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Dai X, Wang K, Xu C, Ding K, Zhang Y, Ding W. Short term efficacy of subtalar arthroscopy combined with medial calcaneal-talar joint distraction in minimally invasive treatment of diabetic patients with calcaneal fractures: a retrospective study. BMC Musculoskelet Disord 2024; 25:849. [PMID: 39448957 DOI: 10.1186/s12891-024-07960-7] [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: 07/18/2024] [Accepted: 10/14/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND The surgical treatment and management of postoperative soft tissue complications in diabetic patients with displaced calcaneal fractures are still controversial. We aimed to evaluate the short-term efficacy of percutaneous minimally invasive screw fixation in treatment of diabetic patients with Sanders II and III calcaneal fractures under subtalar arthroscopy assisted by preoperative musculoskeletal ultrasonic locating lateral calcaneal branch (LCB) of the sural nerve and calcaneal-talar joint distraction device. METHODS The clinical data of 52 diabetic patients diagnosed with Sanders II or III calcaneal fractures from March 2016 to August 2020 were followed up and analyzed. There were 23 patients of type II and 29 patients of type III, 34 males and 18 females, with a mean age of 61.7 ± 14.5 years (range: 45-72 years). Preoperative musculoskeletal ultrasonography was routinely examined to locate LCB of the sural nerve. During surgery, we performed arthroscopic percutaneous prying reduction screw fixation assisted by medial calcaneal-talar joint distraction. Incision healing, local skin paraesthesia and other conditions were observed regularly at 3 days, 6, 12 months, and the last follow-up after surgery. Also, we measured the length, width, height, Böhler angle, and Gissane angle of the calcaneus on lateral and axial x-rays. Visual analogue pain scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score and Maryland score were used to evaluate the efficacy. RESULTS 52 patients were followed up for 23.7 ± 3.2 months (range: 20-28 months) without incision-related complications. Calcaneal radiographic parameters (length, width, height, Böhler/Gissane angle) were improved after surgery, and the differences were all statistically significant (P<0.05). There was no difference between calcaneal radiographic parameters at 6,12 months and the last follow-up compared with 3 days after surgery without significant loss in overall morphology (P>0.05). Postoperative VAS, AOFAS scores, and Maryland scores were significantly improved compared with those before surgery (P<0.05). CONCLUSIONS Preoperative ultrasonic locating LCB of the sural nerve and arthroscopic percutaneous minimally invasive screw fixation of Sanders II and III calcaneal fractures with the assistance of calcaneal-talar joint distraction have good short-term efficacy and clinical feasibility in diabetic patients.
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Affiliation(s)
- Xiaoyu Dai
- Department of Traumatic Orthopedics, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou Affiliated to Soochow University, Changzhou, 213000, China
| | - Kejie Wang
- Department of Traumatic Orthopedics, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou Affiliated to Soochow University, Changzhou, 213000, China
| | - Chenyang Xu
- Department of Traumatic Orthopedics, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou Affiliated to Soochow University, Changzhou, 213000, China
| | - Kai Ding
- Department of Traumatic Orthopedics, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou Affiliated to Soochow University, Changzhou, 213000, China
| | - Yige Zhang
- Department of Traumatic Orthopedics, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou Affiliated to Soochow University, Changzhou, 213000, China
| | - Wenge Ding
- Department of Traumatic Orthopedics, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou Affiliated to Soochow University, Changzhou, 213000, 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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Yeomans D, Lewis TL, Pearkes T, Stone B, Hepple S, Riddick A, Harries W, Kelly M, Winson I, Robinson P. Radiological outcomes following open versus percutaneous fixation versus arthroscopically assisted percutaneous fixation of calcaneal fractures: a ten-year retrospective observational study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:823-832. [PMID: 37715837 DOI: 10.1007/s00590-023-03716-6] [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: 06/14/2023] [Accepted: 08/27/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Calcaneal fractures are often major injuries associated with considerable morbidity. The optimal surgical management of displaced calcaneal fractures remains contentious with open, percutaneous and arthroscopically assisted percutaneous approaches all offering potential benefits for patients. The aim of this study was to assess which of these three separate surgical approaches to the management of displaced calcaneal fractures provides the best radiographic deformity correction. METHODS This is a retrospective observational study of all calcaneal fractures undergoing operative fixation at a single major trauma centre in the UK. The primary outcome was pre- and post-operative assessment of the deformity correction using radiographic parameters (angle of Gissane and Bohler's angle). Secondary outcomes included fracture configuration, complications and re-operation rate. RESULTS Between 01/01/2009 and 31/12/2019, 152 calcaneal fractures in 134 patients underwent operative management via either an open or percutaneous approach. One-way ANOVA testing of the pre- and post-operative radiographic parameters demonstrated that an open approach offered superior post-operative correction of Bohler's angle when compared to percutaneous alone (p < 0.05); however, there was no difference in post-operative angle of Gissane (p > 0.05). The mean follow-up for complication and re-operation data was 3.5 years (range 0.1-12.4). Overall complication rate following all surgical fixation was 7.2% with a further 32.2% requiring further long-term surgical intervention for subtalar arthritis or removal of metalwork. CONCLUSION Arthroscopically assisted percutaneous fixation does not offer superior radiographic deformity correction compared to percutaneous technique alone. Open fixation yielded improved correction of Bohler's angle when compared to percutaneous alone; however, there was no difference in post-operative angle of Gissane. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daniel Yeomans
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.
