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Su Z, Ding M, Zhu N, Cheung JCW, Wong DWC, Sun W, Ni M. Biomechanical role of bone grafting for calcaneal fracture fixation in the presence of bone defect: A finite element analysis. Clin Biomech (Bristol, Avon) 2024; 116:106278. [PMID: 38821036 DOI: 10.1016/j.clinbiomech.2024.106278] [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: 12/26/2023] [Revised: 03/28/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND The purpose of this study was to compare the biomechanical stress and stability of calcaneal fixations with and without bone defect, before and after bone grafting, through a computational approach. METHODS A finite element model of foot-ankle complex was reconstructed, impoverished with a Sanders III calcaneal fracture without bone defect and with moderate and severe bone defects. Plate fixations with and without bone grafting were introduced with walking stance simulated. The stress and fragment displacement of the calcaneus were evaluated. FINDINGS Moderate and severe defect increased the calcaneus stress by 16.11% and 32.51%, respectively and subsequently decreased by 10.76% and 20.78% after bone grafting. The total displacement was increased by 3.99% and 24.26%, respectively by moderate and severe defect, while that of posterior joint facet displacement was 86.66% and 104.44%. The former was decreased by 25.73% and 35.96% after grafting, while that of the latter was reduced by 88.09% and 84.78% for moderate and severe defect, respectively. INTERPRETATION Our finite element prediction supported that bone grafting for fixation could enhance the stability and reduce the risk of secondary stress fracture in cases of bone defect in calcaneal fracture.
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Affiliation(s)
- Zhihao Su
- The Ninth People's Hospital of Wuxi Affiliated to Soochow University, Wuxi 214023, China; School of Medical Instrument, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China; Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China.
| | - Ming Ding
- The Ninth People's Hospital of Wuxi Affiliated to Soochow University, Wuxi 214023, China; School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China.
| | - Ning Zhu
- School of Medical Instrument, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China; Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China.
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China.
| | - Wanju Sun
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China.
| | - Ming Ni
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China; Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
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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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Checa-Betegón P, Valle-Cruz J, Llanos-Sanz S, Miguel-Miguel C, Sánchez-Del-Saz J, García-Coiradas J. External fixation in intra-articular fractures of the calcaneus: Is it a valid option as definitive treatment? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:201-208. [PMID: 37402889 DOI: 10.1007/s00590-023-03621-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/11/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION The therapeutic management of calcaneal fractures is currently a major source of controversy in the literature. There is no consensus on the need to treat these injuries conservatively or surgically, nor on the criteria for deciding one option or the other. Although the gold standard has classically been the open approach and osteosynthesis, there are currently minimally invasive techniques that also report good results. Our objective is to present our results and experience with the MBA® Orthofix external fixator in a series of cases of calcaneal fractures. METHODS We performed a retrospective observational study in our center, between the years 2019 and 2021, of Sanders types II-IV calcaneal fractures operated with MBA® Orthofix external fixator. We recorded a total of 38 patients, 42 fractures. We registered demographic information, intraoperative, postoperative, radiological and functional parameters, using the American Orthopedic Foot and Ankle Society (AOFAS), Manchester-Oxford Foot Questionnaire (MOXFQ), EQ-5D and VAS scales. RESULTS A total of 26 men and 12 women were included, and the median age was 38 years. Mean follow-up was 24,4 months (6, 8-40, 1). The average time to surgery was 7 days and partial loading was started at 2.5 weeks after external fixation, which was removed at 9.2 weeks. The average Böhler angle correction was 7, 4°, Gissane - 12,2°, length 2 mm and calcaneal width was reduced by 5 mm. We recorded two superficial infections, one peroneal entrapment and three subtalar arthrodesis due to post-traumatic osteoarthritis. The AOFAS obtained was 79.1 + / - 15.7 points, MOXFQ 20.1 + / - 16.1 points, EQ-5D 0.84 + / - 0.2 and VAS 3.3 + / - 1.9. CONCLUSION The external fixator is an excellent surgical alternative for complex articular fractures of the calcaneus, obtaining clinical and radiological results comparable to other osteosynthesis techniques and significantly reducing soft tissue complications.
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Affiliation(s)
- P Checa-Betegón
- Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain.
- Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain.
| | - J Valle-Cruz
- Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain
| | - S Llanos-Sanz
- Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain
| | - C Miguel-Miguel
- Complejo Hospitalario de Navarrra., C. de Irunlarrea, 3, 31008, Pamplona, Spain
| | - J Sánchez-Del-Saz
- Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain
| | - J García-Coiradas
- Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain
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Uchiyama Y, Imai T, Takatori N, Watanabe M. Open reduction and Kirschner wire fixation method using a cylindrical block of unidirectional porous β-tricalcium phosphate for tongue-shaped calcaneal fracture: Report of three cases. Trauma Case Rep 2023; 47:100864. [PMID: 37383026 PMCID: PMC10293754 DOI: 10.1016/j.tcr.2023.100864] [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] [Accepted: 06/03/2023] [Indexed: 06/30/2023] Open
Abstract
Background The artificial bone grafts are performed on the defect after reduction of the calcaneal fracture. Generally, it is an artificial bone graft with an implant, and there are a few reports of an artificial bone graft without an implant. Cases We report three cases (42-year-old male, 67-year-old male, 21-year-old female) of a tongue-shaped calcaneal fracture treated using a cylindrical unidirectional porous β-tricalcium phosphate artificial bone (Affinos®, Kurare co Ltd., Hyougo, Japan) to surgically repair bone defects after reduction. The bone defect is often observed when fracture is reduced in calcaneal fracture. There were significant bone defects, which were then fixed using Affinos® (forming a cylindrical shape block; diameter 10 mm x height 20 mm) to support the bone fragment, an artificial β-tricalcium phosphate bone with a porosity of 57 % (pore size 25-300 μm), characterized by a novel unidirectional porous structure. Postoperative early rehabilitation started with partial load from 5 weeks after surgery and was full weight bearing at 9 weeks after surgery. There was no correction loss and good bone fusion was obtained. By 12 months postoperatively, patients were able to be walking without pain and absorption and bone fusion around the artificial bone were observed maintaining the morphology immediately after reduction. The result was a good clinical result of one excellent (92 points) and two good (81 and 84 points) 1 year after surgery in the postoperative AOFAS Ankle-Hindfoot Scale. Conclusion Affinos® has a frost-like structure, which endows it with good tissue invasive properties because of the capillary effect. Moreover, it has excellent osteoconduction capability. In these 3 cases, Affinos® showed good strength, affinity, absorption, and bone substitution in a tongue-shaped calcaneal fracture. Further prospective studies are required to confirm our findings.
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Affiliation(s)
- Yoshiysau Uchiyama
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan
| | - Takeshi Imai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan
| | - Naoki Takatori
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan
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Li X, Wang XK, Yu LK, Zhang C, Zhao MM, Yan J, Han LR. 3D simulation of percutaneous sustentaculum tali screw insertion in calcaneal fractures. BMC Musculoskelet Disord 2023; 24:636. [PMID: 37550653 PMCID: PMC10408215 DOI: 10.1186/s12891-023-06748-5] [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: 02/13/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND In calcaneal fractures, the percutaneous screw fixation (PSF) is currently considered to be the better choice, but it is difficult to accurately place the screw into the sustentaculum tali (ST) during the operation. In this study, the ideal entry point, angle, diameter and length of the screw were calculated by simulating the operation process. METHODS We retrospectively collected the calcaneus computed tomography (CT) scans of 180 adults, DICOM-formatted CT-scan images of each patient were imported into Mimics software to establish calcaneus model. Virtual screws were placed on the lateral of the posterior talar articular surface (PTAS), the lateral edge of the anterior process of calcaneus (APC), and the calcaneal tuberosity, respectively, the trajectory and size of the screws were calculated. RESULTS The mean maximum diameter of the PTAS screw was 42.20 ± 3.71 mm. The vertical distance between the midpoint of the APC optimal screw trajectory and the lowest point of the tarsal sinus was 10.67 ± 1.84 mm, and the distance between the midpoint of the APC optimal screw trajectory and the calcaneocuboid joint was 5 mm ~ 19.81 ± 2.08 mm. The mean maximum lengths of APC screws was 44.69 ± 4.81 mm, and the Angle between the screw and the coronal plane of the calcaneus from proximal to distal was 4.72°±2.15° to 20.52°±3.77°. The optimal point of the maximum diameter of the calcaneal tuberosity screw was located at the lateral border of the achilles tendon endpoint. The mean maximum diameters of calcaneal tuberosity screws was 4.46 ± 0.85 mm, the mean maximum lengths of screws was 65.31 ± 4.76 mm. We found gender-dependent differences for the mean maximum diameter and the maximum length of the three screws. CONCLUSIONS The study provides effective positioning for percutaneous screw fixation of calcaneal fractures. For safer and more efficient screw placement, we suggest individualised preoperative 3D reconstruction simulations. Further biomechanical studies are needed to verify the function of the screw.
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Affiliation(s)
- Xian Li
- School of Clinical Medicine, Weifang Medical University, Weifang, China
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Liaocheng, China
| | - Xiao-Ke Wang
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Lian-Kui Yu
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Liaocheng, China
| | - Chao Zhang
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Liaocheng, China
| | - Ming-Ming Zhao
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Liaocheng, China
| | - Jun Yan
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Liaocheng, China.
| | - Li-Ren Han
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Liaocheng, China.
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Bandyopadhyay A, Kumar S, Mandal P. Calcaneal Fractures Management, Change of Clinical Practice in Recent Years from ELA to STA: A Systematic Review and Meta-Analysis. Indian J Orthop 2023; 57:800-817. [PMID: 37214359 PMCID: PMC10192482 DOI: 10.1007/s43465-023-00871-0] [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: 10/13/2022] [Accepted: 03/10/2023] [Indexed: 05/24/2023]
Abstract
Background Calcaneal fractures are serious injuries that mainly affect young, active people. As a result, these fractures may cause long-term impairment and have a major socioeconomic impact. The current updated systematic review and meta-analysis were conducted to evaluate the functional outcomes, re-operative risk, and complications associated with the treatment of displaced intra-articular calcaneal. Methodology The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this meta-analysis. The literature search was carried out using PubMed, Cochrane, MEDLINE, Google Scholar, and the EMBASE databases with the appropriate keywords. Results A total of 13 studies were included in this review. The follow-up months were diverse, ranging between 12 and 65 months in sinus tarsi approach (STA) and 12 to 76 months in extended lateral approach (ELA) methods. Time to surgery was shorter for the STA when compared to ELA (MD: 3.48; 95% CI 2.43 to 4.53; p < 0.00001). No significant difference was observed in functional outcomes between STA and ELA (MD: 0.34; 95% CI: -0.37 to 1.04; p = 0.35 > 0.05; I2 = 88%). In comparison to the ELA, the STA has significantly less wound healing complications (RR: 0.20; 95% CI 0.11 to 0.36; p 0.00001; I2 = 0%). Conclusion In conclusion, the STA technique in treating calcaneal fractures was significantly safer and more effective when compared to the ELA methods. The STA method of treatment was found to have a lower risk of complications and an infection rate, as well as a shorter operating and recovery time.
