeated studies. After quality assessment and data extraction, the standardized mean difference and risk ratio were selected as effect sizes. The data on Böhler angle, Gissane angle, calcaneal height, American Orthopaedic Foot and Ankle Society hindfoot scores, Maryland Foot Evaluation, and rate of wound infection were analyzed using Revman 5.3 software (Cochrane Collaboration). RESULTS AND CONCLUSIONS This study did not reveal any significant differences (P < .05) in both Böhler and Gissane angles, calcaneal height, American Orthopaedic Foot and Ankle Society hindfoot scores, Maryland foot evaluation, and rate of wound infection between the 2 groups. Due to the lack of a large sample of comparative studies, the use of bone grafting for the management of calcaneal fractures requires additional substantiation.
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Affiliation(s)
- Heng Tian
- Department of Hand Surgery, The Second Hospital of Jilin University
| | - Wenlai Guo
- Department of Hand Surgery, The Second Hospital of Jilin University
| | - Jinlan Zhou
- Center for Applied Statistical Research and College of Mathematics, Jilin University, Changchun, China
| | - Xiaoyue Wang
- Center for Applied Statistical Research and College of Mathematics, Jilin University, Changchun, China
| | - Zhe Zhu
- Department of Hand Surgery, The Second Hospital of Jilin University
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24
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Rodemund C, Krenn R, Kihm C, Leister I, Ortmaier R, Litzlbauer W, Schwarz AM, Mattiassich G. Minimally invasive surgery for intra-articular calcaneus fractures: a 9-year, single-center, retrospective study of a standardized technique using a 2-point distractor. BMC Musculoskelet Disord 2020; 21:753. [PMID: 33189140 PMCID: PMC7666766 DOI: 10.1186/s12891-020-03762-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A fracture of the calcaneus can be a painful and disabling injury. Treatment modalities may be conservative or operative. Surgical treatment strategies include open reduction and internal fixation (ORIF) techniques, as well as a variety of minimally invasive methods. The aim of this study was to evaluate the treatment options and post-treatment complication rates for intra-articular calcaneal fractures at the Traumacenter Linz over a 9-year period. METHODS All patients with calcaneal fractures treated at the Traumacenter Linz between 2007 and 2015 were included in this study. The patients records were retrospectively reviewed, and the data, including demographic parameters, cause of injury, and the time between injury and operative treatment were analyzed. The number of secondary operative interventions due to soft-tissue complications, hardware removal, and the long-term arthrodesis rate were evaluated. RESULTS A minimally invasive 2-point-distractor method was used in 85.8% (n = 182) of all operatively managed calcaneal fractures (n = 212) in our department. The majority of the operations (88.7%) were performed within 2 days after the accident. The secondary operation rate resulting from wound complications was 2.7% in the 2-point distractor group and 16.7% in the ORIF group. A secondary arthrodesis was performed in 4.7% (n = 9) of the subtalar joints in the entire study population. CONCLUSIONS Our data supported the assumption that severe wound complications would be less likely to occur after minimally invasive treatment compared to ORIF treatment. The rate of secondary arthrodesis in the study cohort was comparable to that in the literature. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Christian Rodemund
- AUVA - Traumacenter (UKH) Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Ronny Krenn
- AUVA - Traumacenter (UKH) Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Carl Kihm
- Norton Audubon Hospital, Attending Podiatric Surgeon, Louisville, KY, USA
| | - Iris Leister
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria.,Research Unit of Orthopedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Hall in Tirol, Austria
| | - Werner Litzlbauer
- AUVA - Traumacenter (UKH) Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Angelika M Schwarz
- AUVA - Traumacenter (UKH) Styria
- Graz, Teaching Hospital of the Medical University Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - Georg Mattiassich
- AUVA - Traumacenter (UKH) Styria
- Graz, Teaching Hospital of the Medical University Graz, Göstinger Straße 24, 8020, Graz, Austria.
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25
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Zheng G, Xia F, Yang S, Cui J. Application of medial column classification in treatment of intra-articular calcaneal fractures. World J Clin Cases 2020; 8:4400-4409. [PMID: 33083399 PMCID: PMC7559649 DOI: 10.12998/wjcc.v8.i19.4400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/03/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are many types of treatments for calcaneal fractures, including conservative treatment, conventional surgical treatment, and minimally invasive surgery. The choice of specific treatment options is still controversial. Open reduction and internal fixation are currently the most commonly used surgical procedures in the clinic. A good fracture reduction effect can be achieved by using the lateral extension incision of the calcaneus; however, many studies have reported a high incidence of postoperative incision complications. Although there are many methods for the classification of intra-articular calcaneal fractures, it is generally believed that the computed tomography (CT) classification proposed by Sanders has high application value in the selection of treatment methods and evaluation of prognosis of calcaneal fractures. However, this method has no clear guiding significance for the choice of surgical incision and surgical plan.
AIM To explore the application and clinical efficacy of medial column classification in the treatment of intra-articular calcaneal fractures.
METHODS From July 2017 to July 2018, 91 patients, including 60 males and 31 females aged 27 to 60 years, were enrolled. All participants had closed intra-articular calcaneal fracture, and their surgical options were selected under the guidance of medial column classification. The patients’ fractures were classified according to the Sanders classification: Type II, 35 cases; Type III, 33 cases; and Type IV, 23 cases. Among them, 53 patients had medial column displacement (shortened varus) and underwent open reduction and internal fixation with L-lateral incision of the calcaneus; 38 patients had no displacement of the medial column and underwent open reduction and internal fixation with tarsal sinus incision. The calcaneus Böhler angle, Gissane angle, length, width, height, and step thickness of the articular surface were evaluated by X-ray and three-dimensional CT before and after surgery and at the last follow-up. Foot function recovery was assessed by the Maryland foot scoring criteria.
RESULTS All patients were followed for 5 to 14 mo, with an average of 10.5 ± 2.9 mo. The fractures of all patients healed, and the healing time was 10 to 19 wk, with an average of 10.8 ± 1.5 wk. One patient developed wound infection 1 wk after surgery and was actively debrided and implanted with antibiotic calcium sulfate to control the infection. The patient's fracture healed 5 mo after surgery. One patient developed a sural nerve injury, and the symptoms disappeared 3 mo after surgery. The patients were assessed according to the Maryland foot scoring system: Excellent in 77 cases, good in 10, and fair in 4. The excellent and good rate was 95.6%.
CONCLUSION Medial column classification can effectively guide the surgical selection for intra-articular fractures of the calcaneus.