| | | | - Tim Pearkes
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Bradley Stone
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Steve Hepple
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Andrew Riddick
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | | | - Michael Kelly
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Ian Winson
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Peter Robinson
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
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Dislozierte intraartikuläre Kalkaneusfrakturen. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-023-00592-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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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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Gao D, Wong TM, Fang C, Leung FK, Li X, Jia B, Wang Y, Yu B. Arthroscopic-assisted percutaneous fixation of intra-articular calcaneal fractures using an intraoperative distraction device. J Orthop Surg (Hong Kong) 2021; 29:2309499020979095. [PMID: 33410380 DOI: 10.1177/2309499020979095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the quality of reduction and clinical outcomes by using Percutaneous Distractor and Subtalar Arthroscopy Closed Reduction followed by Internal Fixation (PDSA-CRIF) in the intra-articular calcaneal fracture. METHODS A consecutive case series of 453 patients with 507 displaced intra-articular calcaneal fractures was recruited in this retrospective study. We performed PDSA-CRIF to treat intra-articular calcaneal fractures. The quality of reduction was assessed by early postoperative Computed Tomography (CT) scans and measurement of serial Bohler's angles during follow-ups. Clinical outcomes were evaluated by Visual Analogue Scale (VAS) and the American Foot & Ankle Society ankle-hind foot scale (AOFAS) scoring system. RESULTS Fifty-nine patients (68 fractures) who had complete clinical data and follow-up of at least 12-months (mean: 14 months, range: 12-59 months) were finally included. Anatomical and near-anatomical reduction in subtalar articular surface which had less than 2 mm gap or step-off was found in 93% fractures. Unsatisfactory reduction was found in 7%. CONCLUSION Arthroscopic-assisted percutaneous fixation using a distraction device is effective in achieving positive short-term results in the displaced intra-articular calcaneal fractures. A multicenter, large sample, randomized control trial is needed to fully evaluate the long-term effects of PDSA-CRIF in comparison to other methods.
