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Schleunes S, Lobos E, Saltrick K. Current Management of Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2024; 41:473-490. [PMID: 38789165 DOI: 10.1016/j.cpm.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Intra-articular calcaneal fractures are debilitating injuries that can result in a dramatic effect on quality of life post-injury. Surgical intervention is generally advised when significant displacement or comminution is present but can present a host of complications secondary to the limited blood supply and fragility to the soft tissues following injury. Surgical approaches to calcaneal fractures generally include the lateral extensile approach, minimal incision (sinus tarsi approach), or percutaneous approach. Each approach presents risks and benefits; therefore, determining the optimal incisional approach should be based on patient comorbidities, fracture pathoanatomy, soft tissue envelope concerns, and patient pre-injury functional status.
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Affiliation(s)
- Scott Schleunes
- Division of Foot and Ankle Surgery, Department of Orthopedics, West Penn Hospital, Pittsburgh, PA, USA
| | - Emily Lobos
- Division of Foot and Ankle Surgery, Department of Orthopedics, West Penn Hospital, Pittsburgh, PA, USA
| | - Karl Saltrick
- Department of Orthopedics, West Penn Hospital Foot & Ankle Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
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2
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Pavone V, Sapienza M, Carnazza M, Vaccalluzzo MS, Leotta G, Sergi F, Mobilia G, Di Via D, Testa G. Open Reduction and Internal Fixation with Plate and Screw versus Triplanar External Fixation in the Surgical Treatment of Calcaneal Fractures: A Retrospective Cohort Study. J Clin Med 2024; 13:3770. [PMID: 38999336 PMCID: PMC11242109 DOI: 10.3390/jcm13133770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Background: The treatment of displaced intra-articular calcaneal fractures (DIACF) is debated. This study compares open reduction and internal fixation (ORIF) with minimally invasive osteosynthesis (MIOS). Methods: We conducted a retrospective study on 70 patients with DIACF treated between January 2018 and September 2022, divided into ORIF (n = 50) and MIOS (n = 20) groups. Functional outcomes were assessed using the Maryland Foot Score (MFS) and the Creighton-Nebraska Health Foundation Assessment Scale (CNHFAS). Radiographic outcomes, complication rates, and reintervention rates were evaluated. A chi-square analysis examined the correlation between Sanders classification and treatment choice. Results: The chi-square analysis indicated no significant correlation between the complexity of the fracture and the type of treatment chosen (χ2 = 0.175, p = 0.916). Additionally, the Cochran-Armitage test for trend showed no significant trend in the choice of treatment based on fracture complexity (statistic = 0.048, p = 0.826). A Kaplan-Meier analysis showed a longer time to reintervention for MIOS (p = 0.029). Complication rates were similar, with specific complications varying between groups. Quality-of-life outcomes were comparable. Conclusions: ORIF is preferable for high-demand patients due to better anatomical outcomes, while MIOS suits high-risk patients by reducing reinterventions and complications. Further randomized trials are needed to confirm these findings.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico “Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (V.P.); (M.S.); (M.C.); (M.S.V.); (G.L.); (F.S.); (G.M.); (D.D.V.)
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Matuszewski PE, Phillips SA, Ulrich GL, Hautala GS, Bloomer AK, Hsu JR. Minimally invasive technique for acute fixation and subtalar fusion of displaced intra-articular calcaneus fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-03879-w. [PMID: 38831052 DOI: 10.1007/s00590-024-03879-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/18/2024] [Indexed: 06/05/2024]
Abstract
Displaced intra-articular calcaneus fractures (DIACFs) are difficult injuries to treat and are often encountered by orthopedic surgeons. For DIACFs treated nonoperatively or with open reduction internal fixation (ORIF), a common complication is painful subtalar arthritis and the need for a secondary subtalar fusion, which prolongs the overall recovery time. One treatment option to address this sequela involves ORIF with subtalar fusion as the primary treatment. We describe a reproducible, minimally invasive surgical technique for primary ORIF with subtalar fusion when the calcaneal tuberosity is amendable to cannulated screw fixation to treat these complex calcaneal fractures. Our technique offers advantages compared to other techniques in that it avoids screw traffic, allows easy bony compression of the subtalar joint, and minimizes soft tissue damage via percutaneous screw fixation. Fourteen fractured calcanei in 12 patients underwent our technique and all achieved bony union with a median time to fusion of 107.5 days (range, 54-530 days). Eight patients returned to work with the remaining 4 patients having an unknown work status at last follow-up, although 2 of these 4 patients resumed normal activities. Only 1 patient experienced a complication, which was an infection after achieving bony union, and was treated with successful hardware removal and our infection protocol. Overall, we conclude our surgical technique offers a successful option in the treatment of DIACFs when the calcaneal tuberosity is amendable to cannulated screw fixation.
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Affiliation(s)
- Paul E Matuszewski
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, 740 S. Limestone, Suite K401, Lexington, KY, USA
| | - Seth A Phillips
- Department of Orthopaedic Surgery, Mercy Health St. Vincent Medical Center, Toledo, OH, USA
| | - Gary L Ulrich
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, 740 S. Limestone, Suite K401, Lexington, KY, USA
| | - Gavin S Hautala
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, 740 S. Limestone, Suite K401, Lexington, KY, USA
| | - Ainsley K Bloomer
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
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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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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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Naguib BE, Abdelrahman AF, ElShazly OA, Abd-Ella MM. Functional outcomes of primary subtalar arthrodesis in sanders type IV calcaneal fractures, a case series. Trauma Case Rep 2023; 48:100951. [PMID: 37915537 PMCID: PMC10616545 DOI: 10.1016/j.tcr.2023.100951] [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: 10/17/2023] [Indexed: 11/03/2023] Open
Abstract
Background Primary subtalar arthrodesis (PSTA) is a valid option in treating Sanders IV calcaneal fractures with few studies to assess its outcomes. Methods Seventeen patients with Sanders IV calcaneal fractures were managed by open reduction and primary subtalar arthrodesis. Functional outcomes were measured by AOFAS-AHS and FAAM-ADL. We also documented time to return to work, union rate, wound complications and the need for second surgeries. Results Fourteen patients were followed for two years. At final follow-up, the mean AOFAS-AHS score was 74.42 ± 1.95, while the mean FAAM- ADL score was 59.21 ± 1.6. Conclusion PSTA is a valid option in treating these severe fractures. It may reduce the overall disability time.
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Song Q, Li T, Xia H, Li Y, Feng C, Lin Y, Wang H, Hu J, Jiang Q. Three-dimensional printed cast assisted screw fixation of calcaneal fractures: a prospective study. BMC Musculoskelet Disord 2023; 24:802. [PMID: 37817109 PMCID: PMC10563275 DOI: 10.1186/s12891-023-06927-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Treatment of displaced intra-articular calcaneal fractures (DIACFs) with percutaneous screw fixation remains defective in some aspects. A novel three-dimensional (3D) printed cast was devised to assist screw placement. This study assessed the radiological and functional outcomes of 3D-printed cast assisted screw fixation for patients with DIACFs. METHODS Patients with unilateral Sanders type II or III DIACFs admitted to a single-centre hospital underwent either 3D-printed cast assisted screw fixation (3D group) or minimally invasive plate fixation (control group) from September 2020 to November 2022. All patients were assessed at one, two, three, and six months of follow-up. Comparison between groups was conducted in operative duration, fluoroscopic times, radiographic measurements of the calcaneus, and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. RESULTS A total of 32 patients were enrolled (19 in the 3D group versus 13 in the control group). Significant differences were detected between the 3D group and control group in operative duration (53.63±8.95 min, 95.08±8.31 min, P <0.001), fluoroscopic times (7.37±1.21, 16.85±1.57, P <0.001). At a follow-up of six months, the 3D group showed better restoration than the control group in calcaneal width, height, Bohler angle, and AOFAS Ankle-Hindfoot scores (all P <0.001). No significant differences were shown in calcaneal length and Gissane angle (P >0.05). No wound-related complications occurred in either group. CONCLUSION The 3D-printed cast assisted screw fixation has shown superiority over minimally invasive plate fixation in the operative duration, fluoroscopic exposure, morphological restoration of the calcaneus, and functional outcomes in the treatment of DIACFs.
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Affiliation(s)
- Qizhi Song
- Department of Orthopaedic Surgery, Chonggang General Hospital, Chongqing, China
| | - Tao Li
- Department of Orthopaedic Surgery, Chonggang General Hospital, Chongqing, China
| | - Huan Xia
- Nursing Department, Chonggang General Hospital, Chongqing, China
| | - Yan Li
- Central Sterile Supply Department, Chonggang General Hospital, Chongqing, China
| | - Chengbin Feng
- Department of Orthopaedic Surgery, Chonggang General Hospital, Chongqing, China
| | - Yajun Lin
- Department of Orthopaedic Surgery, Chonggang General Hospital, Chongqing, China
| | - Huahong Wang
- Department of Orthopaedic Surgery, Chonggang General Hospital, Chongqing, China
| | - Jinbiao Hu
- Department of Orthopaedic Surgery, Chonggang General Hospital, Chongqing, China
| | - Qilong Jiang
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, No. 9, Jiefang West Road, 400010, Chongqing, China.