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Affiliation(s)
- Gang Zheng
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Fan Xia
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Shuang Yang
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Jun Cui
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
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26
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Wilhelm MP, Hooper TL, Seeber GH, Browne KL, Sargent E, Gilbert KK, James CR, Brismée JM, Matthijs OC, Matthijs A, Sizer PS. The relationship between measures of foot mobility and subtalar joint stiffness using vibration energy with color Doppler imaging-A clinical proof-of-concept validation study. PLoS One 2020; 15:e0237634. [PMID: 32813729 PMCID: PMC7437893 DOI: 10.1371/journal.pone.0237634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 07/30/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Subtalar joint (STJ) dysfunction can contribute to movement disturbances. Vibration energy with color Doppler imaging (VECDI) may be useful for detecting STJ stiffness changes. OBJECTIVES (1) Support proof-of-concept that VECDI could detect STJ stiffness differences; (2) Establish STJ stiffness range in asymptomatic volunteers; (3) Examine relationships between STJ stiffness and foot mobility; and (4) Assess VECDI precision and reliability for examining STJ stiffness. METHODS After establishing cadaveric testing model proof-of-concept, STJ stiffness (threshold units, ΔTU), ankle complex passive range-of-motion (PROM) and midfoot-width-difference (MFWDiff) data were collected in 28 asymptomatic subjects in vivo. Three reliability measurements were collected per variable; Rater-1 collected on all subjects and rater-2 on the first ten subjects. Subjects were classified into three STJ stiffness groups. RESULTS Cadaveric VECDI measurement intra-rater reliability was 0.80. A significantly lower STJ ΔTU (p = .002) and ankle complex PROM (p < .001) was observed during the screw fixation versus normal condition. A fair correlation (r = 0.660) was observed between cadaveric ΔTU and ankle complex PROM. In vivo VECDI measurements demonstrated good intra-rater (0.76-0.84) versus poor inter-rater (-3.11) reliability. Significant positive correlations were found between STJ stiffness and both dorsum (r = .440) and posterior (r = .390) PROM. MFWDiff exhibited poor relationships with stiffness (r = .103) and either dorsum (r = .256) or posterior (r = .301) PROM. STJ stiffness ranged from 2.33 to 7.50 ΔTUs, categorizing subjects' STJ stiffness as increased (n = 6), normal (n = 15), or decreased (n = 7). Significant ANOVA main effects for classification were found based on ΔTU (p< .001), dorsum PROM (p = .017), and posterior PROM (p = .036). Post-hoc tests revealed significant: (1) ΔTU differences between all stiffness groups (p < .001); (2) dorsum PROM differences between the increased versus normal (p = .044) and decreased (p = .017) stiffness groups; and (3) posterior PROM differences between the increased versus decreased stiffness groups (p = .044). A good relationship was found between STJ stiffness and dorsum PROM in the increased stiffness group (r = .853) versus poor, nonsignificant relationships in the normal (r = -.042) or decreased stiffness (r = -.014) groups. CONCLUSION PROM may not clinically explain all aspects of joint mobility. Joint VECDI stiffness assessment should be considered as a complimentary measurement technique.
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Affiliation(s)
- Mark P Wilhelm
- Tufts University School of Medicine, Medford, Massachusetts, United States of America
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, United States of America
| | - Troy L Hooper
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, United States of America
| | - Gesine H Seeber
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, United States of America
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Kevin L Browne
- College of Health Sciences, University of Texas at El Paso, El Paso, Texas, United States of America
| | - Elizabeth Sargent
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, United States of America
| | - Kerry K Gilbert
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, United States of America
| | - C Roger James
- Texas Tech University Health Sciences Center, Lubbock, Texas, United States of America
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, United States of America
| | - Omer C Matthijs
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, United States of America
- Boma, Physical Therapy Outpatient Clinic, Kapfenberg, Styria, Austria
| | - Anja Matthijs
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, United States of America
- Boma, Physical Therapy Outpatient Clinic, Kapfenberg, Styria, Austria
| | - Phillip S Sizer
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, United States of America
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27
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Qiang MF, Singh RK, Chen YX, Zhang K, Jia XY, Chen S, Wang SG, Wang X, Shi ZM. Computational Biomechanical Analysis of Postoperative Calcaneal Fractures with Different Placement of the Sustentaculum Screw. Orthop Surg 2020; 12:661-667. [PMID: 32053281 PMCID: PMC7189067 DOI: 10.1111/os.12541] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/17/2019] [Accepted: 08/21/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the computational biomechanical analysis of intra-articular calcaneal fractures with different fixation status of the sustentaculum plate screw, when the finite element modeling of calcaneal fractures were fixed by the lateral locking plate. METHODS The normal right foot of a male (age: 36 years; height: 174 cm; body weight: 65 kg) was scanned by the CT scanner. As the computational biomechanical study, the three-dimensional finite element model of the simplified Sanders type-II calcaneal fracture was built. Fixation with the lateral calcaneal locking plate and screws was simulated using a finite element software package according to clinical operation. According to the different placement of the sustentaculum plate screw, the models were categorized as the accurate fixation group, marginal fixation group, and non-fixation group. The loading of 650 N with the vertical axial compression was applied to simulate the standing phase with single foot. The Von Mises stress distribution, maximal displacement, and contact area of the subtalar joint were analyzed among three groups. RESULTS The pressure distribution of the subtalar joint facet was inhomogeneous. The stress concentration of the calcaneus was located at the medial zone of the posterior subtalar joint facet. The peak Von Mises stress distribution in three groups was similar at the subtalar joint facet of 4.9 MPa, 5.1 MPa, and 5.4 MPa. In the accurate fixation group, the contact area on the posterior articular facet was 277.1 mm2 ; the maximal displacement was 0.18 mm. The contact area of the marginal fixation group was 265.3 mm2 on the posterior facet, where the maximal displacement was 0.23 mm. In the non-fixation group, the contact area was 253.8 mm2 ; the maximal displacement was 0.25 mm. There was a slight change in the contact area of the subtalar joint and no prominent displacement of the calcaneus could be detected among the three groups. CONCLUSIONS The biomechanical results, including the peak stress distribution, contact area, and maximal displacement of subtalar joint, were similar whether the screw is placed exactly within the sustentaculum tali or not, when the calcaneal fractures were fixed by the lateral locking plate. The sustentaculum plate screw had less effect on the biomechanical performance of the calcaneus.
