1
|
Pang J, Hussain A, Yan M, Kapur K, Solomou G, Brassett C, Pasapula C, Norrish AR. The cadaveric research model for calcaneus fractures: A scoping review of biomechanical, anatomical, radiographic and fracture fixation studies. Foot (Edinb) 2024; 59:102085. [PMID: 38493665 DOI: 10.1016/j.foot.2024.102085] [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: 07/11/2022] [Accepted: 03/10/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Calcaneal fractures remain a big challenge in orthopaedic surgery and lead to long lasting disabilities. Cadaveric research plays an important role in determining optimal fracture treatment. This scoping review aims to provide insight into cadaveric research that has been conducted on calcaneal fractures, including biomechanics, fixation, approaches and radiographic studies. METHODOLOGY A search strategy was created and implemented as per PRISMA guidance. 3 databases, Medline, Embase and Scopus, were used when conducting this review. RESULTS 484 individual studies were retrieved across the 3 databases, of which 186 duplicates were excluded. Study abstracts were individually reviewed, of which 208 studies were excluded in accordance with study criteria. 90 papers were sought for retrieval, of which 83 full text papers were successfully retrieved. Of the full papers retrieved, 22 did not meet our inclusion criteria, and 19 papers related only to talus fractures. In the end, 43 cadaveric studies pertaining to this scoping review were included and reviewed. DISCUSSION Studies were grouped into biomechanical, anatomical, fixation and radiographic studies for review. CONCLUSION Evaluation of current cadaveric studies pertaining to calcaneal fractures has allowed greater insight into the myriad challenges in the management of these injuries. Effects of intra-articular fractures on calcaneal biomechanics assist in establishing surgical goals. Whilst fixation studies showing good stability of nail fixations could encourage further development in minimally invasive techniques. Avoiding pitfalls seen in the extensile lateral approach. Recommendations of areas for further research include use of external fixators, fixation in non-Sanders Type 2 fractures, and comparison of intraoperative CT/3D fluoroscopy with o conventional fluoroscopy.
Collapse
Affiliation(s)
- Joe Pang
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Department of Orthopaedic Surgery, Gayton Road, King's Lynn PE30 4ET, United Kingdom
| | - Ali Hussain
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
| | - Mathhew Yan
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
| | - Karan Kapur
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
| | - Georgios Solomou
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Department of Orthopaedic Surgery, Gayton Road, King's Lynn PE30 4ET, United Kingdom; School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, United Kingdom.
| | - Cecilia Brassett
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
| | - Chandra Pasapula
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Department of Orthopaedic Surgery, Gayton Road, King's Lynn PE30 4ET, United Kingdom
| | - Alan R Norrish
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Department of Orthopaedic Surgery, Gayton Road, King's Lynn PE30 4ET, United Kingdom; Academic Unit of Injury, Recovery and Inflammation Sciences, Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
| |
Collapse
|
2
|
Delmon R, Vendeuvre T, Pries P, Aubert K, Germaneau A, Severyns M. Percutaneous balloon calcaneoplasty versus open reduction and internal fixation (ORIF) for intraarticular SANDERS 2B calcaneal fracture: Comparison of primary stability using a finite element method. Injury 2023:S0020-1383(23)00272-3. [PMID: 36997362 DOI: 10.1016/j.injury.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/25/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Fractures of the calcaneus are common, with 65% being intra-articular, which can lead to a major impairment of the patient's quality of life. Open reduction and internal fixation with locking plates can be considered as gold-standard technique but has a high rate of post-operative complications. Minimally invasive calcaneoplasty combined with minimally invasive screw osteosynthesis is largely drawn from the management of depressed lumbar or tibial plateau fractures. The hypothesis of this study is that calcaneoplasty associated with minimally invasive percutaneous screw osteosynthesis presents biomechanical characteristics comparable with conventional osteosynthesis. MATERIALS AND METHODS Eight hind feet were collected. A SANDERS 2B fracture was reproduced on each specimen, while four calcanei were reduced by a balloon calcaneoplasty method and fixed with a lateral screw, four others were manually reduced and fixed with conventional osteosynthesis. Each calcaneus was then segmented for 3D finite element modeling. A vertical load was applied to the joint surface in order to measure the displacement fields and the stress distribution according to the type of osteosynthesis. RESULTS Analyses of the intra-articular displacement fields showed lower overall displacements in calcaneal joints treated with calcaneoplasty and lateral screw fixation. Better stress distribution was found in the calcaneoplasty group with lower equivalent joint stresses. These results could be explained by the role of the PMMA cement as a strut, enabling better load transfer. CONCLUSION Balloon Calcaneoplasty combined with lateral screw osteosynthesis has biomechanical characteristics at least comparable to locking plate fixation in the treatment of SANDERS 2B calcaneal joint fractures in terms of displacement fields and stress distribution under the premise of anatomical reduction.