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Affiliation(s)
- Abhijit Bandyopadhyay
- Department of Orthopaedic Surgery, Woodlands Multispeciality Hospital, Shree Jain Hospital & Reserch Centre, Kolkata, India
| | - Sanjay Kumar
- Department of Orthopaedic Surgery, R.G.Kar Medical College, WBUHS U, Kolkata, India
| | - Prasun Mandal
- Department of Orthopaedic Surgery, Uluberia Medical College, Howrah, India
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Caravelli S, Gardini G, Pungetti C, Gentile P, Perisano C, Greco T, Rinaldi VG, Marcheggiani Muccioli GM, Tigani D, Mosca M. Intra-Articular Calcaneal Fractures: Comparison between Mini-Invasive Approach and Kirschner Wires vs. Extensive Approach and Dedicated Plate-A Retrospective Evaluation at Long-Term Follow-Up. J Clin Med 2022; 12:jcm12010020. [PMID: 36614821 PMCID: PMC9821005 DOI: 10.3390/jcm12010020] [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] [Received: 11/13/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Calcaneal fractures (CF) are the most common tarsal fractures, representing up to 75% of foot fractures and 2% of all fractures. The aim of this retrospective study is to analyze fixation with Kirschner wires through a mini-invasive approach and dedicated plate and screws through an extended approach at long-term follow-up. MATERIALS AND METHODS Patients were radiographically and clinically evaluated at final follow-up, by using the validated American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score for the clinical-functional assessment, the Short-Form 12 (SF-12) for the physical and psychological domain assessment, and the Visual Analog Scale (VAS) for pain. RESULTS In total, 38 patients (42 CF) met the inclusion criteria and were retrospectively evaluated and divided into two groups (Kirschner group and plate group) consisting of 19 patients each. The overall mean follow-up was 59.4 ± 11.8 months. The average values of the post-operative clinical outcomes of the two groups KG and PG were, respectively, 70.7 ± 11.9 and 70.1 ± 10.9 (AOFAS), 45.7 ± 6.8 and 46.5 ± 10.8 (SF-12 PCS), 54.7 ± 9.9 and 50.9 ± 11.8 (SF-12 MCS) at the final follow-up. CONCLUSIONS The present study showed that in the cases analyzed, the two surgical approaches used for the treatment of CF achieved comparable clinical outcomes. The only substantial difference found between the two groups of patients was the re-intervention rate that afflicted them.
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Affiliation(s)
- Silvio Caravelli
- II Clinic of Orthopaedic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence:
| | - Giammarco Gardini
- II Clinic of Orthopaedic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Camilla Pungetti
- U.O. Ortopedia e Traumatologia, Ospedale Maggiore “Pizzardi”, 40133 Bologna, Italy
| | - Paolo Gentile
- U.O. Ortopedia e Traumatologia, Ospedale Maggiore “Pizzardi”, 40133 Bologna, Italy
| | - Carlo Perisano
- Orthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Tommaso Greco
- Orthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Vito Gaetano Rinaldi
- II Clinic of Orthopaedic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | - Domenico Tigani
- U.O. Ortopedia e Traumatologia, Ospedale Maggiore “Pizzardi”, 40133 Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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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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Ozturk AM, Ozer MA, Suer O, Derin O, Govsa F, Aktuglu K. Evaluation of the effects of using 3D - patient specific models of displaced intra - articular calcaneal fractures in surgery. Injury 2022; 53 Suppl 2:S40-S51. [PMID: 32456955 DOI: 10.1016/j.injury.2020.04.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/26/2020] [Accepted: 04/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND It was aimed to compare conventional surgery and three-dimensional (3D) model-assisted surgery used in the treatment of calcaneal fractures. MATERIALS & METHODS A total of 37 patients with unilateral calcaneal fractures were randomly divided into two groups as a conventional surgery group (n: 19) and a 3D model-assisted surgery group (n: 18). The preoperative, postoperative and last follow up angles of the Bohler and Gissane, calcaneal width and facet height were measured. The duration of the operation, blood loss volume, fluoroscopy usage, instrumentation time for both groups were recorded. Finally, the follow-up AOFAS scores were evaluated. A questionnaire was used to determine the perceptions of the resident doctors about the 3D model. RESULTS The duration of the operation, blood loss volume, fluoroscopy usage, instrumentation time for 3D model-assisted surgery group were 83.3 ± 4.6 minutes, 83.6 ± 4.6 ml, 6.8 ± 1.4 times and 13.0 ± 0.8 weeks, and as for conventional group they were 130.0 ± 5.8 minutes, 105.1 ± 5.6 minutes, 11.7 ± 1.5 ml, 22.2 ± 2.4 times and 13.3 ± 0.8 weeks, respectively (p < 0.0001). The both groups significantly restored Bohler angle, Gissane angle, calcaneal width and calcaneal facet height after operation (p < 0.0001). The 3D model-assisted group was significantly more succesful in restoration and protection of achieved correction of calcanel facet height (p < 0.0001). The difference was determined among the groups at the final follow-up examination with respect to the amount of change according the values achieved post-op. were significant in Bohler angle (p < 0.001), calcaneal facet height (p < 0.0001) and calcaneal widht (p = 0.017). There was no significant difference between AOFAS scores of the two groups at last follow-up. Resident doctors exhibited high scores of overall satisfaction with the use of a 3D printing model. CONCLUSIONS Compared to the conventional group, the 3D model-assisted group provide successful intervention and reduce operation, instrumentation time and the fluoroscopy usage with less blood loss. Performing 3D-assisted surgery helps the quality of reduction during the surgery and stability of internal fixation to protect achieved reduction at follow-up more succesfully.
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Affiliation(s)
- Anil Murat Ozturk
- Department of Ortopaedic Surgery, Faculty of Medicine, Ege University, Izmir, TURKEY
| | - Mehmet Asim Ozer
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, TURKEY
| | - Onur Suer
- Department of Ortopaedic Surgery, Faculty of Medicine, Ege University, Izmir, TURKEY
| | - Okan Derin
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, TURKEY
| | - Figen Govsa
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, TURKEY
| | - Kemal Aktuglu
- Department of Ortopaedic Surgery, Faculty of Medicine, Ege University, Izmir, TURKEY.
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Huang J, Guo H, Huang W, Tan X, Huang H, Zeng C. Topical Application of Tranexamic Acid Can Reduce Postoperative Blood Loss in Calcaneal Fractures: A Randomized Controlled Trial. J Foot Ankle Surg 2022; 61:1056-1059. [PMID: 35193803 DOI: 10.1053/j.jfas.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 07/06/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
The traditional lateral "L" approach is common for managing calcaneal fractures with a drawback of significant blood loss. Yet there are no prospective studies on the hemostatic effect of the topical use of tranexamic acid (TXA) in calcaneal fracture surgeries. The purpose of this study was to evaluate the role of topical administration of TXA in reducing postoperative blood loss in calcaneal fractures. Forty participants were randomly distributed into the TXA group (n = 20) and the control group (n = 20). All participants underwent the same surgery via the lateral "L" approach. At the end of the operation, the surgical wound was irrigated with 80 mL 0.5 g/L TXA in the TXA group and 80 mL 0.9% sodium chloride in the control group, followed by the routine use of a drainage tube when closing the incision. Then, 20 mL 0.5 g/L TXA (TXA group) or 20 mL 0.9% sodium chloride solution (control group) was injected retrogradely into the wound through the drainage tube, which was clipped for 30 minutes thereafter. There were no significant differences in the baseline data between the 2 groups (p > .05). There was significantly less blood loss in the first 24 hours and total blood loss postoperation in the TXA group (p < .01). The surgical wounds healed well after surgery in both groups with no complication. We concluded that topical application of TXA in calcaneal fracture surgeries is a safe and useful method that can reduce postoperative blood loss.
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Affiliation(s)
- Jianguo Huang
- Resident, Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China; Postgraduate student, Southern Medical University, Guangzhou, Guangdong, China
| | - Hao Guo
- Attending, Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Weiqi Huang
- Attending, Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xinyu Tan
- Attending, Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Huajun Huang
- Attending, Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Canjun Zeng
- Director, Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.
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11
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Liao LQ, Feng ZY, Li YK. Anatomical parameters of sustentaculum Tali screw placement in the Asian population: A retrospective radio-anatomical study. J Orthop Surg (Hong Kong) 2022; 30:10225536221082343. [PMID: 35388728 DOI: 10.1177/10225536221082343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: This study aimed to determine the anatomical parameters of successful Sustentaculum Tali (ST) screw placement in the Asian population. Method: CT scans of unilateral feet of 110 participants were reviewed, retrospectively. The 3 D reconstruction of the calcaneus and morphometric measurements were performed by Mimics Research 19.0 and 3-Matic Research 11.0. Finally, six cadaveric feet were used for verification of the accuracy of the measurements. Results: We discovered a method to help place ST screw successfully: (1) The entry point located at the middle section of the lateral wall of posterior talar articular surface (PTAS), and the perpendicular distance from the entry point to the lateral edge of PTAS (PDEL) was 10.78 mm, (2) Screw was perpendicular to the z-axis, 66.98° to the y-axis (the longitudinal axis of the foot), (3) The length of the ST screw should be approximately 44.74 mm in male and 41.14 mm in female, and (4) The diameter of the ST screw should be approximately 4.0 mm in male and 3.5 mm in female. With this new method, all screws in six cadaveric feet were placed successfully into the middle of ST. Conclusions: In this study, we discovered a general approach to safely place ST screws in the Asian population, which may potentially help surgeons improve their success rate in surgical practice.