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Heinig O, Feicht E, Mahamid A, Liberson R, Picard C, Liberson A. Treatment of a compound calcaneus fracture Sanders IV with an external circular fixator and calcaneal osteotomy. Trauma Case Rep 2023; 46:100850. [PMID: 37333494 PMCID: PMC10272509 DOI: 10.1016/j.tcr.2023.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Compound Gustilo-type III intra-articular calcaneus fractures are challenging to treat. Anatomical reduction of the subtalar joint increases the chances of a better functional outcome and is traditionally achieved by an open reduction and plating. Conversely, ORIF is associated with a high risk of infection and even amputation. In our case study, we present the treatment of a Gustilo-type III intra-articular calcaneus fracture with a circular external fixator and a temporary antibiotic cement spacer for fracture reduction and stabilization. Active bio-glass was implanted to fill bone loss and to prevent infection. A closing-wedge calcaneal tuberosity osteotomy was used to facilitate wound closure. We paid special attention to reducing the posterior facet. The patient returned to work and full ambulation five months post-injury.
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Affiliation(s)
- Ofer Heinig
- Foot & Ankle Unite, Laniado University Hospital, Adelson Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Elia Feicht
- Foot & Ankle Unite, Laniado University Hospital, Adelson Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Assil Mahamid
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roman Liberson
- Foot & Ankle Unite, Laniado University Hospital, Adelson Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Claude Picard
- Foot & Ankle Unite, Laniado University Hospital, Adelson Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Aharon Liberson
- Foot & Ankle Unite, Laniado University Hospital, Adelson Faculty of Health Sciences, Ariel University, Ariel, Israel
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Sayyed-Hosseinian SH, Shirazinia M, Arabi H, Aghaee MA, Vahedi E, Bagheri F. Does the postoperative quality of reduction, regardless of the surgical method used in treating a calcaneal fracture, influence patients' functional outcomes? BMC Musculoskelet Disord 2023; 24:562. [PMID: 37430205 DOI: 10.1186/s12891-023-06697-z] [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: 05/29/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The extensile lateral approach (ELA) and sinus tarsi approach (STA) are commonly utilized for surgically treating calcaneal fractures. This study compared the outcomes of ELA and STA in the management of calcaneal fractures and assessed the influence of postoperative quality of reduction on functional and pain scores. METHODS The study included 68 adults with Sanders type-II and type-III calcaneal fractures who underwent either ELA or STA surgery. Pre- and postoperative radiographs and computed tomography scans were analyzed, and functional and pain scores were evaluated using the Manchester Oxford Foot Questionnaire (MOXFQ), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and Visual Analogue Score (VAS) during follow-up visits. RESULTS Out of the total patients, 50 underwent ELA surgery while 18 underwent STA surgery. The anatomic (excellent) reduction was achieved in 33 (48.5%) patients. There were no significant differences between the ELA and STA groups concerning functional scores, pain scores, the proportion of excellent reduction, and complications. Additionally, anatomic reduction, compared to near or non-anatomic (good, fair, or poor) reduction, demonstrated a decrease in MOXFQ (unstandardized β coefficient: -13.83, 95% CI: -25.47 to -2.19, p = 0.021), an increase in AOFAS (unstandardized β coefficient: 8.35, 95% CI: 0.31 to 16.38, p = 0.042), and a reduction in VAS pain (unstandardized β coefficient: -0.89, 95% CI: -1.93 to -0.16, p = 0.095) scores. CONCLUSION In conclusion, we found no significant differences regarding complications, excellent reduction, and functional scores between STA and ELA surgeries. Therefore, STA may be an effective alternative for the treatment of calcaneal fractures in Sanders type II and type III calcaneal fractures. Furthermore, the anatomic reduction of the posterior facet correlated with improved functional scores, emphasizing the importance of achieving it for restoring foot function regardless of surgery type or time between injury and surgery.
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Affiliation(s)
| | - Matin Shirazinia
- Orthopedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Arabi
- Orthopedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Orthopedic Surgery, Shahid Kamyab Hospital, Fadayian Eslam Street, Mashhad, Iran.
| | - Monavar Afzal Aghaee
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Vahedi
- Orthopedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farshid Bagheri
- Orthopedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Joseph NM, Sinkler MA, Magister S, Bacharach A, Pang A, Boes K, Vallier HA, Hirschfeld AG, Ochenjele G. Fixation of displaced intra-articular calcaneus fractures is safe using either sinus tarsi or extensile lateral approach. Injury 2023; 54:S0020-1383(23)00168-7. [PMID: 36878733 DOI: 10.1016/j.injury.2023.02.036] [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: 08/30/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Management of displaced intra-articular calcaneus fractures continues to challenge surgeons. Use of the extensile lateral surgical approach (ELA) had been standard practice however wound necrosis and infection have become deterrents. The sinus tarsi approach (STA) has gained popularity as a less invasive technique to optimize articular reduction while minimizing soft tissue injury. Our aim was to compare wound complications and infections following calcaneus fractures treated using ELA versus STA. METHODS Retrospective review of 139 displaced intra-articular calcaneus fractures (AO/OTA 82C; Sanders II-IV injuries) treated operatively at 2 level-I trauma centers using STA (n = 84) or ELA (n = 55) over a 3-year period with minimum 1-year follow up was performed. Demographic, injury, and treatment-related characteristics were collected. Primary outcomes of interest included wound complications, infection, reoperation, and American Orthopaedic Foot and Ankle Society ankle and hindfoot scores. Univariate comparisons between groups were conducted using Chi-Square, Mann-Whitney, and independent sample t-tests at the p < 0.05 significance level, where appropriate. Multivariable regression analysis was performed to identify risk factors for poor outcomes. RESULTS Demographic characteristics were homogenous between cohorts. Most sustained falls from height (77%). Sanders III fractures were most common (42%). Patients treated with STA went to surgery earlier (6.0 days STA vs 13.2 ELA, p < 0.001). No differences were seen in restoration of Bohler's angle, varus/valgus angle, or calcaneal height, yet the ELA significantly improved calcaneal width (-2 mm STA vs -13.3 mm ELA, p < 0.001). There were no significant differences in wound necrosis or deep infection based on surgical approach (12% STA vs 22% ELA, p = 0.15). Seven patients underwent subtalar arthrodesis for arthrosis (4% STA vs 7% ELA). No differences in AOFAS scores were seen. Risk factors for reoperation included Sanders type IV patterns (OR = 6.6, p = 0.001), increasing BMI (OR = 1.2, p = 0.021), and advanced age (OR = 1.1, p = 0.005), not surgical approach. CONCLUSION Despite prior concerns, use of ELA versus STA for fixation of displaced intra-articular calcaneus fractures was not associated with more complication risk, illustrating both are safe when indicated and executed appropriately.
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Affiliation(s)
- Noah M Joseph
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Margaret A Sinkler
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Steven Magister
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Abigail Bacharach
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Aaron Pang
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Kirsten Boes
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Heather A Vallier
- Department of Orthpaedic Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Adam G Hirschfeld
- Department of Orthpaedic Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - George Ochenjele
- Department of Orthopaedics, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Shams A, Gamal O, Mesregah MK. Minimally Invasive Reduction of Intraarticular Calcaneal Fractures With Percutaneous Fixation Using Cannulated Screws Versus Kirschner Wires: A Retrospective Comparative Study. Foot Ankle Spec 2023; 16:28-35. [PMID: 33511858 DOI: 10.1177/1938640020987750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several minimally invasive techniques were developed for management of intraarticular calcaneal fractures. This study aimed to compare the functional and radiological outcomes of 2 minimally invasive reduction and fixation techniques using cannulated screws or Kirschner wires (K-wires) for fixation. METHODS This study was a retrospective comparative review of patients with displaced intraarticular calcaneal fractures, who were treated with cannulated screws or K-wires techniques. Clinical and radiological data were collected and compared between both groups. Functional outcomes and patient satisfaction using the Maryland Foot Score (MFS) and the visual analogue scale (VAS) of pain, in addition to the complications, were compared between both groups. RESULTS In total, 70 patients were included in the study: 34 in the cannulated screws group, with a mean age of 35.2 ± 4 years, and 36 in the K-wires groups, with a mean age of 33.4 ± 3 years. The operative time was shorter in the K-wires group (40.5 ± 5.6 minutes) compared to the cannulated screw group (49.5 ± 4.5 minutes), P < .001. There were no statistically significant differences between both groups regarding the radiological parameters, including Bohler's angle, angle of Gissane, calcaneal width, height, or length. The mean MFS, mean VAS, and complications were not different between the 2 groups. CONCLUSION Treatment of displaced intraarticular calcaneal fractures with minimally invasive reduction and fixation using either cannulated screws or K-wires can achieve similar excellent functional and radiological outcomes, with high patient satisfaction. The use of K-wires has the advantage of reduced operative time than cannulated screws. LEVELS OF EVIDENCE Level III: Retrospective comparative study.