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Affiliation(s)
- Min-Fei Qiang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ritesh Kumar Singh
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan-Xi Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Yang Jia
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Song Chen
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shu-Guang Wang
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiong Wang
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhao-Man Shi
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Early Complications Following Articular Calcaneus Fracture Repair: Evaluation of Open Versus Percutaneous Techniques. OTA Int 2019; 2:e049. [PMID: 33937677 PMCID: PMC7997092 DOI: 10.1097/oi9.0000000000000049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 10/16/2019] [Indexed: 11/26/2022]
Abstract
Objectives: To assess complications and secondary operations in patients treated with either open reduction and internal fixation (ORIF) versus percutaneous fixation of displaced intra-articular calcaneus fractures. Design: Retrospective comparative study. Setting: Level 1 trauma center. Patients/Participants: Ninety-three adult patients with 111 fractures treated by a single orthopaedic traumatologist between 2001 and 2014. Intervention: ORIF through an extensile lateral approach or percutaneous reduction and internal fixation. Main Outcome Measurements: Wound-healing complications, infections, posttraumatic arthrosis (PTOA), and secondary procedures. Results: Fifty patients with 58 fractures underwent ORIF, and 43 patients with 53 fractures had percutaneous fixation. Mean age was 43 years, and 80% were male. Open fractures and two-part fractures were more often treated percutaneously (26% vs 8%, P = 0.03) and (49% vs 31%, P = 0.02), respectively. Patients undergoing percutaneous fixation were more often tobacco users (58% vs 36%, P = 0.04) and with history of alcohol and other substance abuse. Twenty-seven patients (29%) had 28 complications, including 21% with PTOA, with no differences based on type of treatment. Six patients had secondary procedures, with no difference based on type of treatment. Patients with open fractures (P = 0.001) or tobacco abuse (P = 0.005) were more likely to experience complications. Conclusions: No differences in complication rates were found for ORIF versus percutaneous fixation. Regardless of fixation technique, patients with open fractures or history of tobacco abuse were more likely to develop complications. Percutaneous reduction and fixation represents an alternative to extensile ORIF in terms of similar early and late complications, particularly in high risk patients. Level of Evidence: Therapeutic Level III
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Evers J, Oberste M, Wähnert D, Grüneweller N, Wieskötter B, Milstrey A, Raschke MJ, Ochman S. [Outcome after surgical treatment of calcaneal fractures]. Unfallchirurg 2019; 122:778-783. [PMID: 30402689 DOI: 10.1007/s00113-018-0578-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND After controversial discussions in the literature about therapy regimens for calcaneal fractures, a retrospective study of patients operatively treated in a maximum care trauma center was conducted. OBJECTIVE Investigation of the influencing factors on the treatment quality of operatively treated patients with calcaneal fractures. MATERIAL AND METHODS Between 2005 and 2013 a total of 90 patients with calcaneal fractures were surgically treated in this hospital with locking plate osteosynthesis. A total of 48 patients with 55 fractures were retrospectively investigated. The assessment with respect to posttraumatic arthrosis was made radiologically and Böhler's and Gissane's angles were also determined. Clinically AOFAS and SF-36 scores were documented. The results were statistically tested with respect to possible risk factors. RESULTS A total of 9 patients (18.8%) were found with complications necessitating operative revision, with 8 patients requiring subtalar arthrodesis and 1 patient with a deep wound infection. Nicotine abuse and a long interval between trauma and reconstructive surgery were identified as factors that influenced the development of wound healing problems. The average AOFAS score was 68 points and the SF-36 was 58.86 points. A poor result in the scores was caused by the development of symptomatic arthritis and the type of insurance. In this cohort factors, such as age and complexity of fractures were not correlated with a poor result. CONCLUSION In this patient collective nicotine abuse and a long interval between trauma and surgery were risk factors for development of wound infections. Other factors with an influence on the outcome were the postoperative development of arthritis and the type of health insurance; however, patient age had no impact on the outcome.
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Affiliation(s)
- J Evers
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland.
| | - M Oberste
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - D Wähnert
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - N Grüneweller
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - B Wieskötter
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - A Milstrey
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - M J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - S Ochman
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
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Toro G, Langella F, Gison M, Toro G, Moretti A, Toro A, Iolascon G. Stentoplasty of calcaneal fractures: Surgical technique and early outcomes. Injury 2019; 50 Suppl 2:S70-S74. [PMID: 30739765 DOI: 10.1016/j.injury.2019.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Calcaneus is the most common site of hindfoot fracture, frequently caused by fall from height or high energy trauma. The therapeutic strategy ranged from non-operative to ORIF (Open Reduction Internal Fixation). Indications for percutaneous fixation include soft tissue damage or relative contraindications to open surgery. Minimally invasive percutaneous calcaneoplasty should be an alternative to ORIF aiming to reach a stable reduction, early functional recovery and short hospital stay. The aim of our study was to evaluate the clinical and radiographic outcomes of calcaneus fractures treated with balloon calcaneoplasty (BCP) by using a new generation vertebral augmentation system, VBS™-Vertebral Body Stent-DePuy Synthes. A total of 10 patients treated with VBS™ system were recruited for the study. Nine fractures were caused by a fall from height and one case by traffic accident. The mean follow-up was 8.9 months (range 2.6-23.1). The fractures were categorized according to Sanders and Essex-Lopresti classifications (5: type II, 3: type III and 2: type IV; 9: "joint depression" type and 1 case "tongue" type). Radiographic measurement (Böhler's and Gissane's angles) were evaluated at both pre-operative and immediate postoperative time. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score as well as a subjective evaluation (Visual Analog Scale, VAS) were used for the clinical assessment at the last follow-up. Mean preoperative Böhler's angle was 12.3 ± 8.41° (95% CI 6.3-18.3°), whereas mean preoperative Gissane's angle was 123.66 ± 20.47° (95% CI 109.0-138.3°). At postoperative follow-up mean Böhler's angle increased to 21.51 ± 4.17° (95% CI 18.5-24.5°; p < 0.01), and mean postoperative Gissane's angle was 121.74°±6.82° (95% CI 116.8°-126.6°). Mean AOFAS at the last follow-up was 70.4 ± 17.44 (95% CI 57.9-82.8). Our study demonstrates that percutaneous calcaneoplasty using VBS™ is an effective treatment for calcaneus fracture and capable to implement correction manoeuvre with clinical and radiographic outcomes comparable with other percutaneous stentoplasty.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Francesco Langella
- Unit of Orthopaedics and Traumatology, Santa Maria della Speranza Hospital, Battipaglia, Italy
| | - Michele Gison
- Unit of Orthopaedics and Traumatology, Martiri del Villa Malta Hospital, Sarno, Italy
| | - Gabriella Toro
- Unit of Radiology and Nuclear Medicine, Santa Maria della Speranza Hospital, Battipaglia, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Toro
- Unit of Orthopaedics and Traumatology, Martiri del Villa Malta Hospital, Sarno, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
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El-Hawary A, Kandil YR, Ahmed M, Elgeidi A, El-Mowafi H. Distraction subtalar arthrodesis for calcaneal malunion. Bone Joint J 2019; 101-B:596-602. [DOI: 10.1302/0301-620x.101b5.bjj-2018-1306.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims We hypothesized that there is no difference in the clinical and radiological outcomes using local bone graft versus iliac graft for subtalar distraction arthrodesis in patients with calcaneal malunion. In addition, using local bone graft negates the donor site morbidity. Patients and Methods We prospectively studied 28 calcaneal malunion patients (the study group) who were managed by subtalar distraction arthrodesis using local calcaneal bone graft. The study group included 16 male and 12 female patients. The median age was 37.5 years (interquartile range (IQR) 29 to 43). The outcome of the study group was compared with a control group of ten patients previously managed by subtalar distraction arthrodesis using iliac bone graft. The control group included six male and four female patients. The median age was 41.5 years (IQR 36 to 44). Results The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly in the study and the control groups (p < 0.001). Fusion was achieved in 27 patients in the study group at a median time of 13 weeks (IQR 12 to 14), while all the patients in the control group achieved fusion at a mean time of 13.2 weeks (11 to 15). The mean talocalcaneal height and talar declination angle improved significantly in both the study and the control groups (p < 0.001). There was no significant difference between both groups concerning the preoperative or the postoperative clinical and radiological measurements. Donor site morbidity was reported in four out of ten patients in the control group. Conclusion Local calcaneal bone graft can successfully be used to achieve subtalar distraction arthrodesis with appropriate correction of alignment and calcaneal malunion. We recommend using local instead of iliac bone graft as it gave comparable results and avoids the possibility of donor site morbidity. Cite this article: Bone Joint J 2019;101-B:596–602.