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Affiliation(s)
- Li-Qing Liao
- Department of TCM Orthopedics and Traumatology, School of Traditional Chinese Medicine, 70570Southern Medical University, Guangzhou, China
| | - Zi-Yu Feng
- Department of TCM Orthopedics and Traumatology, School of Traditional Chinese Medicine, 70570Southern Medical University, Guangzhou, China
| | - Yi-Kai Li
- Department of TCM Orthopedics and Traumatology, School of Traditional Chinese Medicine, 70570Southern Medical University, Guangzhou, China
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12
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Selim A, Ponugoti N, Chandrashekar S. Systematic Review of Operative vs Nonoperative Treatment of Displaced Intraarticular Calcaneal Fractures. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221101609. [PMID: 35655706 PMCID: PMC9152199 DOI: 10.1177/24730114221101609] [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] [Indexed: 11/17/2022] Open
Abstract
Background Management of displaced intraarticular calcaneus fractures can be operative or nonoperative. Several randomized and case-controlled trials have been recently conducted in order to reach a consensus. The purpose of this analysis is to provide recommendations for the management of these injuries based on the best available clinical evidence. Methods An up-to-date search was conducted using predefined eligibility criteria. The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) was followed. Randomized and prospective clinical trials were only included after agreement among all authors. Relevant literature was appraised for methodologic quality using the Cochrane collaboration tool for the randomized controlled trials (RCTs) and Newcastle Ottawa Score for the prospective trials. Outcome measures included American Orthopaedic Foot & Ankle Society ankle-hindfoot score, visual analog scale score, return to activity, complications, residual pain, and development of arthritis. RevMan, version 5.3.5 software, was used for data analysis. A P value of <.05 was considered statistically significant, and CIs were set at 95%. Results A total of 13 studies and 1251 patients were included in our analysis. This involved 10 RCTs and 3 prospective clinical trials. Shoe fitting problems and failure to return to activity favored the operative group. No other studied variables showed clear superiority of a specific treatment approach. Conclusion The best evidence available at this time favors an advantage to operative treatment. Patients should be informed that the clear differences are centered on comfort of shoe wear and return to desired activity level.Level of Evidence: Level II, meta-analysis of RCT and Prospective Cohort studies.
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Affiliation(s)
- Amr Selim
- Department of Trauma & Orthopaedics, Cairo University Hospital, Cairo, Egypt
- Trauma & Orthopaedics, Homerton University Hospital, London, United Kingdom
| | - Nikhil Ponugoti
- Trauma & Orthopaedics, Hampshire Hospitals NHS Trust, Basingstoke, United Kingdom
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13
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Long C, Li K, Zhu J, Liu H, Zhu Y. Three-step closed reduction and percutaneous screw fixation: A reliable and reproducible protocol in managing displaced intra-articular calcaneal fractures. Injury 2022; 54 Suppl 2:S49-S55. [PMID: 35232570 DOI: 10.1016/j.injury.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND For displaced intra-articular calcaneal fractures (DIACFs), the less invasive surgical techniques vary widely. Herein, the study is to introduce a novel, reliable and reproducible protocol of three-step closed reduction (distracting, elevating, and clamping) and percutaneous screw fixation for DIACFs. METHODS This retrospective study included 32 patients with 33 DIACFs treated by the abovementioned surgical procedures with an average follow-up of 17.7 months. Postoperative outcomes were evaluated by complications, radiographs, and functional scores. RESULTS There were no incision complications. Postoperative Böhler's angle, height, and width were significantly recovered with p < 0.001. Especially, mean postoperative subtalar incongruity was 0.5 ± 0.5 mm. The average values of Maryland Foot Score (MFS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score were 93.6 ± 5.9, 91.7 ± 6.7, respectively. The average scores of short form-36 (SF-36) and visual analog scale (VAS) were 89.9 ± 10.4 and 3.1 ± 1.6, respectively. Further subgroup analysis showed that the functional scores were comparable among different fracture types according to either Sanders or Essex-Lopresti classification. CONCLUSION We consider the three-step reduction (distracting, elevating and clamping) and percutaneous screw fixation to be a reliable and reproducible protocol for the treatment of DIACFs.
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Affiliation(s)
- Cheng Long
- Department of Orthopaedics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China; Department of Orthopaedics, Shengli Orthopaedic Hospital, 2 Chenxi Road, Yiyang 413501, China
| | - Kaihu Li
- Department of Orthopaedics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China.
| | - Jianxi Zhu
- Department of Orthopaedics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Hongbin Liu
- Department of Orthopaedics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Yong Zhu
- Department of Orthopaedics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China.
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14
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Local administration of epsilon-aminocaproic acid reduces post-operative blood loss from surgery for closed, Sanders III-IV calcaneal fractures. INTERNATIONAL ORTHOPAEDICS 2022; 46:615-621. [PMID: 35020023 PMCID: PMC8840883 DOI: 10.1007/s00264-021-05268-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/14/2021] [Indexed: 12/02/2022]
Abstract
Purpose To investigate whether local administration of epsilon-aminocaproic acid (EACA) is effective and safe in reducing the post-operative blood loss in surgery for Sanders III–IV calcaneal fractures. Methods Patients with Sanders III–IV calcaneal fractures who were hospitalized in our hospital from January 2016 to February 2021 and underwent open reduction internal fixation (ORIF) via lateral approach with an L-shaped incision were included in the current study. Eighty five patients were randomly divided into two groups, EACA group (43) and control group (42). Twenty milliliters of 5% EACA solution or normal saline was perfused into the incision of patients in EACA group and control group, respectively. The volume of post-operative drainage was investigated as the primary outcome. Post-operative blood test, coagulation test, and wound complications were analyzed as the secondary outcomes. Results The volume of post-operative drainage at 24 and 48 h was 164.8 ± 51.4 ml, 18.9 ± 3.8 ml for patients in EACA group, and 373.0 ± 88.1 ml, 21.2 ± 4.4 ml for patients in the control group, respectively. EACA greatly reduced the post-operative blood loss compared to the control (normal saline). The difference between the two groups was statistically significant. No statistically significant difference was found between EACA group and control group with regard to the pre-operative, baseline characteristics. Post-operative blood test results demonstrated that haemoglobin and hematocrit were significantly higher in EACA compared to those of control group. No significant difference was found between EACA group and control group in terms of the platelet counts, prothrombin time (P.T.), activated partial prothrombin time (APTT), and wound complications. Conclusion Local administration of EACA is effective in post-operative blood loss reduction in ORIF surgeries for Sanders III–IV types of calcaneal fractures without increasing the incidence of periwound complication.
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15
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Predictors for wound healing complications and prolonged hospital stay in patients with isolated calcaneal fractures. Eur J Trauma Emerg Surg 2022; 48:3157-3163. [PMID: 34989813 PMCID: PMC9360130 DOI: 10.1007/s00068-021-01863-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022]
Abstract
Purpose Surgically treated calcaneal fractures have a high risk of postoperative wound healing complications and a prolonged length of hospital stay (LOS). The aim of this study was to identify predictor variables of impaired wound healing (IWH) and LOS in surgically treated patients with isolated calcaneal fractures. Methods This retrospective cohort study analyzed data on patients aged 18 years or older who were admitted to a level I trauma center with isolated calcaneal fractures between 2008 and 2018. Multivariable regression models were used to identify predictor variables. Results In total, 89 patients (age: 45.4 years; SD: 15.1) were included. In 68 of these patients, low-profile locking plate osteosynthesis was performed, and a minimally invasive approach (MIA) (percutaneous single screws/K-wire or low-profile locking plating via a sinus tarsi approach) was applied in 21 patients. Multivariable regression analysis revealed that a higher preoperative Böhler’s angle (β = − 0.16 days/degree, 95% CI [− 0.25, − 0.08], p = 0.004) and MIA (β = − 5.04 days, 95% CI [− 8.52, − 1.56], p = 0.002) reduced the LOS. A longer time-to-surgery (β = 1.04 days/days, 95% CI [0.66, 1.42] p = 0.001) and IWH increased the LOS (β = 7.80 days, 95% CI [4.48, 11.12], p = 0.008). In a subsequent multivariable regression analysis, two variables, open fractures (OR: 14.6, 95% CI [1.19, 180.2], p = 0.030) and overweight (BMI > 24) (OR: 3.65, 95% CI [1.11, 12.00], p = 0.019), increased the risk of IWH. Conclusion Advanced treatment algorithms for open fractures are needed to reduce the risk of IWH. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01863-1.
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Abstract
Treatment of calcaneal fractures has to be tailored to the individual pathoanatomy. If operative treatment is chosen, anatomic reconstruction of the calcaneal shape and joint surfaces is mandatory. For most of the displaced, intraarticular fractures, this can be achieved by less invasive reduction and fixation via a sinus tarsi approach, which may be extended along the "lateral utility" line for calcaneocuboid joint involvement or calcaneal fracture-dislocations. Purely percutaneous fixation is the treatment of choice for displaced extraarticular fractures and simple intraarticular fractures with adequate control of joint reduction. Specific approaches are used for rare calcaneal fracture variants.
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Affiliation(s)
- Stefan Rammelt
- University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, Dresden 01307, Germany.
| | - Michael P Swords
- Michigan Orthopedic Center, Sparrow Hospital, 2815 S. Pennsylvania Avenue, Suite 204 Lansing, MI 48910, USA
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17
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Patel TK, Gainer J, Lamba C, Adil SA, Singh V, Emmer T. Meta-Analysis: Functional Outcome of ORIF Versus Primary Subtalar Arthrodesis of Sanders Type II and Type III Calcaneal Fractures. J Foot Ankle Surg 2021; 60:1038-1043. [PMID: 34039510 DOI: 10.1053/j.jfas.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/04/2021] [Accepted: 04/04/2021] [Indexed: 02/03/2023]
Abstract
The choice of treatment for Sanders Type II and Type III calcaneal fractures remains controversial with unclear patient functional outcomes. A meta-analysis was done to compare the functional outcome of ORIF vs primary subtalar arthrodesis (PSA) according to American Orthopedic Foot and Ankle Score (AOFAS) hindfoot-ankle scores. The PubMed, Embase, and Cochrane Library Databases were searched by two independent evaluators. Fourteen studies met the eligible criteria. ORIF of 501 Type II and Type III fractures was compared to primary subtalar arthrodesis treatment of 57 Type II and Type III fractures. AOFAS for a mixed ORIF group of "Type II and III" fractures was 82.16 ± 1.58 at average follow-up of 25.3 months. For a mixed PSA group of "Type II and III" fractures, the AOFAS was 74.22 ± 2.45 at average follow-up of 28.0 months. This showed a difference between ORIF and primary subtalar arthrodesis of 7.94 points (95% confidence interval [CI] = 7.75-7.98; p value .004) favoring ORIF when adjusting for minimally invasive and percutaneous methods. Without adjustment, there was a difference of 6.54 points favoring ORIF (95% CI = 6.22-6.46; p value .017). In conclusion, while high-quality randomized controlled trials comparing ORIF to primary subtalar arthrodesis for Type II and Type III fractures would further elucidate superior treatment outcomes, this meta-analysis of available data shows a tendency for ORIF of Type II and Type III Sanders calcaneal fractures to have a better functional outcome at approximately 2 years postoperatively compared to primary subtalar arthrodesis.