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Affiliation(s)
- Di Gao
- Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Orthopedics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Tak Man Wong
- Department of Orthopedics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Christian Fang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Frankie Kl Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Xiang Li
- Department of Orthopedics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Bin Jia
- Department of Orthopedics, Shenzhen Pingle Orthopedics Hospital, Shenzhen, China
| | - Yu Wang
- Department of Orthopaedics, Chifeng Municipal Hospital, Inner Mongolia, China.,Chifeng Clinical Medical School of Inner Mongolia Medical University, Inner Mongolia, China
| | - Bin Yu
- Department of Orthopedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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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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Seat A, Seat C. Lateral Extensile Approach Versus Minimal Incision Approach for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: A Meta-analysis. J Foot Ankle Surg 2021; 59:356-366. [PMID: 32131003 DOI: 10.1053/j.jfas.2019.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 08/12/2019] [Indexed: 02/03/2023]
Abstract
Treatment of displaced intra-articular calcaneal fractures remains controversial. Therefore, the purpose of this large meta-analysis was to report the outcomes of the lateral extensile approach versus the minimal incision approach including complications, anatomic reduction, functional outcomes, and timing and to report results when only randomized control trials were compared. Five electronic databases were searched for articles directly comparing the 2 above approaches. Inclusion criteria included articles published from January 2007 to April 2017, adults (>18 years old) with closed, Sanders type II or III fractures, mean follow-up time of ≥12 months, and ≥1 primary outcome reported. Seventeen randomized control trials and 10 retrospective studies were included. There were 2179 participants with 2274 fractures, and mean follow-up of 22.41 months. Our results revealed no statistically significant difference in Gissane's angle, calcaneal width, calcaneal length, deep infection, or subtalar stiffness. When taking into consideration only randomized control trials, there was no statistically significant difference between groups comparing postoperative Bohler's or Gissane's angle. There was a statistically significant difference in wound complications, superficial infection, sural nerve injury, visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scores, operative time, time to operating room, calcaneal height, and postoperative Bohler's angle (when all studies were considered), all in favor of the minimal incision approach. These results remained statistically significant when only the randomized controlled trials were compared, with the exception of Bohler's angle and VAS and AOFAS scores. The results of this meta-analysis indicate that the minimal incision approach is a good alternative to the standard lateral extensile approach.
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Affiliation(s)
- Andrea Seat
- Resident PGY-3, Department of Podiatry, Jesse Brown VA Medical Center, Chicago, IL.
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Williams CE, Joo P, Oh I, Miller C, Kwon JY. Arthroscopically Assisted Internal Fixation of Foot and Ankle Fractures: A Systematic Review. FOOT & ANKLE ORTHOPAEDICS 2021; 6:2473011420950214. [PMID: 35097419 PMCID: PMC8727837 DOI: 10.1177/2473011420950214] [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: 11/16/2022] Open
Abstract
BACKGROUND Patients undergoing fixation for foot and ankle fractures may experience poor outcomes despite achieving apparent anatomic reduction. Adjunct arthroscopy to identify missed concomitant injuries and subtle displacements has been proposed as a vehicle to enhance functional results for these patients. The purpose of this review is to provide an overview of the literature regarding arthroscopically assisted open reduction and internal fixation (AAORIF) methods for commonly encountered foot and ankle injuries including pilon, ankle, and calcaneus fractures published to date. METHODS A systematic review of the literature was performed using the PubMed database to access all studies reporting on arthroscopically assisted internal fixation methods for pilon, ankle, and calcaneus fractures. Relevant publications were analyzed for details on their respective study designs, the operative technique used, clinical outcomes, outcome instruments used, and reported complications. RESULTS A total of 32 studies were included in this review. Two studies on pilon fractures, a randomized controlled trial (RCT) and case series with a total of 243 patients, met inclusion criteria. Postoperative articular reductions, bone union, and Mazur scores were found to be significantly better for those using adjunct arthroscopy when compared to those with no arthroscopy use. Patient-reported outcomes were overall reported as excellent for most patients, with no difference in patient-reported outcomes reported in the RCT. For ankle fractures, a total of 17 studies comprising of 2 systematic reviews, 1 meta-analysis, 2 RCTs, 5 retrospective comparative studies, 6 case series, and 1 case-control study met inclusion criteria for this review. Results were mixed, though the overall consensus was that arthroscopy use may help to better visualize concomitant intra-articular injuries and is generally considered safe with at least comparable outcomes to conventional methods. For the calcaneus, 13 studies met the criteria. Two studies were review papers, 8 were case series, and 3 were retrospective comparative studies. A total of 308 patients with 316 fractures formed the basis of analysis. In general, the studies found comparable functional outcomes between with or without arthroscopy use, but found that anatomical reductions were significantly improved with the use of arthroscopy. CONCLUSIONS Arthroscopy shows promise as a valuable adjunct tool for internal fixation of foot and ankle fractures, though definitive conclusions as to its clinical significance have yet to be drawn because of limited evidence. Potential advantages related to the direct visualization of the fracture site and minimally invasive nature of arthroscopy were suggested throughout studies examined in this review. The presence of intra-articular pathology may lead to unexpectedly poor outcomes seen in some patients who undergo surgical fixation of ankle fractures with an otherwise anatomic reduction on postoperative radiographs; the ability to diagnose and address these lesions with arthroscopy, therefore, has the potential to improve patient outcomes. To date, however, available literature has not shown that significant improvements in anatomical reductions and treatment of these intra-articular injuries provide any improvement in outcomes over standard fixation methods. Few prospective randomized controlled studies have been performed comparing these 2 operative techniques, rendering any suggestion that AAORIF improves clinical outcomes over traditional open fixation difficult to justify. Further research is indicated for what may be a potentially promising surgical adjunct prior to advocating for its routine use in patients.