Collapse
Affiliation(s)
- Romain Delmon
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France
| | - Tanguy Vendeuvre
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France; Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Pierre Pries
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France
| | - Kevin Aubert
- Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Arnaud Germaneau
- Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Mathieu Severyns
- Orthopedic and traumatology department, Clinique Porte Océane, Les Sables d'Olonne, France.
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Zhang H, Lv ML, Liu Y, Sun W, Niu W, Wong DWC, Ni M, Zhang M. Biomechanical analysis of minimally invasive crossing screw fixation for calcaneal fractures: Implications to early weight-bearing rehabilitation. Clin Biomech (Bristol, Avon) 2020; 80:105143. [PMID: 32829234 DOI: 10.1016/j.clinbiomech.2020.105143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/13/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Minimally invasive fixation using crossing screws was believed to produce satisfactory clinical outcome whereas its stability in early weight-bearing remained controversial. This study aimed to analyze the biomechanical stability of minimally invasive fixation during balanced standing and walking stance, and provide evidence for early rehabilitation. METHODS A finite element model of foot-ankle-shank complex was reconstructed based on computed tomography and magnetic resonance images, and validated by plantar pressure of the model participant. A Sanders III calcaneal fracture was created on the model, and then fixed using crossing screws. The predicted stress distribution, fracture displacement, Bohler's angle and Gissane's angle were compared between the intact calcaneus and fracture model with the fixation. FINDINGS Postoperatively, the concentrated stress appeared at the junction of the calcaneus and its surrounding tissues (especially Achilles tendon, plantar fascia and ligaments) during standing and walking stances, and the stress exceeded the yield strength of trabecular bone. The longitudinal screws sustained the highest stresses and concentrated at the tips and the calcaneal tuberosity junction. The displacement of posterior joint facet, Bohler's angle, and Gissane's angle were within the acceptable range either standing or walking after the fixation. INTERPRETATION Early weight-bearing standing and walking after minimally invasive fixation may cause high stress concentration thereby induce calcaneus stress fractures and other complications like plantar fasciitis and heel pain, so it should not be supported. The peri-calcaneus tendons, i.e., Achilles tendon and plantar fascia, play key roles in the stabilization of the calcaneal fracture after operation.
Collapse
Affiliation(s)
- Haowei Zhang
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Miko Lin Lv
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Yin Liu
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Wanju Sun
- Department of Orthopaedics, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201299, China
| | - Wenxin Niu
- Department of Rehabilitation, Medical College of Tongji University, Shanghai 200092, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, SAR 999077, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
| | - Ming Ni
- Department of Orthopaedics, Pudong New Area Peoples' Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201299, China.