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Affiliation(s)
- Tyag K Patel
- Marshall University Orthopedic Surgery, Huntington, WV.
| | - James Gainer
- University of Louisville Orthopedic Surgery, Louisville, KY
| | - Collin Lamba
- University of Louisville Orthopedic Surgery, Louisville, KY
| | - Syed Ali Adil
- University of Louisville Orthopedic Surgery, Louisville, KY
| | | | - Thomas Emmer
- University of Louisville Orthopedic Surgery, Louisville, KY
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Peng C, Yuan B, Guo W, Li N, Tian H. Extensile lateral versus sinus tarsi approach for calcaneal fractures: A meta-analysis. Medicine (Baltimore) 2021; 100:e26717. [PMID: 34397810 PMCID: PMC8341246 DOI: 10.1097/md.0000000000026717] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Calcaneal fractures are the most common tarsal bone fracture, and are often accompanied by heel pain, local swelling, tenderness, and inability to walk or stand. Surgical intervention results in better reconstruction of the calcaneal anatomy and reduces future complications; however, the optimal incision approach is still controversial. The incision is exposed better with extensile lateral approach (ELA), while the sinus tarsi approach (STA) causes fewer complications. The purpose of this meta-analysis is to compare the outcomes of STA and ELA. MATERIALS AND METHODS Published trials comparing ELA and STA in calcaneal fractures were included in our analysis. The quality of each study was assessed using the revised Jadad scale and the Newcastle-Ottawa scale. Two researchers (CP and BY) independently extracted data from all selected studies. Fixed- or random-effects models with mean differences and odds ratios were used to pool the continuous and dichotomous variables to determine the heterogeneity of the included studies. RESULTS Calcaneal height and calcaneal width had high heterogeneity. Results showed that the incidence of incision complications in STA was lower than that in ELA (P < .001). There was high heterogeneity in operative time (I2 = 97%), length of hospital stay (I2 = 98%), Böhler angle (I2 = 80%), Gissane angle (I2 = 98%), and American Orthopaedic Foot & Ankle Society scores (I2 = 73%). No source of heterogeneity was found by sensitivity analysis, subgroup analysis, or regression analysis, and the random-effects model was used. STA operative time was significantly shorter than ELA (P < .001). Length of hospital stay after STA was significantly shorter than after ELA (P = .002). There was no statistical difference in the Böhler and Gissane angles between STA and ELA. Postoperative American Orthopaedic Foot & Ankle Society scores after STA were higher than after ELA (P = .01). CONCLUSIONS Results show that, compared with ELA, STA is superior for treating calcaneal fractures due to anatomical reduction of the calcaneus, reduction of incision complications incidence, and shortened operative time and postoperative stay.
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Affiliation(s)
- Chuangang Peng
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Baoming Yuan
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wenlai Guo
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Na Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Heng Tian
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
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Guan X, Xiang D, Hu Y, Jiang G, Yu B, Wang B. Malunited calcaneal fracture: the role and technique of osteotomy-a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2663-2678. [PMID: 34240235 DOI: 10.1007/s00264-021-05130-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The research is aimed to introduce various corrective osteotomies utilized in treating calcaneal malunions in published papers, to further analyze the results, and to summarize recommended indications. METHODS The relevant research screening was conducted on the following search engines: the Cochrane Library, Web of Science, PubMed, Embase, Medline, and Academic Search Premier. Key words input included "calcaneal/calcaneus", "malunion," and "malunited fracture(s)" with Boolean operators "AND" and "OR." The inclusion criteria were researches containing surgical procedures treating calcaneal malunion with corrective osteotomy and published in the English language. For included research article, such information was extracted and analyzed: the type of calcaneal malunion, the time from initial injury to corrective surgery, the method of osteotomy, outcomes of each osteotomy (score systems, Bohler angle, talocalcaneal height and width of calcaneus, etc.), the function of the affected limb, post-operative complications, and patients' satisfaction. For included review, descriptive, commentary, or indicative sentences about corrective osteotomy were highlighted, analyzed, and summarized. RESULTS Ten research articles (170 patients with 184 feet) and nine reviews were included in this review, presenting seven types of corrective osteotomies (lateral wall exostectomy, Dwyer osteotomy, lateral wedge opening osteotomy, Romash osteotomy, tongue osteotomy, sagittal resection osteotomy, and modified Dwyer osteotomy). CONCLUSION A different corrective osteotomy with/without arthrodesis is recommended to be utilized based on the classification of the malunion and the condition of the cartilage in treating malunited calcaneal fractures. With adequate postoperative care and rehabilitation, the results of treatment could be associated with patients' satisfaction and good function.
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Affiliation(s)
- Xin Guan
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Dayong Xiang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yanjun Hu
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Guiyong Jiang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Bin Yu
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China. .,Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Bowei Wang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Shi F, Wu S, Cai W, Zhao Y. Comparison of 5 Treatment Approaches for Displaced Intra-articular Calcaneal Fractures: A Systematic Review and Bayesian Network Meta-Analysis. J Foot Ankle Surg 2021; 59:1254-1264. [PMID: 32828631 DOI: 10.1053/j.jfas.2020.03.021] [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: 02/26/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 02/03/2023]
Abstract
The choice of the best treatment method for displaced intra-articular calcaneal fractures (DIACFs) remains controversial. Using a network meta-analysis, this study aims to evaluate the radiographic characteristics, clinical effectiveness, and incision complications of nonoperative treatment, open reduction and internal fixation, minimally invasive reduction, and fixation. The studies were abstracted from Medline, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) meeting the inclusion and exclusion criteria were selected. Statistical analyses were conducted using Stata software. Seventeen RCTs involving 1297 participants with 1354 fractures were included. A total of 5 treatments-extensile lateral approach (ELA), minimally invasive longitudinal approach (MILA), sinus tarsi approach (STA), percutaneous reduction and fixation (PRF), and nonoperative treatment-were analyzed. The treatments were ranked based on Surface Under the Cumulative Ranking Curve (SUCRA) probability. In terms of recovery of Böhler's angle, the treatments were ranked as follows: MILA (75.3%), PRF (68.3%), ELA (54.7%), STA (51.6%), and nonoperative (0%). In terms of Böhler's angle after treatment, the treatments were ranked as follows: PRF (65.3%), ELA (64.0%), STA (63.5%), MILA (56.9%), and nonoperative (0.2%). In terms of American Orthopaedic Foot & Ankle Society score, the treatments were ranked as follows: PRF (87.0%), MILA (52.9%), STA (46.6%), ELA (40.4%), and nonoperative (23.1%). In terms of excellent and good satisfaction ratings, the treatments were ranked as follows: STA (96.2%), ELA (66.8%), PRF (34.9%), and nonoperative (2%). In terms of incision complications, the treatments were ranked as follows: PRF (84.1%), MILA (80.0%), STA (35.8%), and ELA (0.1%). Given the good results of the minimally invasive approach in terms of radiographic characteristics, clinical effectiveness and incision complications, the minimally invasive approach is a good alternative for DIACFs. More randomized controlled trials focused on DIACFs are needed to further examine this conclusion.
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Affiliation(s)
- FangLing Shi
- Resident, Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Resident, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - ShiYuan Wu
- Resident, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Cai
- Resident, Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Resident, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - YouMing Zhao
- Resident, Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Professor, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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21
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Zhang Y, Weng Q, Gu Y, Chen J, Yang Y. Calcaneal fractures: 3D-printing model to assist spatial weaving of percutaneous screws versus conventional open fixation-a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2021; 45:2337-2346. [PMID: 34117504 DOI: 10.1007/s00264-021-05094-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study compared the clinical effectiveness and wound complications of a three-dimensional model-assisted spatial weaving screw fixation (3D-SWSF) versus open reduction and internal fixation (ORIF) via an L-shaped extensile lateral approach for calcaneal fractures. METHODS This single-centre retrospective cohort study was conducted with two cohort groups in which patients with Sanders II and III calcaneal fractures underwent 3D-SWSF or conventional ORIF. The clinical outcome measures included operation duration, time to operation, wound complications, blood loss volume, hospital stays, American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and visual analog scale (VAS) score. The pre-operative, post-operative, and one-year follow-up Gissane's angle (GA), Böhler's angle (BA), height, and width and length of the calcaneal fractures were also compared between the two groups. RESULTS From Oct 2015 to Oct 2019, 31 patients received 3D-SWSF and 41 received conventional ORIF. A total of 11 (26.8%) patients in ORIF group had wound complications, compared with only two (6.5%) in 3D-SWSF group (p = 0.032). Operative time, blood loss, and hospital stay in 3D-SWSF group were lesser than those in ORIF group. The patients treated with 3D-SWSF had better AOFAS and VAS scores than those treated with ORIF at the last follow-up. The post-operative and one-year follow-up radiographic indexes as well as the GA, BA, length, width, and height of the calcaneal fractures were relatively comparable between the two groups. CONCLUSION Our study revealed that 3D-SWSF could effectively decrease the risk of wound complications, shorten operation time, reduce length of hospitalization, and improve post-operative rehabilitation.
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Affiliation(s)
- Yong Zhang
- Department of Foot and Ankle Surgery, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.,Department of Trauma Orthopedics Surgery, Ningbo No.6 Hospital, Medical School of Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Qiuyan Weng
- Department of Neurology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang, China
| | - Yang Gu
- Department of Trauma Orthopedics Surgery, Ningbo No.6 Hospital, Medical School of Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Jianming Chen
- Department of Trauma Orthopedics Surgery, Ningbo No.6 Hospital, Medical School of Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Yunfeng Yang
- Department of Foot and Ankle Surgery, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
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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: 0.7] [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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Zhong L, Liu Y, Wang Y, Wang H. Effects of Local Administration of Tranexamic Acid on Reducing Postoperative Blood Loss in Surgeries for Closed, Sanders III-IV Calcaneal Fractures: A Randomized Controlled Study. Indian J Orthop 2021; 55:418-425. [PMID: 34306556 PMCID: PMC8275724 DOI: 10.1007/s43465-021-00417-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/05/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate whether local administration of tranexamic acid (TXA) is effective in postoperative blood loss reduction in surgeries for Sanders III-IV calcaneal fractures. METHODS Calcaneal fracture patients who were hospitalized in our hospital from August 2014 to April 2018 and underwent open reduction internal fixation (ORIF) via lateral approach with an L-shaped incision were included in the present study. 53 Patients were randomly divided into three groups, groups A (17), B (17) and C (19). Twenty milliliters of 10 mg/ml and 20 mg/ml TXA solution were perfused into the incision of patients in group A and group B, respectively. Twenty milliliters of saline were perfused into the incision of patients in group C as control. The volume of postoperative drainage, postoperative blood test, coagulation test, and wound complications were analyzed to evaluate the effectiveness of local administration of TXA on blood loss reduction. RESULTS The amount of drainage at 24 and 48 h after the procedure was 110 ± 170, 30 ± 10 ml and 130 ± 160, 20 ± 17 ml for patients in group A and group B, respectively. The corresponding numbers for patients in group C were 360 ± 320, 20 ± 10 ml. The difference between group A and group C was statistically significant, so was the difference between group B and group C. No statistically significant difference was found between group A and group B. Postoperative blood test results revealed that the levels of hemoglobin and hematocrit were significantly higher in group A and group B when each compared to that of group C. In contrast, no difference was found between group A and group B. No significant difference was found between each experimental group and the control group in terms of platelet counts, prothrombin time (P.T.), activated partial prothrombin time (APTT), and wound complications. CONCLUSION Local administration of TXA is effective in the reduction of postoperative blood loss in surgeries for Sanders III-IV types of calcaneal fractures without notably associated side effects.