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Affiliation(s)
- Ahmed Shams
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Osama Gamal
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt.,Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Wang J, Han W, Su Y, Wang J, Jiang X. Comparison of Robot-Assisted Percutaneous Cannulated Screws Versus Open Reduction and Internal Fixation in Calcaneal Fractures. Orthop Surg 2023; 15:724-730. [PMID: 36600634 PMCID: PMC9977583 DOI: 10.1111/os.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Accurate placement of the screws is challenging in percutaneous cannulated screw fixation of calcaneal fractures, and robot-assisted (RA) surgery enhances the accuracy. We investigated the outcome of percutaneous cannulated screw fixation of Sander's type II and III calcaneal fractures. METHODS This retrospective study analyzed clinical data of 26 patients with fresh closed calcaneal fractures (28 fractures) who were admitted to our center from January 2022 to July 2022. All fractures were divided into the RA group and the open reduction and internal fixation (ORIF) group according to the surgeries performed. RA surgery was performed by closed reduction or open reduction combined with a tarsal sinus approach. Age, sex, operation time, preoperative waiting time, length of postoperative hospital stay, wound complications, and American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale (AOFAS) at 3 months postoperatively were compared. Preoperative and postoperative radiographic parameters (calcaneal length, width, height, Böhler angle, and fixation rate of the sustentaculum tali) were documented. The chi-square test, one-way analysis of variance, and Wilcoxon test were used for the comparison of categorical, normally distributed, and nonnormally distributed continuous variables, respectively. RESULTS The calcaneal width, height, and Böhler angle were significantly corrected postoperatively in both groups. The postoperative calcaneal lengths in both groups were also corrected. However, no significant difference was found. No significant differences in calcaneal length, width, height, and Böhler angle were observed between the two groups. The operation time (p < 0.001), preoperative waiting time (p < 0.001), and length of postoperative hospital stay (p = 0.003) in the RA surgery group were significantly shorter than those in the ORIF group. The fixation rate of the sustentaculum tali (p < 0.001) in the RA surgery group was significantly superior to that in the ORIF group. All wound complications occurred in the ORIF group. All fractures healed within 3 months. The AOFAS scores at 3 months postoperatively were not significantly different. CONCLUSION RA percutaneous screw fixation of the calcaneal fracture is a safe, effective, rapid, and minimally invasive surgical option for surgeons.
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Affiliation(s)
- Jing Wang
- Department of Orthopaedic TraumaBeijing Jishuitan HospitalBeijingChina
| | - Wei Han
- Department of Orthopaedic TraumaBeijing Jishuitan HospitalBeijingChina
| | - Yonggang Su
- Department of Orthopaedic TraumaBeijing Jishuitan HospitalBeijingChina
| | - Junqiang Wang
- Department of Orthopaedic TraumaBeijing Jishuitan HospitalBeijingChina
| | - Xieyuan Jiang
- Department of Orthopaedic TraumaBeijing Jishuitan HospitalBeijingChina
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A novel distractor-assisted reduction combined with the sinus tarsi approach for joint depression-type calcaneal fractures. INTERNATIONAL ORTHOPAEDICS 2023; 47:251-263. [PMID: 36370163 DOI: 10.1007/s00264-022-05625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/29/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE A novel percutaneous distractor with the advantage of axial and direct distraction was designed for the minimally invasive treatment of calcaneal fractures. The purpose of this study was to investigate the clinical results and complications of a novel distractor combined with sinus tarsi approach (STA) in treatment of the joint depression-type of calcaneal fractures. METHODS Fifty-four patients with the depression-type of calcaneal fractures (30 Sanders type II, 22 Sanders type III, 2 Sanders type IV) who were subjected to the novel distractor combined with STA were retrospectively assessed. Calcaneal height, width, and length; Bohler's angle; and the Gissane angle were evaluated pre-operatively and post-operatively. Clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) pain scores from the last follow-up. Complications were also recorded. RESULTS Fifty-two patients achieved an average follow-up of 24.3 months (range 18 to 34 months), and two patients were lost to follow-up six months post-operatively. There was significant difference between pre-operative and post-operative calcaneal height, width, and length; Bohler's angle; and Gissane angle (p < 0.01), but no significant difference was detected between the post-operative and normal side Bohler's angle (p > 0.05). The AOFAS ankle and hind foot score was 88.4 ± 6.6, and the VAS score was 1.9 ± 0.7 at the last follow-up. Nine (17.3%) patients developed complications: One experienced skin necrosis and two had screws loosening; three patients developed early degenerative changes of the subtalar joint; two had no symptoms; one had light pain around the subtalar joint without medical treatment; complex regional pain syndrome (CRPS) developed in one patient after seven months post-operatively; and two developed transient ankle stiffness. CONCLUSION The novel distractor combined with the STA effectively reconstructs the facet depression-type of calcaneal fractures (sanders type II and III) with minimal complications.
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Gomes FF, Maranho DA, Gomes MS, de Castro IM, Mansur H. Effects of Hyaluronic Acid With Intra-articular Corticosteroid Injections in the Management of Subtalar Post-traumatic Osteoarthritis - Randomized Comparative Trial. J Foot Ankle Surg 2022; 62:14-20. [PMID: 35752551 DOI: 10.1053/j.jfas.2022.03.003] [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: 09/21/2021] [Revised: 01/27/2022] [Accepted: 03/03/2022] [Indexed: 02/03/2023]
Abstract
We investigated the potential of exogenous hyaluronic acid (HA) associated with corticosteroid injections to improve pain and function for the treatment of post-traumatic subtalar osteoarthritis, in comparison with isolated intra-articular corticosteroid. Twenty-five symptomatic participants (50 ± 8 years) with a minimum follow-up of 1 year after surgery for calcaneus fractures were enrolled. Participants were randomly assigned into a therapeutic group that underwent isolated corticosteroid intra-articular subtalar injection (Corticosteroid Group, n = 12) or a combination of HA plus corticosteroid (HA+C Group, n = 13). All participants underwent three repeated injections with intervals of 1 week. We assessed the visual analog scale of pain (VAS) and the AOFAS scores at 4 moments: before treatment (pre), 4-, 12-, and 24-weeks following the last injection. HA+C Group showed lower VAS at the 12th (p = .003) and 24th weeks (p = .003) and greater AOFAS at the 4th (p = 0.040), 12th (p = .014), and 24th weeks (p = .021), in comparison to Corticosteroid Group. We observed a reduction in VAS in the Corticosteroid Group only at the 4th week (p = .007), compared with pretreatment values. In the HA+C Group, VAS presented lower levels at the 4- (p < .001), 12- (p < .001), and 24 weeks (p < .001). In the Corticosteroid Group, participants presented higher AOFAS score only at the 4th week (p < .001), while in the HA+C Group, the AOFAS scores were greater at the 4th, 12th, and 24th weeks compared to baseline (p < .001). The combination of exogenous HA and corticosteroid showed greater and longer analgesic effects and function improvement in comparison with isolated intra-articular corticosteroids.
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Affiliation(s)
- Fernanda Ferreira Gomes
- Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, RJ, Brazil
| | | | - Mariana Silva Gomes
- Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, RJ, Brazil
| | - Isnar Moreira de Castro
- Head of the Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, RJ, Brazil
| | - Henrique Mansur
- Department of Orthopedic Surgery, Hospital Santa Helena, Brasília, DF, Brazil.
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Syros A, Perez J, Hodgens BH, Boden AL, Constantinescu DS, Smith B, Davies JP, Steinlauf S. Sinus tarsi approach in high-risk patients with displaced intra-articular calcaneus fractures: A case series. J Orthop 2022; 34:282-287. [PMID: 36158039 PMCID: PMC9493294 DOI: 10.1016/j.jor.2022.09.009] [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: 08/15/2022] [Revised: 08/31/2022] [Accepted: 09/10/2022] [Indexed: 10/31/2022] Open
Abstract
Purpose Though research exists regarding calcaneal fractures, the treatment approach for displaced intra-articular calcaneal fractures (DIACF) remains controversial. The most common approach, the extensile lateral approach (ELA), for the treatment of DIACFs has high rates of wound complications reported. In contrast, the sinus tarsi approach (STA) is becoming more popular due to its minimally invasive technique. The objective of this retrospective study is to investigate the incidence of wound complications in high-risk patients with DIACF following operative fixation via the STA. Methods Following IRB approval, a retrospective chart review was performed between 2007 and 2013 to assess high-risk patients for the presence of wound complications, including deep infections and delayed wound healing, following the use of STA for the management of DIACF's (n = 36). Demographics, risk factors, and secondary outcomes such as time to surgery were recorded. Results Of the 36 high-risk patients included in our study, seven had post-operative complications following operative fixation via the STA. Specifically, four patients had delayed wound healing, and three developed deep infections. Time to surgery had the greatest negative effect on postoperative complications and was influenced by age, sex, and the presence of a concomitant injury. Conclusion In conclusion, this study demonstrates that the STA is a viable option for high-risk patients with displaced intra-articular fractures. Additionally, time to surgery should be minimized, when possible, to reduce risks of post-operative complications, including infections and delayed wound healing.