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Affiliation(s)
- A. El-Hawary
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Y. R. Kandil
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - M. Ahmed
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - A. Elgeidi
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - H. El-Mowafi
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Roukis TS. Closed Manipulation, Intraosseous Reduction, and Rigid Internal Fixation for Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:197-210. [PMID: 30784531 DOI: 10.1016/j.cpm.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Although open reduction and internal fixation for treating displaced intra-articular calcaneal fractures remain common, difficulty obtaining and maintaining both calcaneal morphology and subtalar articular surface reduction remain. In addition, open approaches induce a significant risk of wound-healing complications. For this reason, closed manipulation to restore calcaneal morphology, intra-osseous fracture reduction, and rigid locked nail fixation was developed and validated for clinical use. Conversion to an immediate primary or delayed reconstructive subtalar joint arthrodesis using the same instrumentation remains unique to this system. This article reviews the CALCANAIL surgical technique for performing operative fixation of displaced intra-articular calcaneal fractures.
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Affiliation(s)
- Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, 1900 South Avenue, La Crosse, WI 54601, USA.
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Pranata YD, Wang KC, Wang JC, Idram I, Lai JY, Liu JW, Hsieh IH. Deep learning and SURF for automated classification and detection of calcaneus fractures in CT images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 171:27-37. [PMID: 30902248 DOI: 10.1016/j.cmpb.2019.02.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/29/2019] [Accepted: 02/11/2019] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND OBJECTIVES The calcaneus is the most fracture-prone tarsal bone and injuries to the surrounding tissue are some of the most difficult to treat. Currently there is a lack of consensus on treatment or interpretation of computed tomography (CT) images for calcaneus fractures. This study proposes a novel computer-assisted method for automated classification and detection of fracture locations in calcaneus CT images using a deep learning algorithm. METHODS Two types of Convolutional Neural Network (CNN) architectures with different network depths, a Residual network (ResNet) and a Visual geometry group (VGG), were evaluated and compared for the classification performance of CT scans into fracture and non-fracture categories based on coronal, sagittal, and transverse views. The bone fracture detection algorithm incorporated fracture area matching using the speeded-up robust features (SURF) method, Canny edge detection, and contour tracing. RESULTS Results showed that ResNet was comparable in accuracy (98%) to the VGG network for bone fracture classification but achieved better performance for involving a deeper neural network architecture. ResNet classification results were used as the input for detecting the location and type of bone fracture using SURF algorithm. CONCLUSIONS Results from real patient fracture data sets demonstrate the feasibility using deep CNN and SURF for computer-aided classification and detection of the location of calcaneus fractures in CT images.
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Affiliation(s)
- Yoga Dwi Pranata
- Department of Computer Science and Information Engineering, National Central University, Jhongli County, Taoyuan City, Taiwan
| | - Kuan-Chung Wang
- Department of Computer Science and Information Engineering, National Central University, Jhongli County, Taoyuan City, Taiwan
| | - Jia-Ching Wang
- Department of Computer Science and Information Engineering, National Central University, Jhongli County, Taoyuan City, Taiwan.
| | - Irwansyah Idram
- Department of Mechanical Engineering, National Central University, Jhongli County, Taoyuan City, Taiwan
| | - Jiing-Yih Lai
- Department of Mechanical Engineering, National Central University, Jhongli County, Taoyuan City, Taiwan
| | - Jia-Wei Liu
- Institute of Cognitive Neuroscience, National Central University, Jhongli County, Taoyuan City, Taiwan
| | - I-Hui Hsieh
- Institute of Cognitive Neuroscience, National Central University, Jhongli County, Taoyuan City, Taiwan.
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Roukis TS. Joint-Sparing Surgical Management of Sanders IV Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:251-268. [PMID: 30784535 DOI: 10.1016/j.cpm.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Displaced intra-articular calcaneal fractures represent life-altering injuries. Difficulty obtaining and maintaining calcaneal morphology and the significant risk of wound healing complications with an extensile lateral incision exist. Open reduction with internal fixation as a joint-sparing approach has been studied. Closed manipulation to restore calcaneal morphology, intra-osseous fracture reduction, and rigid locked CALCANAIL fracture nail fixation have recently been applied to Sanders IV fracture patterns. Spontaneous conversion to primary subtalar joint arthrodesis using the same instrumentation remains unique to this system. This article reviews open and percutaneous approaches for joint-sparing and primary arthrodesis procedures to treat Sanders IV fracture patterns.
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Affiliation(s)
- Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, 1900 South Avenue, La Crosse, WI 54601, USA.
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35
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Volait-Rosset L, Pignon C, Manou M, Donnelly TM. Surgical Management of a Calcaneus Fracture in a Pet Rabbit. J Exot Pet Med 2019. [DOI: 10.1053/j.jepm.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vicenti G, Solarino G, Caizzi G, Carrozzo M, Picca G, De Crescenzo A, Cotugno D, Nappi V, Moretti B. Balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation for calcaneal fracture: A retrospective analysis of 42 patients. Injury 2018; 49 Suppl 3:S94-S99. [PMID: 30415676 DOI: 10.1016/j.injury.2018.09.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/25/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The treatment of intra-articular calcaneal fractures is still complex and controversial. Although open reduction and internal fixation (ORIF) is favored by many authors, several percutaneous techniques have been introduced to reduce complications and to obtain satisfactory clinical and radiological results. Among these percutaneous treatments, balloon reduction and bone graft augmentation is gaining an increasing popularity. MATERIALS AND METHODS We retrospectively examined a series of 42 patients treated operatively with a minimally invasive reduction technique using an inflatable bone tamp filled with tricalcium phosphate (calcaneoplasty) for Sander's type II, III and IV calcaneal fractures between 2010 and 2015. Conventional X-rays and CT scan were performed pre-operatively, at 3 and 12 months post-operatively and at the last-follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) score and the Maryland Foot Score (MFS) were used for clinical evaluation. Bohler's angle and the Score Analysis of Verona (SAVE) were calculated to assess bone reduction. RESULTS All 42 patients were available for clinical and radiographic follow-up at an average of 665 months (range 38-92). At the last follow-up the mean AOFAS score was 82.1 (good) and the mean MFS was 80.8 (good). The mean Bohler's angle improved from 1.29° pre-operatively to 27.8° at the last follow-up. The SAVE highlighted good and excellent results in 30 (72%) patients. There were only 3 (7.1%) cases of superficial skin infection with only 6 (14.2%) patients complaining of residual pain. No cases of adverse reaction or deep infection were observed. CONCLUSIONS Calcaneoplasty appears to be a valid option of treatment for calcaneal fractures and a reliable alternative to ORIF. This technique allows stable fracture reduction and early weight-bearing combined with good clinical and radiological results and few complications.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Gianni Caizzi
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy.