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Affiliation(s)
- Lang Zhong
- Department of Orthopaedic Surgery, People’s Hospital of Leshan, Shizhong District, Leshan, Sichuan China
| | - Yu Liu
- Department of Orthopaedic Surgery, People’s Hospital of Leshan, Shizhong District, Leshan, Sichuan China
| | - Yongcai Wang
- Department of Orthopaedic Surgery, People’s Hospital of Leshan, Shizhong District, Leshan, Sichuan China
| | - Hongchuan Wang
- Department of Orthopaedic Surgery, People’s Hospital of Leshan, Shizhong District, Leshan, Sichuan China
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24
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The influence of smoking on foot and ankle surgery: a review of the literature. Foot (Edinb) 2021; 46:101735. [PMID: 33168350 DOI: 10.1016/j.foot.2020.101735] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/28/2020] [Accepted: 08/15/2020] [Indexed: 02/04/2023]
Abstract
The effect of tobacco smoking on foot and ankle procedures is likely to be more pronounced when compared to other orthopaedic surgery. This is due to the peripheral nature of the vasculature involved. This paper reviews the current clinical evidence on the effects of smoking foot and ankle surgery. In the trauma setting, the evidence suggests that wound complications and non-unions are significantly higher in the smoking population. In the elective setting there is a significantly increased risk of non-union in ankle and hindfoot arthrodeses in smokers. In the setting of diabetes, ulceration rate in smokers is higher and there may be a higher risk of amputation.
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Morsi IM, Khalifa AA, Hussien MA, Abdellatef A, Refae H. Evaluation of the short-term results of closed reduction and percutaneous K-wires fixation of displaced intra-articular calcaneal fractures (DIACF). Foot (Edinb) 2020; 45:101740. [PMID: 33011495 DOI: 10.1016/j.foot.2020.101740] [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: 04/16/2020] [Revised: 07/06/2020] [Accepted: 08/29/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Optimum management of displaced intra-articular calcaneal fractures (DIACF) still controversial. Open surgery carries the risk of wound complications, while non-operative management has a high incidence of arthrosis. To avoid these complications, minimally invasive and percutaneous fixation was introduced. The purpose of this study was to prospectively evaluate the short term clinical and radiological outcomes after closed reduction and percutaneous fixation of DIACF using K-wires. PATIENTS AND METHODS Outcomes of twenty patients were evaluated at the final follow up. A functional assessment using the AOFAS scoring system. Radiological parameters recorded included three angles (Böhler's, Gissane and posterior facet inclination angles) and three distances (calcaneal length, height and width). Any complications were reported at any follow-up. RESULTS The mean patient's age was 33 ± 15.2 years, 8 (40%) patients with type II fractures, 10 (50%) patients with type III fractures, and 2 (10%) with type IV fracture according to Sanders classification. After a mean follow-up of 9 months, the mean AOFAS score was 84, excellent in 9 patients (45%), good in 9 (45%), and fair in 2 (10%). At the final follow-up the Böhler's angle, Gissane angle and PFIA was 25.1° ± (5.2), 119.9° ± (9.4) and 51.7° ± (5.9) respectively and the calcaneal height, length and width was 41.8 mm ± (2.1), 75.1 mm ± (3.01) and 40.9 mm ± (2.6) respectively. We had no cases of deep infection, 20% had significant subtalar arthritis. CONCLUSION The closed reduction and percutaneous fixation technique for DIACF management offered acceptable clinical and radiographic outcomes, with fewer complications when compared to other management options.
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Affiliation(s)
- Ibrahim Mahmoud Morsi
- Orthopedics and Traumatology Department, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt.
| | - Ahmed A Khalifa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
| | | | - Ahmed Abdellatef
- Orthopedics and Traumatology Department, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt.
| | - Hesham Refae
- Orthopedics and Traumatology Department, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt.
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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: 0.3] [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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27
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Li M, Lian X, Yang W, Ding K, Jin L, Jiao Z, Ma L, Chen W. Percutaneous Reduction and Hollow Screw Fixation Versus Open Reduction and Internal Fixation for Treating Displaced Intra-Articular Calcaneal Fractures. Med Sci Monit 2020; 26:e926833. [PMID: 33147205 PMCID: PMC7650089 DOI: 10.12659/msm.926833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND We investigated the outcomes of displaced intra-articular calcaneal fractures (DIACFs) treated by percutaneous reduction and hollow screw fixation (PRHCF) versus open reduction and internal fixation (ORIF). MATERIAL AND METHODS Seventy-one patients were randomly allocated to group A (by PRHCF) and group B (by ORIF). Operative time, visual analogue scale (VAS) score, time from injury to operation, postoperative hospital stay, preoperative and postoperative radiographic measurements, and complications were recorded. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scores. RESULTS Finally, 59 patients were followed up for at least 12 months (range, 12-24 months). Group A showed significantly more advantages than group B in term of operative time, intraoperative blood loss, time to operation, postoperative hospital stay, and postoperative pain relief during the first 3 days (P<0.001). However, more intraoperative fluoroscopy was required in group A than in group B (P<0.001). The calcaneal width, height, length, Böhler angle, and Gissane angle in each group were significantly improved postoperatively (all P<0.001), although not significantly different in the postoperative comparisons between both groups. The AOFAS scores were slightly superior in group A than in group B (88.3 vs. 86.4, P=0.08). The rate of incidence of postoperative complications was lower in group A than in group B (3.2% vs. 10.8%, respectively; OR, 0.28, 95% CI, 0.03 to 2.84), although there was no significant difference (P=0.337). CONCLUSIONS PRHCF showed comparable clinical and radiological outcomes as ORIF, demonstrating it is a safe and effective alternative in treating DIACFs.
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Affiliation(s)
- Ming Li
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Xiaodong Lian
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Weijie Yang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Kai Ding
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Lin Jin
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Zhenqin Jiao
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Lijie Ma
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, China (mainland)
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Li Z, Wu X, Zhou H, Xu S, Xiao F, Huang H, Yang Y. Cost-utility analysis of extensile lateral approach versus sinus tarsi approach in Sanders type II/III calcaneus fractures. J Orthop Surg Res 2020; 15:430. [PMID: 32948240 PMCID: PMC7501640 DOI: 10.1186/s13018-020-01963-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Extensile lateral approach had been recognized as the gold standard technique for displaced intra-articular calcaneus fractures (DIACFs) while sinus tarsi approach had been increasingly valued by surgeons and comparative clinical outcome was shown in both techniques. Appropriate decisions could be made by the clinicians with the help of cost-utility analysis (CUA) about optimal healthcare for type II/III calcaneus fracture. Method A single-center, retrospective study was conducted in which basic characteristics, clinical outcomes, and health care costs of 109 patients had been obtained and analyzed. Changes in health-related quality of life (HRQoL) scores, validated by EuroQol five-dimensional-three levels (EQ-5D-3L), were used to enumerate quality-adjusted life years (QALYs). Cost-effectiveness was determined by the incremental cost per QALY. Results One hundred nine patients were enrolled in our study including 62 in the ELA group and 47 in the STA group. There were no significant differences between these two groups in mean total cost, laboratory, and radiographic evaluation expense, surgery, anesthesia, and antibiotic expense. The expense of internal fixation materials ($3289.0 ± 543.9) versus ($2630.6 ± 763.7) and analgesia ($145.8 ± 85.6) versus ($102.9 ± 62.7) in ELA group were significantly higher than in the STA group (P < .001, P = .008, respectively). Visual Analogue Scale (VAS) scores showed significant difference at postoperative 3 and 5 days (P < .001). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and the Bohlers’ and Gissane angle showed no significant differences between the two groups before and after the operation. The cost-effectiveness ratios of ELA and STA were $8766.8 ± 2835.2/QALY and $7914.9 ± 1822.0/QALY respectively, and incremental cost-effectiveness ratio (ICERs) of ELA over STA was $32110.00/QALY, but both showed no significant difference. Conclusion Both ELA and STA techniques are effective operative procedures for the patients with calcaneus fracture. Moreover, STA seems to be more reasonable for its merits including less postoperative pain, and less expense of analgesia as well as internal fixation materials. Level of evidence 5
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Affiliation(s)
- Zihua Li
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Xinbo Wu
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Haichao Zhou
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Shaochen Xu
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Fajiao Xiao
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Hui Huang
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Yunfeng Yang
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
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Allegra PR, Rivera S, Desai SS, Aiyer A, Kaplan J, Gross CE. Intra-articular Calcaneus Fractures: Current Concepts Review. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420927334. [PMID: 35097384 PMCID: PMC8564939 DOI: 10.1177/2473011420927334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures include intra-articular involvement of the posterior facet of the calcaneus. Intra-articular calcaneal fractures are challenging injuries to manage for both patients and surgeons given their association with both early and late complications. This article aims to review the management, classification systems, surgical approaches, and care regarding intra-articular calcaneal fractures. A review of the current literature yielded treatment strategies that aim to reduce complications such as soft tissue injury or loss of articular reduction while maintaining satisfactory clinical outcomes. The purpose of this article is to review these current concepts in the management of intra-articular calcaneal fractures. Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Paul R Allegra
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sebastian Rivera
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sohil S Desai
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Amiethab Aiyer
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jonathan Kaplan
- Miller School of Medicine, University of Miami, Miami, FL, USA
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Akalin Y, Cansabuncu G, Çevik N, Avci Ö, Akinci O, Öztürk A. An evaluation of the results of locked plate osteosynthesis applied without the use of bone graft in Sanders type III and IV intra-articular calcaneus fractures. INTERNATIONAL ORTHOPAEDICS 2020; 44:2753-2760. [PMID: 32676777 DOI: 10.1007/s00264-020-04691-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The clinical and radiological results of locked plate osteosynthesis with an extensive lateral approach without bone graft in Sanders type III and IV intra-articular calcaneus fractures and the factors affecting these results were evaluated retrospectively. METHODS A total of 61 patients with Sanders type 3 and 4 calcaneus fractures who underwent a lateral approach with locked plate osteosynthesis were included in the study. The mean follow-up was 44.8 months. RESULTS The mean pre- and post-operative Gissane and Bohler's angles were 113.5° ± 13.9° and 106.7° ± 13.6° (p = 0.006) and 2.8° ± 14.1° and 19.6° ± 13.1° (p < 0.001), respectively. The mean post-operative AOFAS scores, SF-36, and Maryland were 80.5 ± 13.6 in type IIIAB, 89.4 ± 6.3 in IIIAC, and 82.4 ± 12.5 in IV; 58.6 ± 14.5 in type IIIAB, 60.3 ± 11.7 in IIIAC, and 58.0 ± 15.6 in IV; and 63.8 ± 7.2 in type IIIAB, 64.3 ± 7.1 in IIIAC, and 62.8 ± 11.7 in IV (p = 0.173, p = 0.932, p = 0.824, respectively). Wound problems were observed in 15 (28.6%) patients. Deep infection was not observed in any patient. CONCLUSION The clinical results were similar in type III and IV intra-articular calcaneus fractures applied with locked plate osteosynthesis in an extensive lateral approach and without the use of bone graft. Intra-articular calcaneus fracture fixation with a lateral locked plate is an effective treatment method.