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Affiliation(s)
- Alina Syros
- University of Miami Miller, School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Jose Perez
- University of Miami/Jackson Health Systems, Department of Orthopaedic Surgery, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - Blake H. Hodgens
- University of Miami Miller, School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Allison L. Boden
- University of Miami/Jackson Health Systems, Department of Orthopaedic Surgery, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - David S. Constantinescu
- University of Miami/Jackson Health Systems, Department of Orthopaedic Surgery, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - Bret Smith
- Mercy Regional Medical Center, 1 Mercado St., Suite 202, Durango, CO, 81301, USA
| | - James P. Davies
- Premier Orthopaedic Specialists of Tulsa, CityPlex Towers, 2448 E 81st St. Suite 1520, Tulsa, OK, 74137, USA
| | - Steven Steinlauf
- University of Miami/Jackson Health Systems, Department of Orthopaedic Surgery, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
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Xie W, Cui X, Zhang C, Chen X, Rui Y, Chen H. Modified sinus tarsi approach with a variable-angle locking anterolateral plate for Sanders type II and III calcaneal fractures. Foot Ankle Surg 2022; 28:872-878. [PMID: 34916143 DOI: 10.1016/j.fas.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/25/2021] [Accepted: 11/30/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND We compared the effectiveness of the extensile lateral approach (ELA) and modified sinus tarsi approach (MSTA) with a variable-angle locking anterolateral plate in treating Sanders type II and III calcaneal fractures. METHODS We reviewed 45 DIACFs treated by a single surgeon from 2017 to 2020. Open reduction using ELA and MSTA was performed in 25 and 20 patients, respectively. Follow-up evaluations included radiological assessments and clinical evaluations. RESULTS Pre- and postoperative radiologic parameters for the calcaneus were significantly different. The average American Orthopaedic Foot and Ankle Society scores were 81.24 and 85.00, the mean visual analogue scale scores were 2.28 and 1.65, and the wound-related complication rates were 64.0% and 15.0% in the ELA and MSTA groups, respectively. Bony union was achieved in all cases. CONCLUSIONS For Sanders type II and III fractures, MSTA seems to be a safer and more satisfactory method, with fewer postoperative complications.
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Affiliation(s)
- Wenjun Xie
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Xueliang Cui
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Cheng Zhang
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Xiangxu Chen
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Yunfeng Rui
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Hui Chen
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
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A prospective comparative study between percutaneous cannulated screws and Kirschner wires in treatment of displaced intra-articular calcaneal fractures. INTERNATIONAL ORTHOPAEDICS 2022; 46:2667-2683. [PMID: 35960344 PMCID: PMC9556432 DOI: 10.1007/s00264-022-05521-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/15/2022] [Indexed: 10/26/2022]
Abstract
Abstract
Purpose
Several minimally invasive procedures were used to treat displaced intra-articular calcaneal fractures (DIACFs). No agreement among different authors about either the ideal fixation method or which technique is minimally invasive. The aim of this study was to compare functional and radiographic outcomes of two minimally invasive techniques in treatment of Sanders type II and III DIACFs by using K-wires or cannulated screws without bone grafts.
Methods
A prospective randomized controlled study was conducted on 28 patients (34 feet) with Sanders type II or III DIACFs, treated by closed reduction and fixation using cannulated screws or K-wires, at the Orthopedics Department of Sohag University Hospital, between April 2020 and February 2022. Functional assessment was done by American Orthopedic Foot and Ankle Society (AOFAS) score and VAS for pain. Radiographic assessment was done by measurement of three calcaneal angles (Gissane, Böhler’s, and posterior facet inclination angles) and three calcaneal distances (height, length, and width of the calcaneus).
Results
Mean ages of patients at the time of operation were 34.8 years for the cannulated screw group and 36.6 years for the K-wire group. A vast majority of patients were males (78.6%). Involvement of the right side in the cannulated screw group was 57.1% and that in the K-wire group was 47.9%. Mean operative time was significantly shorter among the K-wire group (42 min) compared to the cannulated screw group (57 min). Mean AOFAS score was higher among the cannulated screw group (85.9 points) compared to the K-wire group (75.8 points). Final VAS was significantly better among the cannulated screw group compared to the K-wire group. Mean time of radiographic union in the cannulated screw group was 8.9 weeks and that in the K-wire group was 10.1 weeks.
Conclusion
Both techniques avoided wound complications associated with ORIF with the advantage of a shorter hospital stay. Patients in the cannulated screw group had better functional and radiographic outcomes and a lower rate of subtalar arthritis than patients in the K-wire group. K-wires had advantages of reduced operative time, and easy removal as an outpatient procedure.
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Smitaman EE, Davis M. Hindfoot Fractures: Injury Patterns and Relevant Imaging Findings. Radiographics 2022; 42:661-682. [PMID: 35275783 DOI: 10.1148/rg.210167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The hindfoot consists of the talus and calcaneus, spans the tibiotalar to transverse tarsal joints, and is critical for support of body weight and absorption and transfer of physiologic loads during bipedal movements. Hindfoot fractures account for approximately 17% of foot and ankle fractures, with calcaneal fractures being more common than talar fractures. Hindfoot fractures are usually caused by high-impact axial loads such as falls from heights and motor vehicle accidents, and understandably, they are often seen in patients with polytrauma. Long term, these fractures have implications in development of posttraumatic osteoarthrosis with associated pain and stiffness, affecting daily living activities. An overview of the talus and calcaneus is presented, with emphasis on fractures with articular involvement-namely, the tibiotalar and subtalar joints. Articular talar and calcaneal injuries can also alter hindfoot alignment, causing ankle and foot function abnormalities. Optimal treatment-that is, restoration of articular surfaces and hindfoot alignment followed by rigid fixation until fracture union-is dependent on an accurate understanding of the injury that is well depicted with imaging, radiography and CT in particular. The discussion of talar and calcaneal fractures includes a review of the normal anatomy, epidemiologic factors, classification systems, and imaging and pathologic-anatomic features of common injury patterns. This review is intended to aid surgical management and restoration of articular and hindfoot alignment for optimal ankle and foot function, thereby reducing patient morbidity in these often devastating injuries. ©RSNA, 2022.
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Affiliation(s)
- Edward Eddie Smitaman
- From the Department of Radiology, UCSD Health System, 408 Dickinson St, San Diego, CA 92103-8226 (E.S.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (M.D.)
| | - Michael Davis
- From the Department of Radiology, UCSD Health System, 408 Dickinson St, San Diego, CA 92103-8226 (E.S.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (M.D.)
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Hu W, Huang C, Zhang Y, Wang X, Jiang Y. A nomogram for predicting post-operative wound complications after open reduction and internal fixation for calcaneal fractures. Int Wound J 2022; 19:2163-2173. [PMID: 35438244 DOI: 10.1111/iwj.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022] Open
Abstract
The purpose of our study was to determine the risk factors for post-operative wound complications (PWCs) after open reduction and internal fixation (ORIF) for calcaneal fracture and establish a nomogram prediction model. We retrospectively analysed the clinical data of patients who suffered from calcaneal fractures and had been surgically treated for ORIF in our institution between January 2010 and January 2020. Perioperative information was obtained through the electronic medical record system, univariate and multivariate analyses were performed to determine the risk factors of PWCs, and a nomogram model was constructed to predict the risk of PWCs. The predictive performance and consistency of the model were evaluated by the Hosmer -Lemeshow (H-L) test and the calibration curve. In total, 444 patients were enrolled in our study. Multivariate analysis results showed that smoking, limb swelling, angle of incision, and CRP were independent risk factors for skin necrosis. The AUC value for skin necrosis risk was 0.982 (95%CI 0.97-0.99). The H-L test revealed that the normogram prediction model had good calibration ability (P = .957). Finally, we found a correlation between PWCs and smoking, limb swelling, angle of incision, and CRP after ORIF for calcaneal fracture patients. Our nomogram prediction model might be helpful for clinicians to identify high-risk patients, as interventions could be taken early to reduce the incidence of PWCs.