| | - Girolamo Picca
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Angelo De Crescenzo
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Domenico Cotugno
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Vittorio Nappi
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari "Aldo Moro"- AOU Policlinico Consorziale - Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic &Trauma Unit, Bari, Italy
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Diranzo-García J, Bertó-Martí X, Castillo-Ruiperez L, Estrems-Díaz V, Hernández-Ferrando L, Villodre-Jiménez J, Bru-Pomer A. Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Takeuchi N, Mae T, Fukushi JI, Tsukamoto N, Mizu-Uchi H, Momii K, Nakashima Y. Management of Intra-Articular Calcaneal Fractures: Clinical Results of Reduction Technique Using a Bone Spreader. J Foot Ankle Surg 2018; 56:1025-1030. [PMID: 28842087 DOI: 10.1053/j.jfas.2017.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Indexed: 02/03/2023]
Abstract
The purpose of the present study was to examine the clinical results of surgery for intra-articular calcaneal fractures using a calcaneal locking plate and a bone spreader as a reduction tool. Ten patients with intra-articular calcaneal fractures were treated. An extended lateral approach was used. The reduction of the intra-articular fragments of the posterior facet was temporarily held using a bone spreader and Kirschner wires. Internal fixation was achieved with a locking calcaneal plate. Böhler's angle and Preiss' angle were assessed on the day of injury and the day of the final follow-up examination. The step off and gap of the posterior facet were assessed on the day of injury and the first week after surgery. The functional outcome was evaluated using the American Orthopaedic Foot and Ankle Society ankle hindfoot scale score. The mean Böhler's angle ranged from 2.1° ± 11.0° to 30.4° ± 5.0° (p < .0001), the mean Preiss' angle ranged from 23.5° ± 4.5° to 15.5° ± 2.9° (p < .0001), the mean step off ranged from 4.0 ± 1.9 mm to 0.1 ± 0.2 mm (p = .0002), and the mean gap ranged from 2.6 ± 1.0 mm to 1.2 ± 0.6 mm (p = .0035). The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score was 89.2 (range 85 to 100) at a mean of 14.3 months after surgery. Our results suggest that a locking calcaneal plate can be used to restore and reduce an intra-articular calcaneal fracture and achieve good clinical results.
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Affiliation(s)
- Naohide Takeuchi
- Orthopedist, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan.
| | - Takao Mae
- Orthopedist, Department of Trauma and Orthopaedic Surgery, Saga-ken Medical Centre Koseikan, Saga City, Japan
| | - Jun-Ichi Fukushi
- Orthopedist, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
| | - Nobuaki Tsukamoto
- Orthopedist, Department of Trauma and Orthopaedic Surgery, Saga-ken Medical Centre Koseikan, Saga City, Japan
| | - Hideki Mizu-Uchi
- Orthopedist, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
| | - Kenta Momii
- Orthopedist, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
| | - Yasuharu Nakashima
- Professor, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
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The primary stability of different implants for intra-articular calcaneal fractures: an in vitro study. Biomed Eng Online 2018; 17:50. [PMID: 29716591 PMCID: PMC5930824 DOI: 10.1186/s12938-018-0484-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 04/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background Calcaneal fractures account for around 2% of all fractures and most of them are intra-articular fractures. Many implants have been used in the fixation of calcaneal fractures, but their biomechanical stability has not yet been well investigated. The aim of this study was to compare the primary stability of four fixations of calcaneal fracture. Methods Eight cadaveric calcaneus samples were used to simulate the Sanders’ types III fracture pattern and fixed through four different implants, namely, K-wires, cannulated screws (CS), absorbable screws (AS), and plate-screw system (PSS). Each specimen was then placed into a custom-made jig and was loaded through a material testing machine to simulate the physiological condition. The primary stability was measured in the vertical direction as the stiffness and anterior–posterior direction as the calcaneocuboid force. One-way analysis of variance was used for data analysis. Results The results showed the highest stiffness of 634 (383–891; SD 226) N/mm in the intact model. It was significantly higher than the models fixed with K-wires, CS or PSS. There was no significant difference in vertical stiffness between fractures fixed with AS and the intact model or other fixed models. The intact model showed the lowest calcaneocuboid force of 153 (120–218; SD 39) N, while the fractures fixed with AS showed the greatest force of 242 (146–398; SD 84) N. The significance was only detected between these two models. Conclusions The global stiffness was similar when the calcaneal fractures were fixed by K-wires, CS and PSS. The stability of the AS fixation differed along both the vertical and anterior–posterior directions, and was greatly influenced by the bone quality. AS for fracture fixation should be designed with greater strength and pull-out resistance.
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Diranzo-García J, Bertó-Martí X, Castillo-Ruiperez L, Estrems-Díaz V, Hernández-Ferrando L, Villodre-Jiménez J, Bru-Pomer A. Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [PMID: 29523412 DOI: 10.1016/j.recot.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the results of surgical treatment of intraarticular calcaneal fractures, and also to analyze the variables that influence the final clinical and radiological outcomes as well as the complications. MATERIAL AND METHODS We retrospectively analyzed 86 intraarticular calcaneal fractures in 78 patients, who underwent surgery with an extended lateral approach and reconstruction plate. The mean age was 48 years (16-74 years) and the mean follow-up was 4.6 years (9-99 months); 54 patients (69.2%) suffered falls from less than 3m in height or banal injuries and 24 patients (30.8%) falls from more than 3m in height or high energy-accidents. According to the Sanders classification we operated 12 (15%) typeII, 54 (62.8%) typeIII and 20 (23.2%) typeIV fractures. RESULTS The postoperative mean AOFAS score was 73.9 points, with good or excellent results in 57% of the patients. Twelve cases (14%) suffered surgical wound complications and 11 (12.8%) required subtalar arthrodesis. Significantly better results were obtained in the patients younger than 30 years old, patients that fell from less than 3m in height and patients with Sanders fractures types II and III compared to typeIV, which were associated with higher rate of subtalar arthrodesis. CONCLUSIONS We consider that open reduction and internal fixation of intraarticular fractures of the calcaneus with reconstruction plate is a valid treatment alternative. Given the complications described and the secondary subtalar arthrodesis rate, we recommend a meticulous technique carried out by experienced surgeons.