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Affiliation(s)
- Yavuz Akalin
- Department of Orthopedics and Traumatology, Bursa Yüksek Ihtisas Training and Research Hospital, Health Sciences University, 16300, Yıldırım, Bursa, Turkey.
| | - Gökhan Cansabuncu
- Department of Orthopedics and Traumatology, Turkish Ministry of Health Bartın State Hospital, 74000, Bartın, Turkey
| | - Nazan Çevik
- Department of Orthopedics and Traumatology, Bursa Yüksek Ihtisas Training and Research Hospital, Health Sciences University, 16300, Yıldırım, Bursa, Turkey
| | - Özgür Avci
- Department of Orthopedics and Traumatology, Bursa Yüksek Ihtisas Training and Research Hospital, Health Sciences University, 16300, Yıldırım, Bursa, Turkey
| | - Orhan Akinci
- Department of Orthopedics and Traumatology, Izmir Dr. Suat Zeren Chest Disease and Surgery Training and Research Hospital, Health Sciences University, 35110, Yenişehir, Izmir, Turkey
| | - Alpaslan Öztürk
- Department of Orthopedics and Traumatology, Bursa Yüksek Ihtisas Training and Research Hospital, Health Sciences University, 16300, Yıldırım, Bursa, Turkey
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Jianchuan W, Song Q, Tienan W, Zongpu W, Chongjun X, Dewei Z. Calcaneus traction compression with orthopaedic reduction forceps combined with percutaneous minimally invasive treatment of intra-articular calcaneal fractures: An analysis of efficacy. Biomed Pharmacother 2020; 128:110295. [PMID: 32554224 DOI: 10.1016/j.biopha.2020.110295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The treatment of displaced calcaneal fractures is controversial.Open reduction and internal fixation are widely described as the gold standard in the literature,but these technique shave many complications,including skin necrosis,internal fixation leakage and deep infection and wound healing problems.Percutaneous reduction and unilateral external fixation have received increasing attention because they can provide a good, stable reduction and reduce the soft tissue complications caused by open surgery(such as deep infection and delayed wound healing).The purpose of this retrospective study was to evaluate the reduction imaging and clinical results of calcaneus traction compressionwith orthopaedic compression reduction forceps combined with percutaneous minimally invasive external fixation for intra-articular calcaneal fractures. METHODS This was a retrospective analysis. A total of 35 patients with unilateral calcaneal fractures were divided into two groups: 1) the open reduction, internal fixation group (19 feet)and 2) the percutaneous minimally invasive, closed reduction external fixation group (16 feet).Evaluation of the reduction include dimaging measurements of the calcaneus length,width,and height,and the Bohler angle and Gissane angle before and after surgery.Clinical outcomes included the time of surgery,length of hospital stay,operation time,wound-related complications,the American Orthopaedic Foot and Ankle Society hindfoot score,the visual analogue score for pain, and the SF-36 score. RESULTS The average follow-up time was 25.52 ± 1.68 months.There was no significant difference in reduction between the open group and the closed group (P > 0.05).The operation time of the open group was significantly longer than that of the closed group(P = 0.0001).The length of hospitalization and waiting time for surgery in the open reduction group were significantly longer than those in the closed reduction group (P < 0.05).Incidence-related complications in the open group and closed group were 21.1 %(4/19) and 6.3 %(1/16),respectively (P = 0.0001).The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores in the open and closed groups were 81.35 ± 5.25 and 82.52 ± 4.78, respectively (P = 0.0875). The visual analogues cale (VAS) scores of the open group and the closed group were 1.81 ± 1.32 and 0.78 ± 0.91, respectively (P = 0.0412).The SF-36 scores were 80 ± 4.5 and 79 ± 4.2, respectively. CONCLUSION Our research shows that for various types of intra-articular calcaneal fractures compared with open reduction,internal plate fixation,calcaneus traction compression with orthopaedic reduction forceps combined with percutaneous minimally invasive external fixation is a simple and effective method for treating calcaneal fractures; not only can the calcaneus be corrected, but it can also provide notable imaging and clinical results.
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Affiliation(s)
- Wang Jianchuan
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Qin Song
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China.
| | - Wang Tienan
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Wang Zongpu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Xia Chongjun
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Zhao Dewei
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
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Percutaneous reduction and screw fixation for all types of intra-articular calcaneal fractures. Musculoskelet Surg 2020; 105:97-103. [PMID: 31907753 DOI: 10.1007/s12306-019-00635-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study compares the outcomes of consecutive of patients with Sanders II and III and IV calcaneal fractures that were stabilized by either close reduction and internal fixation (CRIF) or open reduction and internal fixation (ORIF). MATERIALS AND METHODS Group I (N = 49) underwent close reduction internal fixation (CRIF). Group II (N = 39) underwent open reduction internal fixation (ORIF). The clinical outcomes included time to operation, operative duration, visual analog score (VAS), length of hospital stay, wound-related complications and AOFAS SF-36 score. Preoperative and postoperative radiographic measures also were compared. RESULTS The duration of operation in the CRIF group was considerably shorter than in ORIF group (P = 0.0001). Postoperatively, at seventh day, the VAS in the CRIF group (4.2 ± 1.1) was meaningfully lower than those of the ORIF patients group (4.7 ± 1.2, P = 0.04). Totally, the prevalence of wound complications in CRIF group was significantly lower than in ORIF group. In final follow-up visit after one year, AOFAS scores and SF-36 scores between groups were comparable. Comparable radiographic measures were found in both groups. There was no significant difference between groups regarding preoperative radiographic measures (P > 0.05), while in postoperative imaging acceptable calcaneal fracture reduction was found in both groups. CONCLUSION We believed that for treatment of various types of calcaneal fracture compared with ORIF the percutaneous reduction and screw fixation may lead to shorter hospital stay, decreased subtalar joint stiffness and earlier weight bearing along with much favorable patients' satisfaction.
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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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Nosewicz TL, Dingemans SA, Backes M, Luitse JSK, Goslings JC, Schepers T. A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures. Foot Ankle Surg 2019; 25:580-588. [PMID: 30321924 DOI: 10.1016/j.fas.2018.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/26/2018] [Accepted: 08/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal surgical approach for displaced intra-articular calcaneal fractures (DIACF) is subject of debate. The primary aim of this systematic review and meta-analysis was to assess wound-healing complications following the sinus tarsi approach (STA) compared to the extended lateral approach (ELA). Secondary aims were to assess time to surgery, operative time, calcaneal anatomy restoration, functional outcome, implant removal and injury to the peroneal tendons and sural nerve. METHODS MEDLINE, EMBASE and Cochrane databases were searched for clinical studies comparing the STA and the ELA (until September 2017). RESULTS Nine studies were included (two randomized controlled trials; seven comparative studies). 326 patients (331 fractures) were treated by the STA and 383 patients (390 fractures) by ELA. Ninety-nine per cent were Sanders type II/III fractures. Wound healing complications in the STA and ELA occurred in 11/331 and 82/390 fractures, respectively. Weighted means were 4.9% and 24.9%, respectively. Meta-analysis showed significantly less wound healing complications in the STA compared to ELA (risk ratio 0.20; 95% CI 0.11-0.36; P<0.00001; I2=0%). In general, time to surgery and operative time were shorter in the STA. Meta-analysis was not possible due to heterogeneity between studies. No differences were found in remaining secondary outcomes. CONCLUSIONS The STA is associated with significantly less wound healing complications. With similar functional outcome and calcaneal anatomy restoration, the STA may be the preferred approach in the operative treatment of Sanders type II/III DIACF.
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Affiliation(s)
- Tomasz L Nosewicz
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Siem A Dingemans
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Manouk Backes
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Jan S K Luitse
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Tim Schepers
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Fascione F, Di Mauro M, Guelfi M, Malagelada F, Pantalone A, Salini V. Surgical treatment of displaced intraarticular calcaneal fractures by a minimally invasive technique using a locking nail: A preliminary study. Foot Ankle Surg 2019; 25:679-683. [PMID: 30321926 DOI: 10.1016/j.fas.2018.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/03/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate the outcome of patients with intra-articular calcaneal fractures treated using a minimally invasive locking nail (Calcanail®). METHODS Between January 2016 and April 2017, 15 patients (9 men and 6 women) with a calcaneal fracture were consecutively treated with Calcanail®. The Böhler angle was recorded on standard X-rays pre- and post-operatively. The articular reduction of the posterior facet was evaluated with the Goldzak index in a CT scan 3 months post-operatively. The mean age of the patients was 53 years (range, 24-78). Mean final follow-up was 18 months (range, 12-24). RESULTS Six fractures were classified as Sanders II, 7 as Sanders III and 2 as Sanders IV. In 13 out of the 15 patients treated, the post-operative Böhler angle was of more than 20°. Goldzak index was deemed as excellent in 73.5% of the cases (11 patients), good in 20% of cases (3 patients), and poor in 6.5% (1 patient). Post-operative mean AOFAS score was 85 (range, 60-96). CONCLUSIONS The Calcanail® provides good restoration of the subtalar joint and the calcaneal angles with the advantages of a minimally invasive approach. It was effectively used in Sanders types II and III, even in the presence of poor cutaneous conditions.
