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Mingo-Robinet J, González-García L, González-Alonso C. Treatment of displaced intra-articular calcaneal fractures using a sinus tarsi approach. Surgical technique. Rev Esp Cir Ortop Traumatol (Engl Ed) 2025; 69:110-123. [PMID: 38403112 DOI: 10.1016/j.recot.2024.02.003] [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: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024] Open
Abstract
Calcaneal articular fractures are fractures classically associated with a high rate of complications and poor outcomes. Osteosynthesis of the calcaneus through a sinus tarsi approach has shown results equal to or superior to those of the extended approach, having become the new gold standard. The objective of this article is to detail step by step the surgical technique of osteosynthesis of intra-articular fractures of the calcaneus through a sinus tarsi approach, from the selection of the fracture, positioning of the patient, layout of the operating room and the fluoroscope, the entire surgical process until postoperative treatment. The surgical technique described below is described in 6 steps. Anatomical reduction of complex calcaneal fractures through an Sinus Tarsi Approach requires an understanding of the fracture and its associated deformities. Following the described sequence step by step will help to achieve a better reduction in order to achieve better functional results.
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Affiliation(s)
- J Mingo-Robinet
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de Palencia, Palencia, España.
| | - L González-García
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - C González-Alonso
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de Palencia, Palencia, España
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Mingo-Robinet J, González-García L, González-Alonso C. [Translated article] Treatment of displaced intra-articular calcaneal fractures using a sinus tarsi approach. Surgical technique. Rev Esp Cir Ortop Traumatol (Engl Ed) 2025; 69:T110-T123. [PMID: 39653136 DOI: 10.1016/j.recot.2024.12.004] [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: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 01/12/2025] Open
Abstract
Calcaneal articular fractures are fractures classically associated with a high rate of complications and poor outcomes. Osteosynthesis of the calcaneus through a sinus tarsi approach has shown results equal to or superior to those of the extended approach, having become the new gold standard. The objective of this article is to detail step by step the surgical technique of osteosynthesis of intra-articular fractures of the calcaneus through a sinus tarsi approach, from the selection of the fracture, positioning of the patient, layout of the operating room and the fluoroscope, the entire surgical process until postoperative treatment. The surgical technique described below is described in 6 steps. Anatomical reduction of complex calcaneal fractures through an sinus tarsi approach requires an understanding of the fracture and its associated deformities. Following the described sequence step by step will help to achieve a better reduction in order to achieve better functional results.
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Affiliation(s)
- J Mingo-Robinet
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de Palencia, Palencia, Spain.
| | - L González-García
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | - C González-Alonso
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de Palencia, Palencia, Spain
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Fadle AA, Khalifa AA, Shehata PM, El-Adly W, Osman AE. Extensible lateral approach versus sinus tarsi approach for sanders type II and III calcaneal fractures osteosynthesis: a randomized controlled trial of 186 fractures. J Orthop Surg Res 2025; 20:8. [PMID: 39754179 PMCID: PMC11697837 DOI: 10.1186/s13018-024-05345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 12/06/2024] [Indexed: 01/07/2025] Open
Abstract
AIMS Which is the best extensile lateral (ELA) or sinus tarsi (STA) approach for osteosynthesis displaced intraarticular calcaneal fracture (DIACF) is still debatable. The current RCT's primary objective was to compare the complications incidence after open reduction and internal fixation of DIACFs through STA vs. ELA. The secondary objectives were the differences in intraoperative radiation exposure, time to fracture union, functional and radiological outcomes. METHODS Between August 2020 and February 2023, 157 patients with Sanders type II and III fractures were randomly assigned to either ELA (81 patients with 95 fractures) or STA (76 patients with 91 fractures). The primary outcome was the incidence of complications. The secondary outcomes were Böhler's and Gissane angles angle, fracture union, and American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULTS No statistical differences between both groups regarding basic demographic data, injury characteristics, and fracture classification; however, patients in the STA group were operated upon significantly earlier (4.43 ± 7.37 vs. 7 ± 6.42 days, p = 0.001). STA's operative time was significantly shorter (55.83 ± 7.35 vs. 89.66 ± 7.12 min, p < 0.05), and no statistical difference regarding intraoperative radiation exposure. The time to fracture union was significantly shorter in STA (6.33 ± 0.8 vs. 7.13 ± 0.7 weeks, p = 0.000). Skin complications (superficial or deep infection) and Subtalar osteoarthritis were significantly higher in ELA (18.9% vs. 3.3%, p = 0.001) and (32.6% vs. 9.9%, p = 0.001), respectively. The radiological parameters were significantly better in STA postoperatively and at the last follow up. The AOFAS scores were significantly better in STA (83.49 ± 7.71 vs. 68.62 ± 7.05, respectively, p = 0.000). CONCLUSION During osteosynthesis of Sanders type II and III DIACFs, STA is superior to ELA in terms of operating earlier, shorter operative time, fewer complications, and better radiological and functional outcomes.