| | - Ming Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, SAR 999077, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518057, China
| |
Collapse
|
5
|
Fuchs KF, Heilig P, McDonogh M, Boelch S, Gbureck U, Meffert RH, Hoelscher-Doht S, Jordan MC. Cement-augmented screw fixation for calcaneal fracture treatment: a biomechanical study comparing two injectable bone substitutes. J Orthop Surg Res 2020; 15:533. [PMID: 33189144 PMCID: PMC7666494 DOI: 10.1186/s13018-020-02009-6] [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: 07/01/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background The role of cement-augmented screw fixation for calcaneal fracture treatment remains unclear. Therefore, this study was performed to biomechanically analyze screw osteosynthesis by reinforcement with either a calcium phosphate (CP)-based or polymethylmethacrylate (PMMA)-based injectable bone cement. Methods A calcaneal fracture (Sanders type IIA) including a central cancellous bone defect was generated in 27 synthetic bones, and the specimens were assigned to 3 groups. The first group was fixed with four screws (3.5 mm and 6.5 mm), the second group with screws and CP-based cement (Graftys® QuickSet; Graftys, Aix-en-Provence, France), and the third group with screws and PMMA-based cement (Traumacem™ V+; DePuy Synthes, Warsaw, IN, USA). Biomechanical testing was conducted to analyze peak-to-peak displacement, total displacement, and stiffness in following a standardized protocol. Results The peak-to-peak displacement under a 200-N load was not significantly different among the groups; however, peak-to-peak displacement under a 600- and 1000-N load as well as total displacement exhibited better stability in PMMA-augmented screw osteosynthesis compared to screw fixation without augmentation. The stiffness of the construct was increased by both CP- and PMMA-based cements. Conclusion Addition of an injectable bone cement to screw osteosynthesis is able to increase fixation strength in a biomechanical calcaneal fracture model with synthetic bones. In such cases, PMMA-based cements are more effective than CP-based cements because of their inherently higher compressive strength. However, whether this high strength is required in the clinical setting for early weight-bearing remains controversial, and the non-degradable properties of PMMA might cause difficulties during subsequent interventions in younger patients.
Collapse
Affiliation(s)
- Konrad F Fuchs
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Philipp Heilig
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Miriam McDonogh
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Sebastian Boelch
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Brettreichstraße 11, 97074, Würzburg, Germany
| | - Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Rainer H Meffert
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Stefanie Hoelscher-Doht
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Martin C Jordan
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| |
Collapse
|
6
|
Fourgeaux A, Estens J, Fabre T, Laffenetre O, Lucas Y Hernandez J. Three-dimensional computed tomography analysis and functional results of calcaneal fractures treated by an intramedullary nail. INTERNATIONAL ORTHOPAEDICS 2019; 43:2839-2847. [PMID: 31372810 DOI: 10.1007/s00264-019-04381-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/22/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intramedullary calcaneal nailing is used to treat displaced intra-articular calcaneal fractures. The main goal of the study was to assess the reduction of tomography and secondary goals were patient functional scores and complication rates. METHODS The functional outcome and restoration of the radiographic parameters were evaluated post-operatively, at three months, at one year, and at the last follow-up. The morphology of the posterior facet was evaluated post-operatively, at one year and at the last follow-up by CTs. RESULTS Twenty-six patients were included. The mean follow-up was 2.8 years. The mean AOFAS-AHS was 79 at the last follow-up. The mean calcaneal height index and length rose respectively from 0.44 to 0.86 and 83 to 87 mm, and the width decreased from 50 to 46 mm. CONCLUSION The radiographic parameters were restored. The AOFAS-AHS was comparable with other series. This study confirms the efficiency of this procedure with lower rate of complications.
Collapse
Affiliation(s)
- Antoine Fourgeaux
- Bordeaux Hospital University, Place Amélie Raba-Léon, 33076, Bordeaux cedex, France
| | - John Estens
- The Maitland Hospital, 560 High St., Maitland, NSW, 2320, Australia.,Lake Macquarie Private Hospitals, 3 Sydney St., Gateshead, NSW, 2290, Australia
| | - Thierry Fabre
- Bordeaux Hospital University, Place Amélie Raba-Léon, 33076, Bordeaux cedex, France
| | | | | |
Collapse
|