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Affiliation(s)
- Fabrizio Fascione
- Orthopaedic and Traumatology Unit, Department of Medicine and Science of Aging, University G. "d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Michele Di Mauro
- Orthopaedic and Traumatology Unit, Department of Medicine and Science of Aging, University G. "d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Matteo Guelfi
- Orthopaedic and Traumatology Unit, Department of Medicine and Science of Aging, University G. "d'Annunzio" of Chieti-Pescara, Chieti, Italy; Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy.
| | - Francesc Malagelada
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Andrea Pantalone
- Orthopaedic and Traumatology Unit, Department of Medicine and Science of Aging, University G. "d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Vincenzo Salini
- Orthopaedic and Traumatology Unit, Department of Medicine and Science of Aging, University G. "d'Annunzio" of Chieti-Pescara, Chieti, Italy
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Vicenti G, Carrozzo M, Solarino G, Caizzi G, De Crescenzo A, Portaluri M, Mori CM, Vittore D, Moretti B. Comparison of plate, calcanealplasty and external fixation in the management of calcaneal fractures. Injury 2019; 50 Suppl 4:S39-S46. [PMID: 31133288 DOI: 10.1016/j.injury.2019.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Managing displaced intra-articular calcaneal fractures remains controversial. The purpose of this study is to compare and identify the surgical technique with the best outcomes for the treatment of intra-articular calcaneal fractures. MATERIALS AND METHODS This is a retrospective multicentric study conducted between February 2000 and June 2014 in 206 patients with intra-articular calcaneal fractures presenting to the outpatient or emergency department of three different orthopaedic departments. The patients were treated with one of the following techniques: 1. Open reduction and internal fixation with screws and plate; 2. Percutaneous reduction and monolateral external fixation; and 3. Balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation. RESULTS Patients treated with open reduction and internal fixation using an extensive lateral approach had a mean AOFAS score of 71 points; those treated through a minimal incision and reduction and fixation with an external fixator had a mean score of 83.1 points; and those treated with the balloon-assisted reduction, pin fixation and tricalcium phosphate augmentation had a mean score of 78.75 points. No statistically difference was found comparing the three types of treatment. CONCLUSION Displaced intra-articular calcaneal fractures are still technically demanding injuries to manage. The results of this study suggest that in comparison to open reduction, a percutaneous reduction and fixation leads to higher but not statistical functional scores minimizing the wound-healing 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.
| | - 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
| | - 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
| | - 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
| | - Mauro Portaluri
- Department of Orthopaedics and Traumatology, Sacro Cuore di Gesù Hospital, Gallipoli, Italy
| | - Claudio Maria Mori
- 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
| | - Donato Vittore
- 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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Herlyn A, Brakelmann A, Herlyn PK, Gradl G, Mittlmeier T. Calcaneal fracture fixation using a new interlocking nail reduces complications compared to standard locking plates - Preliminary results after 1.6 years. Injury 2019; 50 Suppl 3:63-68. [PMID: 31378540 DOI: 10.1016/j.injury.2019.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical treatment of displaced intra-articular calcaneal fractures using a standard extended lateral approach for plate fixation is frequently associated with substantial wound healing complications and infections. This matched pairs analysis compares the new minimally-invasive calcaneal interlocking nailing technique to standard locking plate fixation in terms of reduction capacity, complication rates, and functional outcomes. METHODS Forty feet in 38 patients (mean patient age 52.5 years, range 27-78) were treated with calcaneal locking nail (LN)(n=20) or locking plate (LP)(n=20) and followed clinically and radiologically for 20 months. Follow-up included radiological assessments and functional evaluations including the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Foot Function Index (R-FFI). RESULTS Times for surgery were similar for both techniques (LN 93min, range 34 to 175 vs. LP 101min, range 53 to 305). Length of hospital stay was significantly lower in the LN group (7.6 days, range 3 to 14 vs. LP 11 days, range 6 to 37). Time away from work was shorter by 3.5 days in LN group. LP group had superior range of motion in plantarflexion, eversion, and inversion at follow-up, while LP patients were superior in demonstrating a secure heelstrike (79% vs. LN 58%) and fewer needed permanent walking aids. AOFAS and FFI scores revealed no differences for both groups. Radiographs indicated an adequate reconstruction in both groups, followed by a slight loss of reduction at follow-up (LP 4.7° postoperative vs. follow-up; LN 5.1°). The overall complication rate between groups was significant with 5% complications in the LN group vs. 50% in the LP group (5% deep infection, 35% impaired wound healing, 5% hardware breakage, 5% superficial wound infection; LN: 5% superficial wound infection). CONCLUSIONS The new calcaneal interlocking nail shows promising results in terms of reduction capacity and safety. Use of the minimally invasive locking nail technique minimized the risk of postoperative wound complications and achieved superior functional outcomes compared with standard locking plate fixation via the extended lateral approach.
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Affiliation(s)
- Anica Herlyn
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany.
| | - Anna Brakelmann
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany
| | - Philipp Ke Herlyn
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany
| | - Georg Gradl
- Dept. of Trauma, Orthopedic and Reconstructive Surgery, Klinikum München Harlaching, Sanatoriumsplatz 2, D-81545 München, Germany
| | - Thomas Mittlmeier
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany
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Abstract
Objective This study was performed to analyze the outcomes of calcaneal fractures using a minimally invasive internal fixation method with a thin plate and bone grafting. Methods This retrospective analysis included 21 patients treated using our minimally invasive approach. The outcome measures were the change in the Bohler and Gissane angles and the calcaneus width after fixation. The clinical outcomes were evaluated by the Maryland foot scoring system and assessment of soft tissue complications. Results The follow-up time was 12 to 18 months. The Bohler angle, Gissane angle, and width of the calcaneus were significantly different between the preoperative and postoperative periods. The rate of excellent and good outcomes was 85.7% according to the Maryland foot scoring system. The incidence of soft tissue complications was 14.3%. Conclusion Treatment of calcaneal fractures using a minimally invasive internal fixation method with a plate and bone grafting provides good to excellent clinical outcomes with few soft tissue complications.
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Affiliation(s)
- Guangming Zhang
- Orthopedics Department, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shenglong Ding
- Orthopedics Department, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiyong Ruan
- Orthopedics Department, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
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Buzzi R, Sermi N, Soviero F, Bianco S, Campanacci DA. Displaced intra-articular fractures of the calcaneus: ORIF through an extended lateral approach. Injury 2019; 50 Suppl 2:S2-S7. [PMID: 30770121 DOI: 10.1016/j.injury.2019.01.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Displaced intra-articular calcaneal fractures (DIACF) represent a challenging and controversial issue in traumatology. Conservative treatment has been recommended to avoid surgical problems and complications. The final result, however, is often a painful malunioun of the calcaneus with peroneal impingement. Surgical treatment is gaining acceptance since it offers a chance to restore bone anatomy improving function as long as complications are avoided. MATERIAL AND METHOD We reviewed a series of 59 DIACF treated by a single surgeon during a 9 years period. A clinical and radiological follow-up was obtained in 44 cases (74,6%) (average of 5,5 years; range 2-9). There were 29 males and 15 females with an average age of 54 years (range 25-74). Patients were operated through an extended l-shaped lateral approach and fixation was achieved with lag screws and plate. Outcome measures method included the AOFAS score, the Maryland Foot Score, the Foot Function Index and the SF-36. RESULTS The average AOFAS score was 80,5 points. The result was excellent in 18 cases (40,9%), good in 14 cases (31,8%), fair in 10 cases (22,7%) and poor in 2 (4,6%). The mean score for pain was 33,5/40 points, for function 40/50 and for alignment 7/10. Pain was absent in 17 cases (38%), 19 patients (43%) had no functional limitations and 11 (25%) could walk on uneven ground without difficulties. The average FFI score was 25/100 points. The average MFS score was 89/100 points. Subtalar motion was reduced. Reconstruction of the calcaneus was anatomic in 20 cases (45,5%) with an improved clinical outcome. Eight patients (17%) had minor wound healing complications. Three patients (6,8%) required a subtalar arthrodesis after the procedure. CONCLUSIONS Ostheosytesis through an extended lateral approach restored bone morphology with a reasonable complications rate. The clinical results were good but a normal function and complete subtalar motion were rarely achieved.
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Affiliation(s)
- Roberto Buzzi
- Department of Traumatology and General Orthopedics, Azienda Ospedaliera Universitaria Careggi, Largo P. Palagi 1, 50134, Firenze, Italy
| | - Niccolò Sermi
- Department of Traumatology and General Orthopedics, Azienda Ospedaliera Universitaria Careggi, Largo P. Palagi 1, 50134, Firenze, Italy
| | | | - Stefano Bianco
- Department of Traumatology and General Orthopedics, Azienda Ospedaliera Universitaria Careggi, Largo P. Palagi 1, 50134, Firenze, Italy
| | - Domenico A Campanacci
- Department of Orthopedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo P. Palagi 1, 50134 Firenze, Italy.
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Sinus Tarsi Approach with Subcutaneously Delivered Plate Fixation for Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:225-231. [PMID: 30784533 DOI: 10.1016/j.cpm.2018.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Displaced intra-articular calcaneal fractures can be treated with open reduction and internal fixation through various methods, including the extensile lateral approach, sinus tarsi approach, percutaneous reduction and fixation, external fixation, and calcaneoplasty. Although the gold standard is the extensile lateral approach, this method has significant wound-healing complications associated with it. Literature shows that the reduction achieved through minimally invasive techniques is equal to that achieved with the extensile lateral approach, while reducing the amount of postoperative complications. This article outlines a technique that uses the sinus tarsi approach with subcutaneous plate fixation.
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Jandova S, Pazour J, Janura M. Comparison of Plantar Pressure Distribution During Walking After Two Different Surgical Treatments for Calcaneal Fracture. J Foot Ankle Surg 2019; 58:260-265. [PMID: 30658959 DOI: 10.1053/j.jfas.2018.08.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Indexed: 02/03/2023]
Abstract
The aim of our study was to compare gait in terms of foot loading and temporal variables after 2 different operative approaches (the extended lateral approach [ELA] and sinus tarsi approach). Twenty-two patients who sustained an intra-articular calcaneal fracture underwent plantar pressure distribution measurements 6 months after surgery. Measurements were performed while patients walked on the pedobarography platform. The values of dynamic variables were significantly lower on the operated limb in the ELA. In the sinus tarsi approach, no differences were observed between the operated and uninjured limbs (UIN) at peak pressure and at maximal vertical force. The values of temporal variables (contact time of the foot and of the heel) between the operated and UIN differed in the ELA. The hypothesis that differences in foot load between operated and UIN will be more significant in the ELA was confirmed. Our results showed that the differences in loading and temporal variables between the operated and the UIN persisted 6 months after surgery in both methods. The operated limb was less loaded, with the tendency to shift the load toward the midfoot and forefoot. After the less invasive sinus tarsi approach, the dynamic and temporal variables on the operated limb were nearly the same as those on the healthy one. The sinus tarsi surgical approach can be recommended for treatment of displaced calcaneal fractures.