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Affiliation(s)
- J Diranzo-García
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - X Bertó-Martí
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Castillo-Ruiperez
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - V Estrems-Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Hernández-Ferrando
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J Villodre-Jiménez
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - A Bru-Pomer
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Haapasalo H, Laine HJ, Mäenpää H, Wretenberg P, Kannus P, Mattila VM. Epidemiology of calcaneal fractures in Finland. Foot Ankle Surg 2017; 23:321-324. [PMID: 29202996 DOI: 10.1016/j.fas.2016.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 07/15/2016] [Accepted: 10/21/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to assess the nationwide incidence (per 100,000 person-years) of operative treatment and hospitalization due to calcaneal fractures (CF) in Finland. METHODS The study was based on the Finnish National Hospital Discharge Register. All patients aged 18-years or older admitted to Finnish hospitals for primary treatment of CF in 1987-2012 were included. RESULTS During the 26-year study period 5977 patients were hospitalized with main or secondary diagnosis of a CF. The incidence of hospitalization due to CF remained relatively stable: (12.5)/100,000 in men and 3.9/100,000 in women. The men were younger (median 43 years) than the women (median 61 years). CONCLUSIONS The incidence of the hospitalization due to CF in Finland has remained at steady level during the past 26 years. The incidence of CF is three times higher in men. In 2012 22% of the fractures were operatively treated.
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Affiliation(s)
- Heidi Haapasalo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland.
| | - Heikki-Jussi Laine
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland
| | - Heikki Mäenpää
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland
| | - Per Wretenberg
- Department of Molecular Medicine and Surgery, Section of Orthopaedics Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Pekka Kannus
- Injury & Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland; The School of Medicine, University of Tampere, Finland; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Division of Orthopedics and Biotechnology, Karolinska Institute and Department of Orthopedics at Karolinska University Hospital Solna and Huddinge, Sweden
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Renovell-Ferrer P, Bertó-Martí X, Diranzo-García J, Barrera-Puigdorells L, Estrems-Díaz V, Silvestre-Muñoz A, Brú-Pomer A. Functional outcome after calcaneus fractures: a comparison between polytrauma patients and isolated fractures. Injury 2017; 48 Suppl 6:S91-S95. [PMID: 29162249 DOI: 10.1016/s0020-1383(17)30801-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Displaced intra-articular calcaneal fractures (DIACFs) can have long-term consequences in terms of foot pain and disability. This injury frequently occurs in the context of polytrauma patients and its influence in long-term functional prognosis is well known. The purpose of this study is to compare the etiology, severity, and functional outcome of the operated DIACFs between polytrauma patients and isolated cases. METHODS Eighty-six patients with operated displaced intra-articular calcaneal fractures through open reduction and internal fixation (ORIF) were managed at our institution between January 1, 2008 and December 31, 2015. Eighty patients completed the follow-up, nine of them with both calcaneus operated (89 calcaneus) by ORIF with a plate. Two groups were established; one included 11 (14%) polytrauma patients, three of them with operated bilateral calcaneus, and 69 (86%) patients without polytrauma diagnosis. Severity of trauma, injury patterns, psychiatric background, associated fractures, second surgeries and functional questionnaire (adjusted American Orthopedic Foot and Ankle Society - AOFAS - ankle-hindfoot scale and SF-36) were collected. A detailed comparative statistical analysis is provided. RESULTS There was significant statistical relationship between polytrauma patients and those with psychiatric comorbidities, severe trauma or severe injury, but not with second surgeries, later subtalar arthrodesis or outcome measures. Only calcaneal fractures with comminution according to Sanders classification was associated with second surgeries and later subtalar arthrodesis. The AOFAS score was solely related to trauma severity (71.5 vs 77; p = 0.29) and calcaneal fracture's comminution according to Sanders classification (79.4 type II and 79.3 type III vs 69.2 type IV; p = 0.000 and p = 0.008, respectively) and SF-36 score only with trauma severity (67.4 vs 78.1; p = 0.00) and psychiatric comorbidities (62.2 vs 75.8; p = 0.048). CONCLUSION No differences in outcome measures and second surgeries were found between polytrauma patients and isolated fractures. For DIACFs, the severity of the impact was correlated with a higher number of second surgeries and worse functional outcomes. Following a DIACF, patients with psychiatric comorbidities presented worse health-related quality of life than people without this background.
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Affiliation(s)
- Pablo Renovell-Ferrer
- Department of Trauma and Orthopaedic Surgery, Consorcio Hospital General of Valencia, Spain.
| | - Xavier Bertó-Martí
- Department of Trauma and Orthopaedic Surgery, Consorcio Hospital General of Valencia, Spain
| | - José Diranzo-García
- Department of Trauma and Orthopaedic Surgery, Consorcio Hospital General of Valencia, Spain
| | | | - Vicente Estrems-Díaz
- Department of Trauma and Orthopaedic Surgery, Consorcio Hospital General of Valencia, Spain
| | | | - Antonio Brú-Pomer
- Department of Trauma and Orthopaedic Surgery, Consorcio Hospital General of Valencia, Spain
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Xu C, Li M, Wang C, Li K, Liu H. RETRACTED: Ankle-hindfoot after calcaneal fractures: A biomechanical study. Orthop Traumatol Surg Res 2017; 103:709-716. [PMID: 28619268 DOI: 10.1016/j.otsr.2017.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/10/2017] [Accepted: 05/22/2017] [Indexed: 02/02/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief. The decision to retract this article is based on the fact that it contains much of the same information that the authors stated in the following report, which was published in another journal: Xu C, Liu H, Li M, Wang C, Li K. A Three-Dimensional Finite Element Analysis of Displaced Intra-Articular Calcaneal Fractures. J Foot Ankle Surg. 2017 Mar-Apr; 56(2): 319–326. https://doi.org/10.1053/j.jfas.2016.09.018. PMID: 28231965. A review of the timeline of events related to our publication indicated that the manuscript was originally submitted and accepted for publication shortly after the other report was published in Journal of Foot and Ankle Surgery. The authors were aware that the two reports contained much of the same (in large part, identical) information, and that the two manuscripts were under consideration by two different journals, despite indication from the corresponding authors to each journal that the work that each journal was considering was original. Because of this breach of scientific publication ethics, specifically self-plagiarism, this report (PMID: 28619268) has been retracted from Orthopaedics & Traumatology: Surgery & Research / Orthop Traumatol Surg Res.