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Affiliation(s)
- Caroline E. Williams
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- University of Miami/Miller School of Medicine, Miami, FL, USA
| | - Peter Joo
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
| | - Irvin Oh
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
| | | | - John Y. Kwon
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Üçer M. Minimally Invasive Approach Toward Percutaneous Direct Pars Repair: An Observational Study. World Neurosurg 2020; 146:e1301-e1306. [PMID: 33307253 DOI: 10.1016/j.wneu.2020.11.165] [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: 11/04/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Spondylolysis refers to a defect of the vertebral pars interarticularis. Percutaneous direct pars repair using a minimally invasive technique was performed in a group of young patients to maintain their spinal segment movement and to restore their normal anatomy. The aim of this study was to present the clinical, functional, and radiologic outcomes of pars defects that were repaired percutaneously via the minimally invasive technique. METHODS This was a single-center, nonrandomized, prospective study of the demographic, clinical, functional, and radiographic outcomes of 18 patients (age range, 18-32 years). The visual analog scale for back pain and the Oswestry Disability Index were used to evaluate the functional outcomes. The Macnab criteria were applied to evaluate patient satisfaction after surgery. RESULTS All patients were admitted with bilateral pars fracture at the level of L4 (n = 4) or L5 (n = 14). The average duration of clinical follow-up was 16.04 months (range, 12-28 months). With reference to the Macnab criteria, 17 patients (94%) showed perfect or good outcomes. Fusion or bridging of bones was observed on computed tomography in 14 patients (77%) at the last radiological examination. CONCLUSIONS Minimally invasive surgery to treat symptomatic spondylolysis is a safe option that minimizes muscle and soft tissue dissection. In this study, good clinical and functional outcomes were achieved in young patients with low complications and high fusion rates using completely percutaneous treatment.
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Affiliation(s)
- Melih Üçer
- Department of Neurosurgery, Kanuni Sultan Süleyman Education and Research Hospital, University of Health Sciences, Istanbul, Turkey.
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11
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Percutaneous arthroscopic calcaneal osteosynthesis for displaced intra-articular calcaneal fractures: Systematic review and surgical technique. Foot Ankle Surg 2020; 26:503-508. [PMID: 31320206 DOI: 10.1016/j.fas.2019.07.002] [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: 01/16/2019] [Revised: 06/18/2019] [Accepted: 07/02/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to systematically evaluate the available literature on technique and outcomes of percutaneous arthroscopic calcaneal osteosynthesis for displaced intra-articular calcaneal fractures. METHODS A systematic review of the literature available in MEDLINE, EMBASE, and the Cochrane Library database was performed, including studies from January 1985 to august 2018. The literature search, data extraction, and quality assessment were conducted by 2 independent reviewers. The surgical technique and perioperative management, clinical outcomes scores, radiographic outcomes and complication rate were evaluated. RESULTS Of 66 reviewed articles, 8 studies met the inclusion criteria. The included studies reported on the results of 152 patients. At last follow up the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot was ranging from 72.1 to 94.1. The complication rate was low, including only one superficial infection. CONCLUSIONS The studies included were of too little level of evidence to allow for data pooling or meta-analysis. However, the percutaneous arthroscopic calcaneal osteosynthesis seems to be a good option for displaced intra-articular calcaneal fractures with a low complication rate. Appropriately powered randomized controlled trials with long-term follow up are needed to confirm the efficacy of this technique. LEVEL OF EVIDENCE Level III, systematic review of Level III studies.