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Affiliation(s)
- Wei Hu
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengbin Huang
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yingying Zhang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xingyu Wang
- Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yanshu Jiang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Bischofreiter M, Litzlbauer W, Breulmann F, Kindermann H, Rodemund C, Mattiassich G. Return-to-sports after minimally invasive stabilization of intra-articular calcaneal fractures. SPORTVERLETZUNG-SPORTSCHADEN 2022; 36:100-110. [PMID: 35345053 DOI: 10.1055/a-1688-3720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Evaluation of different factors in patient quality of life after minimally invasive stabilization of intra-articular calcaneal fractures, including the return-to-sports rate. PATIENTS AND METHODS Patients with minimally invasive stabilization of intra-articular calcaneal fractures were collected from the database of a Level I trauma center and evaluated in a retrospective and explorative way. The clinical and radiological examination have been done immediately after the operation, after 2 and 6 weeks postoperative and after a minimum follow-up of 2 years. Clinical and radiological examination was performed by applying the American Orthopedic Foot and Ankle Society hindfoot scale score (AOFAS), 36-item Short Form Health Survey (SF-36), the Tegner Activity Scale, the Foot and Ankle Outcome Score (FAOS) and with a questionnaire about pre- and postoperative engagement in sport and recreational activities. RESULTS Fourty-nine patients with an isolated uni-lateral fracture of the calcaneus who fulfilled all inclusion criteria were assessed. Fourty-two of them were male and 24 were under the age of 50 years. No statistically significant differences were noted between Sanders I/II and Sanders III/IV in terms of SF-36, AOFAS, FAOS or Tegner-scale. A less satisfying result was noticed in Sanders III/IV patients. General health, pain in FAOS, physical functioning and pain in SF-36 were strongly dependent on Tegner score values. Twenty-nine percent of our study population changed sport activities after injury, whereas 22 percent stopped all kinds of sports. Consequently, our overall return-to-sport rate was 78 percent. CONCLUSION Clinical results including different scores and quality of life parameters in our study population were satisfying. About 80 percent of patients could return to sports, but there are still many patients that were not able to perform sports and physical activities on the same level as before.
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Affiliation(s)
- Martin Bischofreiter
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz + Department of Orthopedic Surgery, Clinic Diakonissen Schladming
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Vosoughi AR, Borazjani R, Ghasemi N, Fathi S, Mashhadiagha A, Hoveidaei AH. Different types and epidemiological patterns of calcaneal fractures based on reviewing CT images of 957 fractures. Foot Ankle Surg 2022; 28:88-92. [PMID: 33563519 DOI: 10.1016/j.fas.2021.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/23/2021] [Accepted: 02/03/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Calcaneal fractures may have lifelong debilitating sequences, if not treated properly. Identifying different types of calcaneal fractures based on the computed tomography (CT) scans can increase our conception about these fractures. METHODS In a cross-sectional study, the available CT images of all consecutive patients with the diagnosis of calcaneal fracture, from January 2015 to December 2018, were reviewed to determine different patterns and types of these fractures. RESULTS CT images of 886 patients (mean age, 41.29 ± 14.9; range, 3-89 years; male/female, 4.86; pediatric: 3.7%) with 957 calcaneal fractures were evaluated. The peak incidence of calcaneal fractures was seen in patients between 30 to 39 years of age (29%). The rate of open fractures and bilateral involvements were 2.4% and 8.0%, respectively. Among 680 (71.0%) intra-articular calcaneal fractures, subtalar calcaneal fractures were the most common type (94.3%). The majority of intra-articular subtalar calcaneal fractures were displaced (95.0%) with calcaneocuboid joint (CCJ) involvement (59.9%). Fracture lines were extended to the CCJ in about 86.9% of Sanders type IV, 66.3% of type III, and 60.2% of type II. Among 261 extra-articular fractures (27.3%), calcaneal body fracture (55.6%) was the most frequent type, followed by medial tubercle fracture (24.1%), calcaneal tuberosity fracture (10.4%), Degan type I anterior process fractures (5.4%), Degan type II anterior process fracture (3.4%), and isolated lateral tubercle fracture (1.1%). Most of bilateral calcaneal fractures were intra-articular subtalar fractures with involvement of CCJ. Although majority of intra-articular calcaneal fractures were displaced; less than half of the extra-articular fractures were displaced. CONCLUSION Displaced intra-articular subtalar calcaneal fractures with CCJ involvement are the most frequent type of unilateral and bilateral calcaneal fractures. It appears that there is a correlation between Sanders type and the probability of CCJ involvement. Unlike intra-articular subtalar calcaneal fractures, the CCJ in the majority of extra-articular calcaneal body fractures was intact. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Amir Reza Vosoughi
- Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Roham Borazjani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Niayesh Ghasemi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Shiva Fathi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Amirali Mashhadiagha
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Amir Human Hoveidaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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22
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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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23
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Loewen A, Ge SM, Marwan Y, Berry GK. Isolated Arthroscopic-Assisted Subtalar Fusion: A Systematic Review. JBJS Rev 2021; 9:01874474-202108000-00005. [PMID: 34415883 DOI: 10.2106/jbjs.rvw.20.00231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The subtalar joint has a complex anatomic function that includes inversion and eversion of the hindfoot, assisting in walking on uneven surfaces. Arthritis is the most common pathological condition affecting this joint and can require fusion. The surgery can be performed open or with arthroscopic assistance. This systematic review assesses articles written on the safety and efficacy of isolated arthroscopic subtalar fusion. METHODS Using MEDLINE and Embase, we systematically reviewed articles published before May 21, 2020. RESULTS Of 395 articles, 17 on a total of 395 patients (409 operations) were included in the review. The average duration of follow-up was 40.0 months (range, 3 to 105 months). Radiographic evidence of union was reported for 95.8% of cases at an average of 11.9 weeks (range, 6 to 56 weeks) postoperatively. Delayed union was reported in 1.0% of patients and nonunion, in 4.3% of patients. In the articles reporting patient satisfaction, including pain relief, 95.4% of patients had positive outcomes. Postoperative complications were reported in 64 patients (16.2%), including 37 (9.4%) with symptomatic implants, 11 (2.8%) with dysesthesia or neuropathic pain, and 3 (0.8%) with postoperative infection. CONCLUSIONS Arthroscopic subtalar fusion is a safe and effective alternative to open subtalar arthrodesis, with high patient satisfaction rates, high union rates at similar follow-up intervals, and low complication rates. The aim of future research should be to determine the ideal cases for this approach as well as the most efficient arthroscopic surgical technique and postoperative rehabilitation to optimize function and union as seen on radiographs. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Allison Loewen
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Susan M Ge
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yousef Marwan
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gregory K Berry
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Reduced pre-operative skin oxygen saturation predicts revision after open reduction and internal fixation in calcaneal fractures : A reduced pre-operative oxygen saturation as measured by laser-Doppler spectrophotometry in 8 mm depth is associated with revision surgery after open reduction and internal fixation of calcaneal fractures through an extended lateral approach. INTERNATIONAL ORTHOPAEDICS 2021; 45:2355-2363. [PMID: 34357432 DOI: 10.1007/s00264-021-05157-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess which pre-operative parameters correlate with wound revisions after an extended lateral approach to the calcaneus. METHODS Pre-operative laser-Doppler spectrophotometry was applied in patients undergoing open reduction and internal fixation. The number of wound revisions was recorded during pos-toperative follow-up. Spearman rho analysis was used to identify factors associated with wound revision and receiver operator characteristics curves were calculated for the identified factors. RESULTS Thirty-four patients (29 men, 5 women; 37 calcanei) with a mean patient age of 43 ± 14 years were analyzed. The minimal oxygen saturation value at the five measurement locations as well as the minimal value for flow correlated negatively with wound revisions (p value = 0.025 and 0.038, respectively). The area under the curve for the pre-operative minimal value of oxygen saturation was 0.841 (95%CI 0.64-1.00, p = 0.028), indicating a good accuracy as a test to predict wound revision. CONCLUSION A pre-operative oxygen saturation of at least 20.5% across five measurement points along the anticipated incision identified all patients not needing a wound revision (negative predictive value 100%). On the other hand, patients with at least one measurement below 20.5% were at risk for wound revision surgery (sensitivity 100%, specificity 48.5%). ClinicalTrials.gov NCT01264146.