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Affiliation(s)
- C Xu
- Department of Orthpaedics, Xiangya Hospital, Central South University, Changsha city, Hunan province, China
| | - M Li
- Department of Orthpaedics, Xiangya Hospital, Central South University, Changsha city, Hunan province, China
| | - C Wang
- Department of Orthpaedics, Xiangya Hospital, Central South University, Changsha city, Hunan province, China
| | - K Li
- Department of Orthpaedics, Xiangya Hospital, Central South University, Changsha city, Hunan province, China
| | - H Liu
- Department of Orthpaedics, Xiangya Hospital, Central South University, Changsha city, Hunan province, China
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Qiang M, Chen Y, Jia X, Zhang K, Li H, Jiang Y, Zhang Y. Post-operative radiological predictors of satisfying outcomes occurring after intra-articular calcaneal fractures: a three dimensional CT quantitative evaluation. INTERNATIONAL ORTHOPAEDICS 2017; 41:1945-1951. [PMID: 28752205 DOI: 10.1007/s00264-017-3577-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE No functional outcome related to 3-D CT evaluations for calcaneal fractures has been presented. The aims of this study are to analyze the post-operative morphological parameters of calcaneal fractures in 3-D space and to correlate the 3-D morphological parameters with functional outcomes. METHODS Between 2009 and 2015, 156 patients operatively treated for displaced calcaneal fractures were retrospectively reviewed with an average follow-up time of 32.4 months. Böhler's angle, Gissane's angle, the length of calcaneal axis, the height of posterior facet, the length of posterior facet, and the subtalar joint congruity were evaluated post-operatively in accordance with 3-D CT. Each parameter was quantified, and then its association with the clinical outcomes assessed by the AOFAS score and Short Form-36 questionnaire was evaluated. RESULTS The restoration of the length of calcaneal axis, the height of posterior facet, and the length of posterior facet had no significant correlation with the clinical outcomes (P > 0.05). The restoration of Böhler's angle and Gissane's angle had significant correlation with the better AOFAS score (P < 0.001), while no correlation was found with the SF-36 physical component summary score (P > 0.05). No significant association emerged between the clinical outcomes and reconstruction of the posterior facet congruity (P > 0.05). CONCLUSION The predictable functional outcome is related to the reconstruction of post-operative morphological characteristics of the calcaneus as evaluated on 3-D CT, especially the Böhler's angle and Gissane's angle. Despite post-operative step-off of the posterior facet exiting, the clinical outcomes appear to be not related to the posterior facet congruity.
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Affiliation(s)
- Minfei Qiang
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Yanxi Chen
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China.
| | - Xiaoyang Jia
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Haobo Li
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Yuchen Jiang
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Yijie Zhang
- Department of Orthopaedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
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Abstract
The aim of this study was to compare the clinical effect of operative treatment and nonoperative treatment for elderly patients with Sanders II-III calcaneal fractures.The study consisted of 60 patients with Sanders II-III calcaneal fractures who were treated in our institution from January 2007 to April 2012. The clinical effect between the operative treatment group of 32 patients and the nonoperative treatment group of 28 patients was studied. Böhler angle, Gissane angle, subtalar joint motion, calcaneal width, and calcaneal height were measured before and after treatment, and these indexes were also measured on the uninjured foot. All patients were followed-up for at least 2 years, and at the last follow-up, we evaluated foot function that was assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score system. A 10-cm visual analog scale (VAS) was used to measure the degree of pain.Böhler angle, Gissane angle, calcaneal width, and calcaneal height, which were preoperatively and postoperatively measured, had a significant difference in the operative group (P < .001), but there was no significant difference between pretreatment and post-treatment in the nonoperative group. Subtalar joint motion was measured pre-treatment and post-treatment and had a significant difference in the 2 groups. When we compared the values of Böhler angle, Gissane angle, subtalar joint motion, calcaneal width, and calcaneal height between post-treatment and the uninjured foot, there was no significant difference in the operative group, but there was a significant difference in the nonoperative group. The values measured after treatment in the 2 groups had a significant difference. Finally, the AOFAS score in the operative group and the nonoperative group were 83.4 ± 9.7 and 74.7 ± 10.3, respectively, and there was a significant difference (P < .001). Also, the 10-cm VAS had a significant difference between the 2 groups.Good clinical result could be obtained with operative treatment in elderly patients with Sanders II-III calcaneal fractures. Open reduction and internal fixation should be performed if there is no surgical contraindication.
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Pan M, Chai L, Xue F, Ding L, Tang G, Lv B. Comparisons of external fixator combined with limited internal fixation and open reduction and internal fixation for Sanders type 2 calcaneal fractures: Finite element analysis and clinical outcome. Bone Joint Res 2017; 6:433-438. [PMID: 28747337 PMCID: PMC5539306 DOI: 10.1302/2046-3758.67.2000640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited internal fixation (EFLIF) and open reduction and internal fixation (ORIF) in treating Sanders type 2 calcaneal fractures. METHODS Two types of fixation systems were selected for finite element analysis and a dual cohort study. Two fixation systems were simulated to fix the fracture in a finite element model. The relative displacement and stress distribution were analysed and compared. A total of 71 consecutive patients with closed Sanders type 2 calcaneal fractures were enrolled and divided into two groups according to the treatment to which they chose: the EFLIF group and the ORIF group. The radiological and clinical outcomes were evaluated and compared. RESULTS The relative displacement of the EFLIF was less than that of the plate (0.1363 mm to 0.1808 mm). The highest von Mises stress value on the plate was 33% higher than that on the EFLIF. A normal restoration of the Böhler angle was achieved in both groups. No significant difference was found in the clinical outcome on the American Orthopedic Foot and Ankle Society Ankle Hindfoot Scale, or on the Visual Analogue Scale between the two groups (p > 0.05). Wound complications were more common in those who were treated with ORIF (p = 0.028). CONCLUSIONS Both EFLIF and ORIF systems were tested to 160 N without failure, showing the new construct to be mechanically safe to use. Both EFLIF and ORIF could be effective in treating Sanders type 2 calcaneal fractures. The EFLIF may be superior to ORIF in achieving biomechanical stability and less blood loss, shorter surgical time and hospital stay, and fewer wound complications.Cite this article: M. Pan, L. Chai, F. Xue, L. Ding, G. Tang, B. Lv. Comparisons of external fixator combined with limited internal fixation and open reduction and internal fixation for Sanders type 2 calcaneal fractures: Finite element analysis and clinical outcome. Bone Joint Res 2017;6:433-438. DOI: 10.1302/2046-3758.67.2000640.