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Affiliation(s)
- Amr A Fadle
- Orthopaedic Department, Assiut Faculty of Medicine, Assiut University Hospital, Assiut University, Kasr Elini Street, Number 7, P.O. Box 110, Assuit, 71515, Egypt.
| | - Ahmed A Khalifa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt
| | - Peter Mamdouh Shehata
- Orthopaedic Department, Assiut Faculty of Medicine, Assiut University Hospital, Assiut University, Kasr Elini Street, Number 7, P.O. Box 110, Assuit, 71515, Egypt
| | - Wael El-Adly
- Orthopaedic Department, Assiut Faculty of Medicine, Assiut University Hospital, Assiut University, Kasr Elini Street, Number 7, P.O. Box 110, Assuit, 71515, Egypt
| | - Ahmed Ekram Osman
- Orthopaedic Department, Assiut Faculty of Medicine, Assiut University Hospital, Assiut University, Kasr Elini Street, Number 7, P.O. Box 110, Assuit, 71515, Egypt
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Eelsing R, Ahmadi AM, Halm JA, Schepers T. Geographical Differences in Wound Complication Rates Following the Sinus Tarsi Approach in Displaced Intra-articular Calcaneal Fractures: A Systematic Review of the Literature. Clin Orthop Surg 2024; 16:134-140. [PMID: 38304215 PMCID: PMC10825260 DOI: 10.4055/cios23241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/12/2023] [Indexed: 02/03/2024] Open
Abstract
Background The sinus tarsi approach (STA) has gained popularity for the treatment of displaced intra-articular calcaneal fractures. No large studies comparing wound complications worldwide after STA surgery are available. The aim of this systematic review was to compare postoperative wound complication (POWC) and postoperative wound infection (POWI) rates following STA surgery between continents and countries and their differences in climate. Methods A literature search was performed using the databases of PubMed, Embase, and the Cochrane Library. Studies published before January 1, 2000, including < 10 patients and written in a language other than English were excluded. Results In total, 86 studies containing 4,392 surgeries via STA from 20 different countries were included. The mean POWC was 5.9% and the mean POWI was 4.4%. The highest median POWC rate was in North America (8.5%) and the lowest in South America (2.0%). No significant differences were found in the POWC and POWI rates between countries (p = 0.178 and p = 0.570, respectively), but significant differences were found between the POWC and POWI rates between continents (p = 0.011 and p = 0.036, respectively). The number of surgeries per year and climate differences, as represented by mean local temperature, were not correlated with both the POWC/POWI rates and functional outcome scores. Conclusions Significant differences between the POWC and POWI rates were found between continents but not between individual countries. With a mean POWC of 5.9% and a mean POWI rate of 4.4%, STA has an intrinsic low risk for complications given the minimally invasive nature of the approach and is inevitably becoming the gold standard for calcaneal surgery.
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Affiliation(s)
- Robin Eelsing
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, Netherlands
| | - Ahmad Masih Ahmadi
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, Netherlands
| | - Jens Anthony Halm
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, Netherlands
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Leigheb M, Codori F, Samaila EM, Mazzotti A, Villafañe JH, Bosetti M, Ceccarini P, Cochis A, Daou F, Ronga M, Grassi FA, Rimondini L. Current Concepts about Calcaneal Fracture Management: A Review of Metanalysis and Systematic Reviews. APPLIED SCIENCES 2023; 13:12311. [DOI: 10.3390/app132212311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2025]
Abstract
Background: The fracture of the calcaneus is the most common traumatic lesion of the hindfoot and can cause severe disability with social and economic sequelae. Since 1980, an increasing number of studies and new technologies have led to an improvement in the management of calcaneal fractures, but treatment is still controversial. The purpose of this review was to investigate the secondary scientific literature to detect the optimal management of calcaneal fracture. Methods: A MEDLINE search via PubMed was conducted. A total of 4856 articles were identified, and only meta-analyses and systematic reviews were included. Results: 59 articles with more than 10,000 calcaneus fractures were examined, and the results were divided into various topics. Most articles agree on the superiority of surgical treatments compared to conservative ones. Moreover, minimally invasive access to the sinus tarsi showed better results and fewer complications than traditional extended lateral access. Also, reduction and osteosynthesis with percutaneous and/or minimally invasive techniques seem to provide better outcomes when compared to open treatments. Conclusions: The management of calcaneal fractures requires an individualized treatment plan based on the functional demands of the patient, the type of fracture, and associated injuries. New technologies and further studies can lead to an improvement in the management of calcaneal fractures.