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Vosoughi AR, Tamadon A, Gholamzadeh S, Fereidooni M. Can We Release All Calcaneal Attachments of the Superior Peroneal Retinaculum During Extensile Lateral Approach to the Calcaneus? J Foot Ankle Surg 2021; 60:85-88. [PMID: 33129678 DOI: 10.1053/j.jfas.2020.09.005] [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: 08/29/2019] [Revised: 06/03/2020] [Accepted: 09/04/2020] [Indexed: 02/03/2023]
Abstract
During extensile lateral approach to the calcaneus, in order to see all fractured fragments and subtalar joint, all soft tissues including insertion site of superior peroneal retinaculum (SPR) on the calcaneus should be released. The aim of this study was to evaluate the probability of peroneal tendon dislocation by releasing all soft tissues attached to the calcaneus. In 10 fresh cadavers, after standard extensile lateral approach to the calcaneus in right side, all soft tissues attached to the lateral wall of the calcaneus were excised. In the left side of each cadaver, all soft tissues inserted to the superior border of calcaneal tuberosity in addition to the lateral wall of the calcaneus were cut out. Probable anterior dislocation of peroneal tendons in the retromalleolar groove was assessed by placing a clamp into the peroneal tendon sheath from distal to proximal and advancing it to the retromalleolar groove. Also by careful dissection, any instability of peroneal tendons was visualized. Not any anterior dislocation of peroneal tendons to the lateral malleolus tip was seen in any stage of the procedure. Insertions of the SPR to the fascia of the deep posterior compartment of the leg and the Achilles tendon sheath are the main soft tissue stabilizer of the peroneal tendons in the retromalleolar groove. So resection of the insertion site of the SPR to the calcaneus might not result in the peroneal tendon instabilities.
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Affiliation(s)
- Amir Reza Vosoughi
- Associate Professor of Orthopedic Surgery and Foot & Ankle Surgeon, Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Afrasiab Tamadon
- Medical Student, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeid Gholamzadeh
- General Practitioner and Forensic Medicine Expert, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Mehran Fereidooni
- General Practitioner and Forensic Medicine Expert, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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26
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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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27
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Liu Y, Cai P, Cheng L, Li Y. Local Random Pattern Flap Coverage for Implant Exposure following Open Reduction Internal Fixation via Extensile Lateral Approach to the Calcaneus. BMC Musculoskelet Disord 2021; 22:567. [PMID: 34154601 PMCID: PMC8218457 DOI: 10.1186/s12891-021-04427-x] [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: 01/08/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background Skin necrosis and implant exposure most often appear at the corner of Extensile Lateral Approach for open reduction and internal fixation (ORIF) for displaced intra-articular fracture of the calcaneus. Flap transfer is often used for coverage of this implant exposure. We introduced a new simple local random pattern flap to cover the implant exposure. Methods From March 2017 to March 2020, 12 patients with implant exposure after ORIF for displaced intra-articular fracture of the calcaneus were treated with this procedure. The sizes of the defects ranged from 2 × 2 cm2 to 5 × 2 cm2. A local random pattern flap was designed according to the defect size. The lower edge of the flap was along with the wound upper edge and extended distally. The upper horizontal incision of the flap was made at the lateral malleolus level with a length of 5–7 cm depending on the wound defect. Then the random pattern flap was elevated and transferred to cover the defect area. Results The mean follow-up duration was 6.3 months (ranging 4–13 months). All 12 flaps were uneventfully healed and all patients were able to wear shoes, and no debulking procedures were required. Conclusion The local random pattern flap could be a choice for surgeons when implant exposure at the corner of Extensile Lateral Approach to the Calcaneus occurs.
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Affiliation(s)
- Yingjie Liu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan road, Shanghai, 200233, China
| | - Peihua Cai
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan road, Shanghai, 200233, China
| | - Liang Cheng
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan road, Shanghai, 200233, China.
| | - Yanfeng Li
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan road, Shanghai, 200233, China
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Park YH, Cho HW, Choi JW, Choi GW, Kim HJ. Bone Defects After Surgery for Displaced Intraarticular Calcaneal Fractures Spontaneously Improve Without Bone Grafting. Clin Orthop Relat Res 2021; 479:1265-1272. [PMID: 33428344 PMCID: PMC8133131 DOI: 10.1097/corr.0000000000001634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/11/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most intraarticular displaced calcaneal fractures are accompanied by bone defects after surgical treatment, but the concern about negative effects of bone defects has not been resolved yet owing to the few studies on this issue. Therefore, studies on volumetric changes in bone defects over time and the correlation between postoperative outcomes and residual bone defects will be helpful to address the controversy on the necessity of bone grafting in bone defects of calcaneal fractures. QUESTIONS/PURPOSES (1) Do bone defects change in size in the first year after surgical treatment of displaced intraarticular calcaneal fractures? (2) Does the size of residual bone defects correlate with postoperative radiographic or clinical outcomes? METHODS Between 2015 and 2019, 99 patients with displaced intraarticular calcaneal fractures visited the investigators' institution, of whom 95 received surgical treatment. Of the patients treated with surgery, 25% (24 of 95) did not undergo open reduction and internal fixation via an extensile lateral approach, and 19% (18 of 95) had multiple fractures, bilateral fractures, open fractures, or a history of previous surgery on the calcaneus; all of these patients were excluded. During the study period, CT was routinely performed for calcaneal fractures immediately after and 12 months after the surgery, but 6% (6 of 95) of the patients had insufficient CT data due to loss to follow-up before 12 months or other reasons, leaving 47 patients for evaluation in this retrospective study. Fractures were fixed with plate and screws, and bone grafting was not performed in all patients. To answer our first question, which was on the changes in bone defects over time, volumetric measurements of the bone defect were performed using CT via the ITK-SNAP software. The percentage of volumetric change was calculated as a fraction of the volumetric change over 12 months from the initial volume. The percentage of the residual bone defect was calculated as a fraction of the volume of the residual bone defect relative to the volume of the entire calcaneus. To answer our second question, which was on the correlation between residual bone defects and postoperative outcomes, we assessed the Böhler angle, Gissane angle, calcaneal height, Olerud-Molander Ankle Score (OMAS), and VAS score for pain and compared these parameters with the size of the residual bone defect using the Pearson correlation coefficient. The OMAS and VAS scores for pain were evaluated and recorded during patient visits, and we obtained the scores through a chart review. All volumetric measurements and radiographic evaluations were performed by two orthopaedic surgeons, and the intraobserver and interobserver reliability were assessed using the intraclass correlation coefficient. RESULTS The mean volume of the bone defect measured using CT was 4 ± 3 cm3 immediately after surgery and 1 ± 1 cm3 12 months after surgery. During the first 12 months after surgery, the mean volume of the bone defect was reduced by 77% (95% confidence interval 73% to 80%). The mean residual bone defect in the entire calcaneus was 2% (95% CI 1% to 2%), and none of the postoperative outcomes were correlated with the residual bone defect. CONCLUSION As bone defects substantially resolve without treatment, surgeons do not need to use bone graft for the surgical treatment of displaced intraarticular calcaneal fractures. Future studies that include patients who underwent bone grafting for the treatment of calcaneal fractures are needed to confirm our findings and to further investigate whether bone grafting has additional benefits for the recovery of bone defects. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Young Hwan Park
- Y. H. Park, H. W. Cho, J. W. Choi, H. J. Kim, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
- G. W. Choi, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Hyun Woo Cho
- Y. H. Park, H. W. Cho, J. W. Choi, H. J. Kim, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
- G. W. Choi, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Jung Woo Choi
- Y. H. Park, H. W. Cho, J. W. Choi, H. J. Kim, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
- G. W. Choi, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Gi Won Choi
- Y. H. Park, H. W. Cho, J. W. Choi, H. J. Kim, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
- G. W. Choi, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Hak Jun Kim
- Y. H. Park, H. W. Cho, J. W. Choi, H. J. Kim, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
- G. W. Choi, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Korea
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Pflüger P, Zyskowski M, Greve F, Kirchhoff C, Biberthaler P, Crönlein M. Patient-Reported Outcome Following Operative and Conservative Treatment of Calcaneal Fractures: A Retrospective Analysis of 79 Patients at Short- to Midterm Follow-Up. Front Surg 2021; 8:620964. [PMID: 34124129 PMCID: PMC8194093 DOI: 10.3389/fsurg.2021.620964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 04/13/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Fractures of the calcaneus are severe injuries of the hindfoot, mostly resulting from high-energy axial loads, which still present enormous challenges to modern trauma surgery. Possible variables influencing the outcome are the type of fracture, age, and quality of fracture reduction. These might also be factors affecting the self-reported patient outcome, but large studies are still lacking. Therefore, the aim of this study was to analyze the patient-reported outcome of calcaneal fractures following operative and conservative treatment. Methods: All patients suffering from calcaneal fractures between 2002 and 2015 were enrolled in this retrospective analysis. The calcaneal fractures were classified according to Sanders and the AO classification system. For further analysis, two groups were formed: group I involved complex intra-articular fractures defined by the involvement of the posterior calcaneal facet, while group II consisted of extra-articular and process calcaneal fractures. Data were collected via the patient registry, radiographs, and a standardized questionnaire (Foot and Ankle Outcome Score, FAOS). For outcome analysis, non-parametric Mann–Whitney U-test was performed, and Spearman's rank correlation coefficient was calculated. Results: In total, the functional outcome of 79 patients with calcaneal fractures was analyzed. In group 1 (n = 43), the mean FAOS score was 65.5 ± 18.9. The surgically treated patients with a Sanders type II calcaneal fracture had a mean FAOS score of 72.9 ± 17.2, type III fractures had 65.6 ± 20.8, and type IV had 61.1 ± 19 (p = 0.15). The reoperation rate was 22%, most frequently caused by wound complications (10%). The mean follow-up time was 64.5 ± 44 months. The mean FAOS score of group 2 (n = 36) was 75.2 ± 18.4, and 83% of the patients (=30) were managed conservatively. Only one out of six operatively managed patients had a reoperation due to regular implant removal. The mean follow-up time was 31 ± 25.9 months. Conclusion: Intra-articular calcaneal fractures are severe injuries of the hindfoot leading to a fair to poor functional outcome in the majority of the patients. Complications regarding wound healing are the most common causes for revisional surgery. Extra-articular calcaneal fractures are a heterogenous entity commonly managed non-operatively. Overall, they show a better functional outcome in comparison to intra-articular calcaneal fractures.