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Grün W, Molund M, Nilsen F, Stødle AH. Results After Percutaneous and Arthroscopically Assisted Osteosynthesis of Calcaneal Fractures. Foot Ankle Int 2020; 41:689-697. [PMID: 32412812 PMCID: PMC7294532 DOI: 10.1177/1071100720914856] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Operative treatment of calcaneal fractures using the extensile lateral approach is associated with high rates of soft tissue complications. In the past years, there has been a trend toward less invasive surgical approaches. Percutaneous and arthroscopically assisted calcaneal osteosynthesis (PACO) combines the advantages of visualization of the posterior facet of the subtalar joint with a minimally invasive approach. METHODS We conducted a follow-up of 25 patients with 26 calcaneal fractures (Sanders II and III), treated with PACO with a minimum follow-up of 12 months. The median age was 44 years (range, 21-72) and the follow-up period 15 months (12-33). Our clinical outcomes were the Manchester-Oxford Foot Questionnaire (MOxFQ), the Calcaneus Fracture Scoring System (CFSS), the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, the Short-Form-36 (SF-36), the visual analog scale (VAS) for pain, and the number of complications. Radiographs on follow-up were obtained to evaluate the reduction of the fractures as well as osteoarthritis of the subtalar joint. RESULTS The median MOxFQ score was 26.6 (0-76.6), the CFSS score 85 (26-100), and the AOFAS score 85 (50-100). The VAS pain score was 0 (0-5.7) at rest and 4.1 (0-8.2) during activity. The Böhler angle improved from a mean (SD) of 3.5 (12.3) degrees preoperatively to 27.7 (10.5) degrees postoperatively. The follow-up radiographs showed subsidence of the fractures and a Böhler angle of 20.3 (12.9) degrees. There were no wound-healing complications. Two patients had additional surgery with screw removal due to prominent hardware. CONCLUSION Our results suggest that PACO gives good clinical outcomes and a low risk of complications in selected calcaneal fractures. Prospective long-term studies will be necessary to better document the potential advantages and limitations of this operating technique. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Wolfram Grün
- Department of Orthopaedic Surgery, Østfold Hospital, Grålum, Norway,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway,Wolfram Grün, MD, Ortopedisk avdeling, Oslo universitetssykehus, Kirkeveien 166, Oslo, 0450, Norway.
| | - Marius Molund
- Department of Orthopaedic Surgery, Østfold Hospital, Grålum, Norway
| | - Fredrik Nilsen
- Department of Orthopaedic Surgery, Østfold Hospital, Grålum, Norway
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O’Hara NN, Isaac M, Slobogean GP, Klazinga NS. The socioeconomic impact of orthopaedic trauma: A systematic review and meta-analysis. PLoS One 2020; 15:e0227907. [PMID: 31940334 PMCID: PMC6961943 DOI: 10.1371/journal.pone.0227907] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023] Open
Abstract
The overall objective of this study was to determine the patient-level socioeconomic impact resulting from orthopaedic trauma in the available literature. The MEDLINE, Embase, and Scopus databases were searched in December 2019. Studies were eligible for inclusion if more than 75% of the study population sustained an appendicular fracture due to an acute trauma, the mean age was 18 through 65 years, and the study included a socioeconomic outcome, defined as a measure of income, employment status, or educational status. Two independent reviewers performed data extraction and quality assessment. Pooled estimates of the socioeconomic outcome measures were calculated using random-effects models with inverse variance weighting. Two-hundred-five studies met the eligibility criteria. These studies utilized five different socioeconomic outcomes, including return to work (n = 119), absenteeism days from work (n = 104), productivity loss (n = 11), income loss (n = 11), and new unemployment (n = 10). Pooled estimates for return to work remained relatively consistent across the 6-, 12-, and 24-month timepoint estimates of 58.7%, 67.7%, and 60.9%, respectively. The pooled estimate for mean days absent from work was 102.3 days (95% CI: 94.8-109.8). Thirteen-percent had lost employment at one-year post-injury (95% CI: 4.8-30.7). Tremendous heterogeneity (I2>89%) was observed for all pooled socioeconomic outcomes. These results suggest that orthopaedic injury can have a substantial impact on the patient's socioeconomic well-being, which may negatively affect a person's psychological wellbeing and happiness. However, socioeconomic recovery following injury can be very nuanced, and using only a single socioeconomic outcome yields inherent bias. Informative and accurate socioeconomic outcome assessment requires a multifaceted approach and further standardization.