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Affiliation(s)
- Massimiliano Leigheb
- Orthopaedics and Traumatology Unit, “Maggiore della Carità” Hospital, Department of Health Sciences, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
| | - Francesco Codori
- Specialization School in Orthopedics and Traumatology, University of Pavia, 27100 Pavia, Italy
| | - Elena Manuela Samaila
- Department of Orthopedics and Trauma Surgery, University of Verona, 37121 Verona, Italy
| | - Antonio Mazzotti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | | | - Michela Bosetti
- Dipartimento di Scienze del Farmaco (DSF), Università Piemonte Orientale “A. Avogadro”, Largo Donegani 2, 28100 Novara, Italy
| | - Paolo Ceccarini
- Orthopedic and Traumatology Unit, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
| | - Andrea Cochis
- Department of Health Sciences, Center for Translational Research on Autoimmune and Allergic Diseases-CAAD, Università del Piemonte Orientale UPO, 28100 Novara, Italy
| | - Farah Daou
- Department of Health Sciences, Center for Translational Research on Autoimmune and Allergic Diseases-CAAD, Università del Piemonte Orientale UPO, 28100 Novara, Italy
| | - Mario Ronga
- Orthopaedics and Traumatology Unit, “Maggiore della Carità” Hospital, Department of Health Sciences, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
| | - Federico Alberto Grassi
- Specialization School in Orthopedics and Traumatology, University of Pavia, 27100 Pavia, Italy
| | - Lia Rimondini
- Department of Health Sciences, Center for Translational Research on Autoimmune and Allergic Diseases-CAAD, Università del Piemonte Orientale UPO, 28100 Novara, Italy
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Eelsing R, Aronius LB, Halm JA, Schepers T. Implant Choice and Outcomes of the Sinus Tarsi Approach for Displaced Intra-articular Calcaneal Fractures. Foot Ankle Int 2023; 44:738-744. [PMID: 37254513 PMCID: PMC10394952 DOI: 10.1177/10711007231176276] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Operative fixation of displaced intra-articular calcaneal fractures is considered the gold standard, for which multiple fixation methods are available. This study compares the (functional) outcome of screw fixation (SF), plate fixation (PF), and anatomical plate fixation (APF) via the sinus tarsi approach (STA). METHODS A total of 239 patients (265 fractured calcanei) who received surgical treatment of a displaced intra-articular calcaneal fracture via STA between 2011 and 2022 were included. RESULTS Böhler angle (BA) measured immediately postoperatively (BA post-OR) and the decrease in BA at 1 year (∆BA) differed significantly in favor of PF/APF compared with SF (BA post-OR: SF vs PF P = .010 and SF vs APF P = .001; ∆BA: SF vs PF P = .032 and SF vs APF P = .042). Implant removal surgery was performed significantly less in the APF group as compared to the SF/PF groups (APF vs SF/PF; 9.9% vs 22.9%/23.7%, P = .015). Surgical site infections and secondary arthrodesis of the subtalar joint occurred equally in the 3 groups. Furthermore, the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index score, and EuroQOL-5D-index / visual analog scale score, did not differ notably between SF, PF, and APF. CONCLUSION The results show that both PF and APF are favored over SF because of an improved correction of BA measured directly postoperatively, a lower secondary loss of BA and, for APF, a lower implant removal rate. There was no difference in the rate of surgical site infections, need for secondary arthrodesis, nor functional outcome scores between different implants using the STA. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Robin Eelsing
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| | - Loran B. Aronius
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| | - Jens A. Halm
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
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A novel distractor-assisted reduction combined with the sinus tarsi approach for joint depression-type calcaneal fractures. INTERNATIONAL ORTHOPAEDICS 2023; 47:251-263. [PMID: 36370163 DOI: 10.1007/s00264-022-05625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/29/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE A novel percutaneous distractor with the advantage of axial and direct distraction was designed for the minimally invasive treatment of calcaneal fractures. The purpose of this study was to investigate the clinical results and complications of a novel distractor combined with sinus tarsi approach (STA) in treatment of the joint depression-type of calcaneal fractures. METHODS Fifty-four patients with the depression-type of calcaneal fractures (30 Sanders type II, 22 Sanders type III, 2 Sanders type IV) who were subjected to the novel distractor combined with STA were retrospectively assessed. Calcaneal height, width, and length; Bohler's angle; and the Gissane angle were evaluated pre-operatively and post-operatively. Clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) pain scores from the last