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Affiliation(s)
- Patrick Pflüger
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Zyskowski
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Frederik Greve
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Moritz Crönlein
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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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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Abstract
Displaced intra-articular calcaneal fractures are among the most difficult articular fractures to treat, with a high rate of potential complications. Is important to restore calcaneus posterior facet anatomy as well as calcaneus width, length, and height. The extensile lateral approach provides excellent fracture visualization and allows reduction of the displaced fracture fragments, but high complication rate has been described with this approach, so many studies favor the sinus tarsi approach. Recent evidence favoring sinus tarsi rather than the extensile lateral approach has shifted opinion toward this less invasive approach, which can be considered the new gold standard.
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Affiliation(s)
- Gabriel Khazen
- Hospital de Clinicas Caracas, Av Panteón, San Bernardino, Caracas 01050, Venezuela.
| | - Cesar Khazen Rassi
- Hospital de Clinicas Caracas, Av Panteón, San Bernardino, Caracas 01050, Venezuela
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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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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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夏 燊, 赵 泽, 徐 永, 吕 乾, 浦 绍, 陈 汉, 齐 欣, 朱 跃. [Anatomical calcaneal external fixator self-designed according to the morphology of heel]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:475-481. [PMID: 32291984 PMCID: PMC8171517 DOI: 10.7507/1002-1892.201908149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The anatomical calcaneal external fixator was designed by measuring and calculating the morphological data of the heel. METHODS A total of 100 normal people were randomly selected to obtain 200 hind foot data, including 45 males and 55 females, with an average age of 43.9 years (range, 19-67 years). According to the principles of human engineering and local anatomy, the morphological data of the heel in the weight-bearing standing position and supine position were measured with the direct measurement mode. The heel length, heel width, heel height, medial ankle height, lateral ankle height, and calcaneal pitch angle (CPA) were measured by vernier calipers and ulnar markers in weight-bearing standing position, and the gender groups and left and right foot groups were compared; the shape of the hind foot in the supine position was measured by three-dimensional (3D) dot matrix inverse model method. According to the stereoscopic data of the comprehensive anatomical morphology of the heel, the anatomical calcaneal external fixator was designed with AutoCAD 2019 and other 3D industrial design softwares. RESULTS The measurements of shoe size, heel length, heel width, heel height, medial ankle height, lateral ankle height, and CPA in male were significantly higher than those in female ( P<0.05). There was no significant difference between the left and right feet in the other indexes except that the height of the medial malleolus of the left foot was significantly lower than that of the right foot ( t=-2.827, P=0.005). The measurement of 3D dot matrix inverse model in supine position showed that the heel part was non-circular arc edge, and many groups of arc edges fluctuate in a limited range. Based on the above data, an anatomical calcaneal external fixator was designed, which could fit the anatomic radian in theory, so as to be flexible in configuration. On this basis, the ordinary configuration, compression configuration, and orthodontic configuration were designed to meet the treatment needs of calcaneal fractures in different degrees. The ordinary configuration was suitable for patients with Sanders Ⅰ, ⅡA, and ⅡB calcaneal fractures with no or slight displacement of intra-articular fractures; the ordinary configuration was mainly used for simple fixing. The compression configuration was suitable for patients with Sanders ⅡC, ⅢA, and ⅢB, tongue fractures, and avulsion fractures with severe displacement of intra-articular fractures; the compression configuration used obliquely drawn console wires to fix the displaced bones. The orthodontic configuration was suitable for patients with Sanders ⅢC and Ⅳ calcaneal fractures with severe displacement of intra-articular fractures or severe calcaneal bone defects; the orthodontic configuration was a multi-module design, which took into account the stable fixation of the fracture and the arbitrary adjustment of the joint fixation angle. CONCLUSION The hind foot is special for morphology, so the external fixator designed based on the vernier caliper measurement method and 3D dot matrix measuring plate measurement method is an anatomical type and its configuration can theoretically meet stable and flexible clinical needs.
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Affiliation(s)
- 燊 夏
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 泽雨 赵
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 永清 徐
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 乾 吕
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 绍全 浦
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 汉芬 陈
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 欣 齐
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 跃良 朱
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
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Harvey EJ, Martineau PA, Schemitsch E, Nowak LL, Agel J. Evidence-Based Medicine: Boom or Bust in Orthopaedic Trauma? J Bone Joint Surg Am 2020; 102:e6. [PMID: 31609888 DOI: 10.2106/jbjs.19.00547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Edward J Harvey
- McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Paul A Martineau
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Julie Agel
- Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, Seattle Washington
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Bremer AK, Kraler L, Frauchiger L, Krause FG, Weber M. Limited Open Reduction and Internal Fixation of Calcaneal Fractures. Foot Ankle Int 2020; 41:57-62. [PMID: 31478393 DOI: 10.1177/1071100719873273] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique. METHODS Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months). RESULTS The mean AOFAS score was 87 ± 13 (range, 32-100). "Excellent" and "good" results, as well as hindfoot motion with "normal/mild" and "moderate" restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%). CONCLUSION The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Anne K Bremer
- Department of Orthopaedic Surgery, Siloah Hospital, Gümligen/Bern, Switzerland
| | - Lukas Kraler
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Lars Frauchiger
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Fabian G Krause
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Martin Weber
- Department of Orthopaedic Surgery, Siloah Hospital, Gümligen/Bern, Switzerland
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Vosoughi AR, Shayan Z, Salehi E, Jaberi FM, Solooki S, Kardeh B. Agreement between Sanders classification of intraarticular calcaneal fractures and assessment during the surgery. Foot Ankle Surg 2020; 26:94-97. [PMID: 30587438 DOI: 10.1016/j.fas.2018.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/07/2018] [Accepted: 12/02/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sanders classification, based on the number of displaced fractured fragments of posterior facet, can predict the prognosis of calcaneal intraarticular fractures. The aim of the study was assessing not only intraobserver reproducibility and interobserver reliability of Sanders classification but also the agreement between preoperative reported types based on computed tomography (CT) scan and direct observation during the surgery. METHODS In this cross-sectional study, preoperative CT scans of 100 patients with intra-articular calcaneal fracture operated by a single surgeon were studied by two orthopedic and trauma surgeons (A & B), twice with an interval of three weeks. Their result were compared with each other and with the number of displaced fractured fragments recorded in the operation notes. Quadratic weighted kappa test was used to check the agreement between two observers and between the observers and the surgeon. RESULTS Intraobserver reproducibility for Sanders classification of intraarticular calcaneal fractures was found to be good to excellent (A1-A2: 0.91 and B1-B2: 0.75). There was a moderate agreement between the two observers (A1-B1: 0.56, A1-B2:0.58, A2-B1:0.48, and A2-B2:0.51). The agreement between reported types of Sanders classification and the number of displaced fractured fragments seen during the surgery was fair (A1-surgeon: 0.27, A2-surgeon: 0.29, B1-surgeon: 0.38, and B2-surgeon: 0.50). CONCLUSIONS Agreement between Sanders classification and what is real during surgery is fair. Hence, Sanders classification as determined in the widest cut of coronal CT scan extended posteriorly should be cautiously interpreted for surgery.