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Affiliation(s)
- M Pan
- Orthopaedics Department, Southern Medical University Fengxian District Central Hospital, No. 6600, Nanfeng Road, Fengxian District, Shanghai, China
| | - L Chai
- Orthopaedics Department, The People's Hospital of Bozhou, Anhui Province, No. 3, Xuejia Alley, Qiaocheng District, Bozhou city, Anhui Province, China
| | - F Xue
- Orthopaedics Department, Southern Medical University Fengxian District Central Hospital, No. 6600, Nanfeng Road, Fengxian District, Shanghai, China
| | - L Ding
- Orthopaedics Department, Southern Medical University Fengxian District Central Hospital, No. 6600, Nanfeng Road, Fengxian District, Shanghai, China
| | - G Tang
- Orthopaedics Department, Southern Medical University Fengxian District Central Hospital, No. 6600, Nanfeng Road, Fengxian District, Shanghai, China
| | - B Lv
- Orthopaedics Department, Southern Medical University Fengxian District Central Hospital, No. 6600, Nanfeng Road, Fengxian District, Shanghai, China
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Zhou HC, Yu T, Ren HY, Li B, Chen K, Zhao YG, Yang YF. Clinical Comparison of Extensile Lateral Approach and Sinus Tarsi Approach Combined with Medial Distraction Technique for Intra-Articular Calcaneal Fractures. Orthop Surg 2017; 9:77-85. [PMID: 28276647 DOI: 10.1111/os.12310] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 09/27/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To study and compare the clinical outcomes of open reduction and internal fixation via extensile L-shape incision and limited open reduction via the sinus tarsi approach using the medial distraction technique for intra-articular calcaneal fractures. METHODS We performed a retrospective review of 65 intra-articular calcaneal fractures treated operatively between March 2012 and February 2015. Patients were divided into two groups: 28 were in the sinus tarsi approach group and 37 were in the extensile lateral approach group. All patients were asked to return for a research visit that included radiography and clinical evaluation. The postoperative function was evaluated using the ankle and hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and the visual analogue scale (VAS). RESULTS No significant difference was found in demographics between the two groups. The corrected value of the calcaneal varus angle between the two groups is statistically significant (P < 0.05). The overall wound complication rate was 3.6% in the minimally invasive group versus 13.5% in the extensile group. Four patients in the extensile lateral approach group had developed hindfoot varus deformity at last follow-up. At the last follow-up, the average AOFAS ankle and the hindfoot score of the minimal group was 88.4 ± 6.6, and the VAS score was 1.9 ± 0.7, while that of the extensile lateral approach group was 83.2 ± 5.6 and 2.3 ± 1.0, respectively. CONCLUSION Limited open reduction via the sinus tarsi approach for intra-articular calcaneal fractures could reduce the incidence of wound complications effectively, and the medial distraction technique is helpful for correcting the calcaneus varus deformity.
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Affiliation(s)
- Hai-Chao Zhou
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Yu
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao-Yang Ren
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bing Li
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kai Chen
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - You-Guang Zhao
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yun-Feng Yang
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Xu C, Liu H, Li M, Wang C, Li K. A Three-Dimensional Finite Element Analysis of Displaced Intra-Articular Calcaneal Fractures. J Foot Ankle Surg 2017; 56:319-326. [PMID: 28231965 DOI: 10.1053/j.jfas.2016.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Indexed: 02/03/2023]
Abstract
A better understanding of displaced intra-articular calcaneal fractures, their effect on joint mechanics, and the relationship between altered mechanics and osteoarthritis could aid in the development or refinement of treatment methods. Finite element modeling is accepted as the reference standard for evaluating joint contact stresses. The objective of the present study was to analyze the in vivo joint mechanical data from finite element modeling for normal and injured subtalar joints. A 3-dimensional model of the ankle-hindfoot was developed and validated. Both height loss and width increases in the calcaneus were simulated. Next, they were used to investigate the relationship between calcaneal height or width and the contact mechanics of the posterior facet of the subtalar joint. The contact area/joint area ratio increased in the subtalar joint with injury when the calcaneal width increased. Moreover, the peak contact pressure and the proportion of the area under high contact pressure (>6 MPa) increased. The contact area/joint area ratio decreased with reduced calcaneal height, but the peak contact pressure remained almost constant. The width increases of the calcaneus somewhat limited the subtalar joint motion, especially for eversion; however, the height loss mostly resulted in subtalar rotatory instability. The height loss diminished the subtalar joint's stability in eversion, internal rotation, and external rotation. The results of the present study support the advisability of surgery for these complex injuries. Reestablishing the calcaneal height and width could restore the normal kinematics and contact stress distribution in the subtalar joint, improve the tibiotalar position, and diminish long-term degeneration in the ankle.
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Affiliation(s)
- Can Xu
- Lecturer, Department of Orthpaedics, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Hua Liu
- Assistant Professor, Department of Orthpaedics, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Mingqing Li
- Lecturer, Department of Orthpaedics, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Chenggong Wang
- Lecturer, Department of Orthpaedics, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Kanghua Li
- Professor, Department of Orthpaedics, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China.
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Sonmez MM, Armagan R, Ugurlar M, Eren T. Allografts versus Equine Xenografts in Calcaneal Fracture Repair. J Foot Ankle Surg 2017; 56:510-513. [PMID: 28242215 DOI: 10.1053/j.jfas.2017.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Indexed: 02/03/2023]
Abstract
Displaced intra-articular calcaneal fractures are difficult to treat. We determined the functional results and complications of using allografts or equine xenografts in treating these fractures. We reviewed patients seen at our center from May 2011 to December 2014 with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and an additional bone allograft or equine xenograft. A minimum of 1 year after surgery, a history of infection and functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society clinical rating system. Changes in the Gissane angle (GA) and Böhler angle were assessed from radiographs. Of the 91 eligible patients, 15 were lost to follow-up, leaving a sample of 76 patients (42 males): 45 received allografts (19 for type III and 26 for type IV fractures) and 31 received xenografts (20 for type III and 11 for type IV fractures). The mean age was about 40 years in both groups. After ≥1 year of follow-up, the proportion of patients in the American Orthopaedic Foot and Ankle Society scoring categories did not differ significantly between the 2 groups (mean ankle score, 86.5 in the allograft group and 85.1 in the xenograft group), and the American Orthopaedic Foot and Ankle Society functional outcomes were good or excellent in 69% and 68%, respectively (p = .986). The groups did not differ in the incidence of superficial or deep infection (p = 1.000). The Böhler angles were significantly decreased in the xenograft group. Xenografts might be preferred for repairing intra-articular calcaneal fractures because they can perform as well as allografts, avoid donor site morbidities, and are more available and less expensive than allografts.
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Affiliation(s)
- Mehmet Mesut Sonmez
- Doctor, Department of Orthopaedics, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Raffi Armagan
- Doctor, Department of Orthopaedics, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Meric Ugurlar
- Doctor, Department of Orthopaedics, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Tugrul Eren
- Associate Professor, Department of Orthopaedics, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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50
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[Minimally invasive treatment of intra-articular calcaneal fractures with the 2‑point distractor]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2017; 29:149-162. [PMID: 28101590 DOI: 10.1007/s00064-016-0478-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/19/2016] [Accepted: 08/18/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Open treatment of calcaneus fractures often has an increased risk of wound healing. Minimally invasive treatment with small incisions reduces complications. INDICATIONS Calcaneal fractures with malalignment/comminution >1-2 mm; broadening, varus alignment of the calcaneal length axis or shortening; emergency surgery for open fractures or compartment syndrome. CONTRAINDICATIONS Local or general contraindications. SURGICAL TECHNIQUE Standardised positioning; restoration of length/axis with 2‑point distractor under fluoroscopic control. Fragment reduction via small incisions. Fixation with 7.3 mm cannulated screws and 4.0 mm sustentaculum screws. POSTOPERATIVE MANAGEMENT Cast-free and no weight bearing for 6 weeks; then weight bearing in a heel off-loading shoe for another 6 weeks with physiotherapy; if needed postoperative cast until soft tissue consolidation. RESULTS Of 212 calcaneal fractures, 182 were treated with this technique. Wound healing complication rate was 2.7%; 4.7% of patients required secondary arthrodesis of the subtalar joint.
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