follow-up. Complications were also recorded. RESULTS Fifty-two patients achieved an average follow-up of 24.3 months (range 18 to 34 months), and two patients were lost to follow-up six months post-operatively. There was significant difference between pre-operative and post-operative calcaneal height, width, and length; Bohler's angle; and Gissane angle (p < 0.01), but no significant difference was detected between the post-operative and normal side Bohler's angle (p > 0.05). The AOFAS ankle and hind foot score was 88.4 ± 6.6, and the VAS score was 1.9 ± 0.7 at the last follow-up. Nine (17.3%) patients developed complications: One experienced skin necrosis and two had screws loosening; three patients developed early degenerative changes of the subtalar joint; two had no symptoms; one had light pain around the subtalar joint without medical treatment; complex regional pain syndrome (CRPS) developed in one patient after seven months post-operatively; and two developed transient ankle stiffness. CONCLUSION The novel distractor combined with the STA effectively reconstructs the facet depression-type of calcaneal fractures (sanders type II and III) with minimal complications.
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Xie W, Cui X, Zhang C, Chen X, Rui Y, Chen H. Modified sinus tarsi approach with a variable-angle locking anterolateral plate for Sanders type II and III calcaneal fractures. Foot Ankle Surg 2022; 28:872-878. [PMID: 34916143 DOI: 10.1016/j.fas.2021.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/25/2021] [Accepted: 11/30/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND We compared the effectiveness of the extensile lateral approach (ELA) and modified sinus tarsi approach (MSTA) with a variable-angle locking anterolateral plate in treating Sanders type II and III calcaneal fractures. METHODS We reviewed 45 DIACFs treated by a single surgeon from 2017 to 2020. Open reduction using ELA and MSTA was performed in 25 and 20 patients, respectively. Follow-up evaluations included radiological assessments and clinical evaluations. RESULTS Pre- and postoperative radiologic parameters for the calcaneus were significantly different. The average American Orthopaedic Foot and Ankle Society scores were 81.24 and 85.00, the mean visual analogue scale scores were 2.28 and 1.65, and the wound-related complication rates were 64.0% and 15.0% in the ELA and MSTA groups, respectively. Bony union was achieved in all cases. CONCLUSIONS For Sanders type II and III fractures, MSTA seems to be a safer and more satisfactory method, with fewer postoperative complications.
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Affiliation(s)
- Wenjun Xie
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Xueliang Cui
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Cheng Zhang
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Xiangxu Chen
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Yunfeng Rui
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Hui Chen
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
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The methodological quality was low and conclusions discordant for meta-analyses comparing proximal humerus fracture treatments: a meta-epidemiological study. J Clin Epidemiol 2021; 142:100-109. [PMID: 34718123 DOI: 10.1016/j.jclinepi.2021.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/08/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the association between methodological quality and reported conclusions of meta-analyses comparing operative with non-operative treatments for proximal humerus fractures. STUDY DESIGN AND SETTING Cross-sectional meta-epidemiological study. We searched EMBASE, PubMed, The Cochrane Library, and Web of Science for systematic reviews with meta-analyses comparing non-operative with operative treatments for proximal humerus fractures. Methodological quality was assessed using AMSTAR2 and the reported conclusions were scored for three outcome domains (functional outcome, quality of life, and harm) on a scale from 1 to 6. The Mann-Whitney and Kruskal-Wallis tests were used to investigate the association between methodological quality and reported conclusions. RESULTS We included 21 systematic reviews: 19 pairwise meta-analyses and 2 network meta-analyses, although there are only 8 published randomized controlled trials. Most (n = 18) of the meta-analyses were rated as critically low quality, while the remaining 1 was rated as high quality. The conclusions were discordant for all three outcome domains, even for meta-analyses reporting similar inclusion criteria. We could not perform most of the statistical tests due to the predominantly critically low quality. CONCLUSION The methodological quality was so predominantly critically low that it was not possible to evaluate the association between methodological quality and reported conclusions.
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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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