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Affiliation(s)
- Nathan N. O’Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marckenley Isaac
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Gerard P. Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Niek S. Klazinga
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Success and Failure of Percutaneous Minimally Invasive Direct Pars Repair: Analysis of Fracture Morphology. World Neurosurg 2019; 126:181-188. [DOI: 10.1016/j.wneu.2019.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 11/24/2022]
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Lui TH, Pan XH, Pan Y. Arthroscopic and Endoscopic Management of Common Complications After Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:279-293. [PMID: 30784537 DOI: 10.1016/j.cpm.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The list of late complications after calcaneal fracture that can be treated through arthroscopic and/or endoscopic approach continues to expand. The late complications of calcaneal fractures can be classified into 3 groups: (1) those causing focal hindfoot or ankle pain, (2) those causing functional deficit, and (3) those present with diffuse and poorly localized pain. Many group 1 and some group 2 complications can be managed arthroscopically and/or endoscopically. There are usually multiple coexisting sources of the pain. Careful evaluation and analysis of a problem and detailed surgical planning with combination of arthroscopic/endoscopic and open procedures are key to success.
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Affiliation(s)
- Tun-Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong, China.
| | - Xiao-Hua Pan
- Guangdong Provincial Engineering Research Center of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Guangdong Provincial Academician Workstation of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Department of Trauma and Orthopedics, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China
| | - Yu Pan
- Guangdong Provincial Engineering Research Center of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Guangdong Provincial Academician Workstation of Wound Repair and Regenerative Medicine, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China; Department of Trauma and Orthopedics, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, The 8th People's Hospital of Shenzhen, Shenzhen, Guangdong 518101, China
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Abstract
Subtalar arthroscopy has an important role in enhancing the reduction of the posterior facet in percutaneous and open approaches of displaced intra-articular calcaneal fractures. In the percutaneous approach, arthroscopically assistant percutaneous approach must be selected carefully for mild-to-moderately displaced fractures. In the open approach, there is still little evidence of the utility of subtalar arthroscopy. Therefore, intraoperative arthroscopy should always be used in conjunction with fluoroscopy to achieve reduction and assess the internal fixation placement.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Hyeonchungno 170, Nam-gu, Daegu, 42415, Republic of Korea.
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17
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Abstract
PURPOSE OF REVIEW To review literature published in the last 3 years related to minimally invasive approaches to calcaneal fracture fixation. RECENT FINDINGS Numerous randomized control trials, cohort studies, and meta-analyses have been done in the last 3 years comparing surgical treatment of calcaneus fractures. These studies indicate minimally invasive procedures decrease wound complication rates and achieve similar radiographic and clinical outcomes to open reduction internal fixation. In comparing different surgical treatment methods to non-operative treatment, operative management has increased complication rates but may lead to better functional outcomes in certain patient populations. Optimal treatment for displaced intra-articular calcaneus fractures continues to be debated. Current literature would suggest that the decision to operate be based on patient and fracture characteristics and surgeon capabilities. Minimally invasive techniques aim to improve patient reported outcomes and quality of life while decreasing complications and offer another option for surgeons in the treatment of displaced intra-articular calcaneal fractures.
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Affiliation(s)
- Emily A Wagstrom
- Hennepin County Medical Center, Minneapolis, MN, USA.
- Department of Orthopaedic Surgery, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55415, USA.
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Abstract
Traumatic injury to the subtalar joint occurs during subtalar dislocations, talar and calcaneal fractures, and fracture-dislocations. After closed reduction of subtalar dislocations, peripheral talar or calcaneal fractures need to be ruled out by computed tomography scanning. In fractures and fracture-dislocations of the talus and calcaneus involving the subtalar joint, anatomic reconstruction of joint congruity is essential for functional rehabilitation. Failure to anatomically reduce the subtalar joint potentially leads to chronic instability, subtalar arthritis and posttraumatic hindfoot deformity. Despite adequate management, subtalar arthritis may develop as a result of primary cartilage damage at the time of injury.
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Affiliation(s)
- Stefan Rammelt
- Foot & Ankle Section, University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus at the TU Dresden, Fetscherstrasse 74, Dresden 01307, Germany.
| | - Jan Bartoníček
- Department of Orthopaedics, First Faculty of Medicine, Charles University, Central Military Hospital Prague, U Vojenské nemocnice 1200, Prague 6 169 02, Czech Republic
| | - Kyeong-Hyeon Park
- Department of Orthopedic Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
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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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