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Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Shayan
- Trauma Research Center, Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ehsan Salehi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Fereidoon Mojtahed Jaberi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Saeed Solooki
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Bahareh Kardeh
- Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Ma ZJ, Bai LP, Zhang GM, Zhang LB, Chen Z. Natural Value of Böhler's Angle in Normal Chinese Population. Orthop Surg 2019; 11:1201-1208. [PMID: 31773895 PMCID: PMC6904593 DOI: 10.1111/os.12560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/26/2019] [Accepted: 09/19/2019] [Indexed: 12/18/2022] Open
Abstract
Objective To determine the value of Böhler's angle (BA) in a group of Chinese people, analyze possible factors that influence it, and compare BA with that in previous literature. Methods A total of 143 cases, aged from 4 to 79 years, were enrolled in the study, including 64 males and 79 females (79 left feet and 64 right feet). Radiographs were independently measured by six observers. Age, sex, body side, subtalar joint congruity (STJC), and X‐beam obliquity (TT) were recorded. The database was assessed based on intraobserver agreement, data distribution, the randomness of case selection, and the ratio equality of binomial variables. Then, the normal value of BA was established, as well as the correlation between BA and other parameters. Results In the present study, the interobserver reliability of BA, STJC, and TT was excellent. The BA data revealed a normal distribution, and the randomness of case selection was verified for age, sex, and body side. The ratio of sex and body side was equal. Homogeneity of variance was observed when comparing the value of BA between different groups. The value of BA was 31.6° ± 5.19° (range, 20.08°–47.19°), which was not related to age, sex, body side, and minor X‐ray beam obliquity. BA application was not suitable for individuals younger than 10 years. The mean value of BA in this study was not identical with those in previous reports. This demonstrated that BA varies for different races. Conclusion For Chinese people, 30° to 33° is recommended as the target value of BA for calcaneal fracture reduction, except in children under 10 years of age.
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Affiliation(s)
- Zhi-Jian Ma
- Trauma Center, The Second People's Hospital of Yunnan Province, Kunming, Yunnan, China.,Trauma Center, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Li-Ping Bai
- Trauma Center, The Second People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Guang-Ming Zhang
- Trauma Center, The Second People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Lian-Bi Zhang
- Trauma Center, The Second People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Zhong Chen
- Trauma Center, The Second People's Hospital of Yunnan Province, Kunming, Yunnan, China
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Clinical Outcomes Following Tongue Type Calcaneus Fractures. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE To determine whether increased surgeon and hospital volume is associated with lower rates of complications after tarsal fractures. DESIGN Retrospective cohort study of the State Inpatient Databases. SETTING Two hundred ninety-nine hospitals in Florida (2005-2012) and New York (2006-2008). PATIENTS/PARTICIPANTS Four thousand one hundred thirty-two tarsal fractures that underwent fixation by 1223 surgeons. INTERVENTION Surgical repair of tarsal fractures. MAIN OUTCOME MEASUREMENTS Composite of readmission for infection requiring operative treatment, wound dehiscence, nonunion, avascular necrosis, or amputation within 2 years of the index procedure. RESULTS The mean age was 44 (±15) years, a majority were men (70%) and white (69%), and the mean number of Charlson comorbidities was 0.21 (±0.58). Multivariable logistic regression demonstrated a reduction in the likelihood of complications by 9% for each 5 additional surgeries performed by the operating surgeon [odds ratio (OR), 0.91 per 5 surgeries; 95% confidence interval (CI), 0.82-0.99]. Other factors associated with complications included increased age (OR, 1.23 per 10 years; 95% CI, 1.10-1.36), male sex (OR, 1.56; 95% CI, 1.12-2.17), open fractures (OR, 2.84; 95% CI, 1.92-4.19), number of Charlson comorbidities (OR, 1.23; 95% CI, 1.02-1.48), income quartile (OR, 1.48; 95% CI, 1.00-2.17), uninsured (OR, 2.47; 95% CI, 1.39-4.39), and other government program insurance (OR, 1.52; 95% CI, 1.06-2.18). CONCLUSIONS We observed a significant inverse relationship between surgeon volume and complication rates when controlling for patient and injury characteristics. In contrast to previous research, a volume-outcome relationship was not observed at the hospital level. These results suggest that such complex injuries should be triaged to the most experienced providers. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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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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Stupay KL, Briceño J, Velasco BT, Miller CP, Kwon JY. Tuber-to-Anterior Process Angle (TAPA): A cadaveric study and surgical technique for placing axial calcaneal screws. Injury 2019; 50:1398-1403. [PMID: 31147185 DOI: 10.1016/j.injury.2019.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/22/2019] [Accepted: 05/21/2019] [Indexed: 02/02/2023]
Abstract
We describe results of a cadaveric study and an accompanying surgical technique which simplifies posterior-to-anterior axial screw placement into the calcaneus, often utilized during fixation of displaced intra-articular calcaneus fractures or calcaneal osteotomies. By defining the Tuber-to-Anterior Process Angle (TAPA), this technique facilitates axial screw placement, thereby decreasing reliance on intraoperative fluoroscopy and reducing operative time.
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Affiliation(s)
- Kristen L Stupay
- Harvard Combined Orthopaedic Surgery Residency Program, Massachusetts General Hospital, Boston, MA, United States.
| | - Jorge Briceño
- Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Brian T Velasco
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | | | - John Y Kwon
- Beth Israel Deaconess Medical Center, Boston, MA, United States
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Abstract
Objective This study was performed to introduce a new method of minimally invasive subtalar arthrodesis (MISA) and assess its clinical effects on traumatic subtalar arthritis (TSA). Methods Fifteen patients (8 male and 7 female; age range, 36–56 years; mean age, 48.67 years) with TSA who underwent MISA were included. All patients were treated using a series instrument. The intraoperative and postoperative indexes were recorded. Results Among all patients, the mean operation time was 59.67 ± 16.31 minutes and the mean intraoperative blood loss was 43.33 ± 52.87 mL. Four patients underwent iliac crest bone graft surgery, and one patient developed a complication involving fat liquefaction of the iliac crest wound. The mean bony fusion time among all patients was 3.5 months. According to the American Orthopaedic Foot and Ankle Society standard, an excellent outcome was obtained in eight patients and a good outcome was obtained in seven patients. The operation time and intraoperative blood loss were significantly different between patients who did and did not undergo iliac crest bone graft surgery. Conclusion MISA is a simple and effective method for the treatment of TSA.
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Affiliation(s)
| | - Zhigang Kong
- Zhigang Kong, Department of Traumatology & Orthopedics, The Third Hospital of Hebei Medical University, No. 361 East Zhongshan Road of Chang’an District, Shijiazhuang, Hebei 050051, P.R. China.
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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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Roukis TS. Closed Manipulation, Intraosseous Reduction, and Rigid Internal Fixation for Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:197-210. [PMID: 30784531 DOI: 10.1016/j.cpm.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Although open reduction and internal fixation for treating displaced intra-articular calcaneal fractures remain common, difficulty obtaining and maintaining both calcaneal morphology and subtalar articular surface reduction remain. In addition, open approaches induce a significant risk of wound-healing complications. For this reason, closed manipulation to restore calcaneal morphology, intra-osseous fracture reduction, and rigid locked nail fixation was developed and validated for clinical use. Conversion to an immediate primary or delayed reconstructive subtalar joint arthrodesis using the same instrumentation remains unique to this system. This article reviews the CALCANAIL surgical technique for performing operative fixation of displaced intra-articular calcaneal fractures.
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Affiliation(s)
- Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, 1900 South Avenue, La Crosse, WI 54601, USA.
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Schepers T. Sinus Tarsi Approach with Screws-Only Fixation for Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:211-224. [PMID: 30784532 DOI: 10.1016/j.cpm.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Treatment of displaced intra-articular calcaneal fractures has changed numerous times in the last decades. Currently, less invasive surgery has reemerged and is increasingly used. The sinus tarsi approach is most commonly used. It combines the open approach to the subtalar joint with percutaneous reduction of the overall shape of the calcaneus. The results in the literature show overall similar functional outcome compared with the extended lateral approach, however with a significant reduction in wound complications. This article deals with the sinus tarsi approach in which the reduction is fixated using screws only. Indications, surgical technique, and possible pitfalls are discussed.
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Affiliation(s)
- Tim Schepers
- Trauma Unit, Amsterdam UMC, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands.
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Roukis TS. Joint-Sparing Surgical Management of Sanders IV Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:251-268. [PMID: 30784535 DOI: 10.1016/j.cpm.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Displaced intra-articular calcaneal fractures represent life-altering injuries. Difficulty obtaining and maintaining calcaneal morphology and the significant risk of wound healing complications with an extensile lateral incision exist. Open reduction with internal fixation as a joint-sparing approach has been studied. Closed manipulation to restore calcaneal morphology, intra-osseous fracture reduction, and rigid locked CALCANAIL fracture nail fixation have recently been applied to Sanders IV fracture patterns. Spontaneous conversion to primary subtalar joint arthrodesis using the same instrumentation remains unique to this system. This article reviews open and percutaneous approaches for joint-sparing and primary arthrodesis procedures to treat Sanders IV fracture patterns.
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Affiliation(s)
- Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, 1900 South Avenue, La Crosse, WI 54601, USA.
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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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50
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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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