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Affiliation(s)
- Sona Jandova
- Associate Professor, Technical University of Liberec, Liberec, Czech Republic.
| | - Jan Pazour
- Surgeon, Traumacenter, Liberec Regional Hospital, Liberec, Czech Republic
| | - Miroslav Janura
- Professor, Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
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Bellaaj Z, Aloui I, Othman Y, Koubaa M, Zrig M, Abid A. The place of the modified palmer technique for articular calcaneal fractures. ARCHIVES OF TRAUMA RESEARCH 2019. [DOI: 10.4103/atr.atr_79_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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A minimally invasive (sinus tarsi) approach with percutaneous K-wires fixation for intra-articular calcaneal fractures in children. J Pediatr Orthop B 2018; 27:556-562. [PMID: 30113912 PMCID: PMC6166695 DOI: 10.1097/bpb.0000000000000532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of this study was to analyze the management of displaced intra-articular calcaneal fractures in children at our pediatric orthopedic and to determine the results following open reduction via minimally invasive sinus tarsi approach and fixation with Kirschner wires (K-wires). Overall, 25 available cases of calcaneal fractures in children with mean age of 9.8 years were treated by open reduction from January 2010 to December 2015. All patients were followed up from 12 to 30 months (mean: 19 months). Clinical functional outcomes were graded using the American Orthopedic Foot and Ankle Society hindfoot scores. Radiographic evaluation included measurement of the Bohler's angle and Gissane's angle of the calcaneus on the lateral view. All fractures healed within 3 months. According to the American Orthopedic Foot and Ankle Society foot scoring system, the mean scores of type II fractures were 92.7±2.1, type III 90.2±1.8, and type IV 89.7±2.7 at the latest follow-up. The preoperative and postoperative Bohler's angles were 17.1°±10.7° and 35.9°±6.7° in Sanders type II fractures, 14.4°±11.5° and 34.7°±8.5° in type III, 9.3°±9.7° and 35.1°±4.9° in type IV, respectively. The preoperative and postoperative Gissane's angles were 102.6°±11.5° and 125.7°±7.8° in Sanders type II fractures, 101.7°±9.1° and 117.5°±10.8° (P<0.05) in type III, and 104.7°±5.1° and 122.8°±9.1° (P<0.05) in type IV, respectively. No secondary arthrosis has been observed so far. No deep infection and wound necrosis occurred. One patient had superficial infection around K-wires that was managed using dressings. Treatment of calcaneal fractures in children by open reduction by sinus tarsi approach and K-wires fixation is a safe and effective method with low incidence of complications.
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Macdonald J, Kelly G, McCaffrey D. A CALCANEUS FRACTURE WITH INTERPOSED FLEXOR HALLUCIS LONGUS TENDON; A SURGICAL TIP TO AID TENDON REDUCTION. THE ULSTER MEDICAL JOURNAL 2018; 87:201-202. [PMID: 31061547 PMCID: PMC6500420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- J. Macdonald
- Correspondence to: J Macdonald, Altnagelvin Area Hospital, Northern Ireland, E-mail:
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Majeed H, Barrie J, Munro W, McBride D. Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures: A systematic review of the literature. EFORT Open Rev 2018; 3:418-425. [PMID: 30233817 PMCID: PMC6129959 DOI: 10.1302/2058-5241.3.170043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this article is to systematically identify and analyse research evidence available to compare the outcomes of minimally invasive reduction and percutaneous fixation (MIRPF) versus open reduction and internal fixation (ORIF) for displaced intra-articular calcaneal fractures. Articles from 2000 to 2016 were searched through MEDLINE (PubMed), Cochrane Library, Embase, ScienceDirect, Scopus and ISI Web of Knowledge using Boolean logic and text words. Of the 570 articles identified initially, nine were selected including three randomized controlled trials and six retrospective comparative studies. All nine studies had a total of 1031 patients with 1102 displaced intra-articular calcaneal fractures. Mean follow-up was 33 months. Of these, 602 (54.6%) were treated with MIRPF and 500 (45.4%) were treated with ORIF. Overall incidence of wound-related complications in patients treated with MIRPF was 4.3% (0% to 13%) compared with 21.2% (11.7% to 35%) in the ORIF group Functional outcomes were reported to be better in the minimally invasive group in all studies; however, the results did not reach statistical significance in some studies. All the studies had methodological flaws that put them at either ‘unclear’ or ‘high’ risk of bias for multiple domains. Overall quality of the available evidence is poor in support of either surgical technique due to small sample size, flaws in study designs and high risk of bias for various elements. Individual studies have reported minimally invasive techniques to be an effective alternative with lower risk of wound complications and better functional outcomes.
Cite this article: EFORT Open Rev 2018;3:418-425. DOI: 10.1302/2058-5241.3.170043
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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: 0.5] [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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Abstract
The best treatment for displaced, intraarticular fractures of the calcaneum remains controversial. Surgical treatment of these injuries is challenging and have a considerable learning curve. Studies comparing operative with nonoperative treatment including randomized trials and meta-analyses are fraught with a considerable number of confounders including highly variable fracture patterns, soft-tissue conditions, patient characteristics, surgeon experience, limited sensitivity of outcome measures, and rehabilitation protocols. It has become apparent that there is no single treatment that is suitable for all calcaneal fractures. Treatment should be tailored to the individual fracture pathoanatomy, accompanying soft-tissue damage, associated injuries, functional demand, and comorbidities of the patient. If operative treatment is chosen, reconstruction of the overall shape of the calcaneum and joint surfaces are of utmost importance to obtain a good functional result. Despite meticulous reconstruction, primary cartilage damage due to the impact at the time of injury may lead to posttraumatic subtalar arthritis. Even if subtalar fusion becomes necessary, patients benefit from primary anatomical reconstruction of the hindfoot geometry because in situ fusion is easier to perform and associated with better results than corrective fusion for hindfoot deformities in malunited calcaneal fractures. To minimize wound healing problems and stiffness due to scar formation after open reduction and internal fixation (ORIF) through extensile approaches several percutaneous and less invasive procedures through a direct approach over the sinus tarsi have successfully lowered the rates of infections and wound complications while ensuring exact anatomic reduction. There is evidence from multiple studies that malunited displaced calcaneal fractures result in painful arthritis and disabling, three-dimensional foot deformities for the affected patients. The poorest treatment results are reported after open surgical treatment that failed to achieve anatomic reconstruction of the calcaneum and its joints, thus combining the disadvantages of operative and nonoperative treatment. The crucial question, therefore, is not only whether to operate or not but also when and how to operate on calcaneal fractures if surgery is decided.
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Affiliation(s)
- Stefan Rammelt
- University Center for Orthopaedics and Traumatology, University Hospital Carl-Gustav Carus, Dresden, Germany,Address for correspondence: Prof. Stefan Rammelt, University Center for Orthopaedics and Traumatology, University Hospital Carl-Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany. E-mail:
| | - Bruce J Sangeorzan
- Department of Orthopedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
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Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T. Review article: Best practice management of common ankle and foot injuries in the emergency department (part 2 of the musculoskeletal injuries rapid review series). Emerg Med Australas 2017; 30:152-180. [PMID: 29235235 DOI: 10.1111/1742-6723.12904] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 09/26/2017] [Indexed: 12/16/2022]
Abstract
Ankle and foot injuries are the most common musculoskeletal injuries presenting to Australian EDs and are associated with a large societal and economic impact. The quality of ED care provided to patients with ankle and foot fractures or soft tissue injuries is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common ankle and foot injuries in the ED. Databases including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. Primary studies, systematic reviews and guidelines were considered for inclusion. English language articles published in the last 12 years that addressed the acute assessment, management or prognosis in the ED were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 1242 articles, of which 71 were included in the review (n = 22 primary articles, n = 35 systematic reviews and n = 14 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the ankle and foot in the ED a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. Following a thorough history and physical examination, including the application of the Ottawa ankle rules, ED clinicians should not only provide a diagnosis, but rate the severity of soft tissue injuries, or stability of fractures and dislocations, which are the pivotal decision points in guiding ED treatment, specialist referral and the follow-up plan.
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Affiliation(s)
- Kirsten Strudwick
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Megan McPhee
- Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Anthony Bell
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Wei N, Yuwen P, Liu W, Zhu Y, Chang W, Feng C, Chen W. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: A meta-analysis of current evidence base. Medicine (Baltimore) 2017; 96:e9027. [PMID: 29245290 PMCID: PMC5728905 DOI: 10.1097/md.0000000000009027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The relative efficacy of operative and nonoperative treatments for the displaced intra-articular calcaneal fractures (DIACF) remains uncertain. OBJECT We conducted a meta-analysis to compare the effectiveness of operative and nonoperative treatments in treating patients with DIACF. METHODS Databases including Cochrane Library, Medline, Embase, CBM, CNKI, and Google Scholar were searched. After independent study selection by 2 authors, data were extracted and collected independently. Comparisons were performed between operative treatment group and nonoperative treatment group. The quality of included studies was assessed using the Newcastle-Ottawa Scale. RevMan 5.3 was used for data analysis. The primary outcome measures were anatomical measures (changes in Böhler angle and calcaneal height and width), functional measures (shoe problems, resuming preinjury work, and residual pain), and complications (including superficial and deep wound infection, skin flap necrosis, neurovascular injury, secondary arthrodesis, reflex sympathetic dystrophy, osteotomy, thromboembolism, and compartment syndromes). RESULTS Eighteen trials (8 randomized controlled trials and 10 controlled clinical trials) including 1467 patients were considered. For anatomical measurements, the overall mean differences (MDs) for the mean Böhler angle, calcaneal height and width were 15.39 (95% confidence interval [CI] 9.12-21.67), 6.55 (95% CI 2.67-10.43), and 7.05 (95% CI -7.83 to -6.27), respectively. In functional measures, the overall effect MD of American Orthopedic Foot and Ankle Society was 6.23 (95% CI 5.22-17.67) and 0.38 (95% CI 0.22-0.67). The overall relative risks (RRs) of wearing shoes, resuming preinjury work, and having residual pain were 0.32 (95% CI 0.32-1.00), 0.56 (95% CI 0.40-0.77), and 0.90 (95% CI 0.68-1.20), respectively. The overall RR of the incidence of complications was 2.00 (95% CI 1.51-2.64). CONCLUSION Operative treatment of DIACF may lead to a higher incidence of complications but has better anatomical recovery when compared with nonoperative treatment.
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Wei N, Zhou Y, Chang W, Zhang Y, Chen W. Displaced Intra-articular Calcaneal Fractures: Classification and Treatment. Orthopedics 2017; 40:e921-e929. [PMID: 29116324 DOI: 10.3928/01477447-20170907-02] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/24/2017] [Indexed: 02/03/2023]
Abstract
The calcaneus is the most commonly fractured tarsal bone. Displaced intraarticular calcaneal fractures are usually caused by a fall from height with one or both heels directly hitting the ground. Displaced intra-articular calcaneal fractures are complex and highly disabling injuries. There is ongoing debate regarding the optimal treatment for each type of displaced intra-articular calcaneal fracture. This review aims to summarize the classification of, various treatment options for, prevention of perioperative complications in, and management algorithms for displaced intra-articular calcaneal fractures. [Orthopedics. 2017; 40(6):e921-e929.].
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