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Zhang Y, Weng Q, Chen J, Yang Y. Design and Biomechanical Finite Element Analysis of Spatial Weaving Infracalcaneal Fixator System. Orthop Surg 2024; 16:976-983. [PMID: 38438142 PMCID: PMC10984816 DOI: 10.1111/os.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE Traditional internal fixation of calcaneus fractures, involving lateral L-shaped incisions and plate fixation, has disadvantages such as increased operative exposure, eccentric plate fixation, and complications. The aim of this study was to design a Spatial Weaving Intra-calcaneal Fixator System (SWIFS) for the treatment of complex calcaneal fractures and to compare its biomechanical properties with those of traditional calcaneal plates. METHODS The computed tomography (CT) data of the normal adult calcaneus was used for modeling, and the largest trapezoidal column structure was cut and separated from the model and related parameters were measured. The SWIFS was designed within the target trapezoid, according to the characteristics of the fracture of the calcaneus. The Sanders model classification type IV calcaneal fracture was established in finite element software, and fixation with calcaneal plate and the SWIFS examined. Overall structural strength distribution and displacement in the two groups were compared. RESULTS The maximum 3D trapezoidal column in the calcaneus was constructed, and the dimensions were measured. The SWIFS and the corresponding guide device were successfully designed. In the one-legged erect position state, the SWIFS group exhibited a peak von Mises equivalent stress of 96.00 MPa, a maximum displacement of 0.31 mm, and a structural stiffness of 2258.06 N/mm. The conventional calcaneal plate showed a peak von Mises equivalent stress of 228.66 Mpa, a maximum displacement of 1.26 mm, and a structural stiffness of 555.56 N/mm. The SWIFS group exhibited a 75.40% decrease in displacement and a 306.45% increase in stiffness. CONCLUSION Compared with fixation by conventional calcaneal plate, the SWIFS provides better structural stability and effective stress distribution.
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Affiliation(s)
- Yong Zhang
- Department of Trauma Orthopedics SurgeryThe 6th Hospital of NingboNingboPeople's Republic of China
| | - Qiuyan Weng
- Department of NeurologyThe Affiliated Hospital of Medical School of Ningbo UniversityZhejiangPeople's Republic of China
| | - Jianming Chen
- Department of Trauma Orthopedics SurgeryThe 6th Hospital of NingboNingboPeople's Republic of China
| | - Yunfeng Yang
- Department of Orthopedics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
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Vosoughi AR, Medhati P, Hosseini E, Labidi M, Hoveidaei AH. Clinical outcomes following treatment of deep surgical site infection after fixation of calcaneal fractures: A retrospective case-control study. Foot Ankle Surg 2023; 29:334-340. [PMID: 37032190 DOI: 10.1016/j.fas.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/20/2023] [Accepted: 04/01/2023] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Deep surgical site infection (SSI) may be a complication of open reduction and internal fixation (ORIF) of calcaneal fractures. This study aimed to describe the characteristics of patients with deep SSI following ORIF of calcaneal fractures via extensile lateral approach (ELA). We compared clinical outcomes of these patients, with a minimum follow-up of one year after successful treatment of deep SSI with a matched control group. METHODS In this retrospective case-control study, demographic data, fracture characteristics, bacterial pathogens, medical treatments and surgical approaches were collected, also the outcome was evaluated by the visual analog scale (VAS) for pain, foot function index (FFI) and AOFAS ankle-hindfoot score. The differences in Böhler and Gissane's angles between infected and contralateral feet were measured. By matching a control group of uninfected cases, clinical outcomes were compared between 2 groups using the Mann-Whitney U test. RESULTS Among 331 calcaneus fractures in 308 patients (mean age, 38.0 ± 13.1; male/female ratio, 5.5), 21 had deep SSI (6.3 %). There were 16 (76.2 %) males and 5 (23.8 %) females with a mean age of 35.1 ± 11.7 years. Thirteen (61.9 %) patients had unilateral fractures. The most common Sanders Type was found to be type II. The most frequent type of detected microorganisms was Staphylococcus species. Intravenous antibiotic therapy, mostly clindamycin, imipenem and vancomycin, based on the microbiological results, was prescribed with a mean±SD duration of 28.1 ± 16.5 days. The mean number of surgical debridements was 1.8 ± 1.3. Implants needed to be removed in 16 (76.2 %) cases. Antibiotic-impregnated bone cement was applied in three (14.3 %) cases. The clinical outcomes of 15 cases (follow up, 35.5 ± 13.8; range, 12.6-64.5 months) were 4.1 ± 2.0, 16.7 ± 12.3 and 77.5 ± 20.8 for VAS for pain, FFI % and AOFAS ankle-hindfoot score, respectively. Comparing with the control group (VAS for pain, 2.3 ± 2.7; FFI %, 12.2 ± 16.6, and AOFAS, 84.6 ± 18.0), only VAS pain was statistically lower in this group (p-value: 0.012). The differences in Böhler and Gissane's angles between both feet of infected cases were - 14.3 ± 17.9 and - 7.7 ± 22.5 (worse in the infected side), respectively. CONCLUSION Proper on-time approaches to deep infection following ORIF of calcaneal fractures may lead to acceptable clinical and functional outcomes. Sometimes aggressive approaches with intravenous antibiotic therapy, multiple sessions of surgical debridement, removal of implants and antibiotic impregnated cement are necessary to eradicate deep infection. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Pourya Medhati
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elahe Hosseini
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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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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Wallace B, Chhabra A, Narayanan A, O'Neill D, Xi Y, Van Pelt M, Wukich DK, Liu G, Sanders D, Lalli T. Low Risk of Wound Complications With Sinus Tarsi Approach for Treatment of Calcaneus Fractures. J Foot Ankle Surg 2022; 61:771-775. [PMID: 34973867 DOI: 10.1053/j.jfas.2021.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/25/2021] [Accepted: 11/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Operative management displaced intra-articular calcaneus fractures is commonly associated with wound complications. Open reduction internal fixation is traditionally performed through the extensile lateral approach has relatively high rates of wound complications. The sinus tarsi approach to displaced intra-articular calcaneus fractures is a less invasive approach to achieve fracture reduction and fixation as well as reduce wound healing complications. The purpose of this study is to report the rates of wound complications associated with the sinus tarsi approach in the treatment of displaced intra-articular calcaneus fractures. METHODS We retrospectively identified patients treated with a limited sinus tarsi approach for displaced intra-articular calcaneus fractures from January 2009 to December 2018. Demographic and radiographic data were collected including age, gender, mechanism of injury, occupation, presence of diabetes mellitus, smoking status, Sanders classification, Bohler and Gissane angles. Postoperatively, we recorded the presence of complications, return-to-work time, and radiographic measurements. RESULTS One hundred and five fractures were identified in 100 patients who underwent open reduction internal fixation for displaced intra-articular calcaneus fractures. Using the Sanders computed tomographic classification, we identified 32% Type 2, 48% Type 3, 18% Type 4, and 2% tongue-type variants. For the preoperative Bohler's angle, 38% of fractures displayed a negative angle, 50% had an angle 0° to 20°, and 12% over 20°. Postoperatively, all patients demonstrated an improvement in Bohler's angle with 13% with 0° to 20° and 87% over 20°. Approximately, 72% of patients working prior to the injury had returned to work by 6 months, and 89% by 12 months. The wound complication rate was 11.9% (12/105), with 1.9% (2/105) requiring additional procedures. There was no significant difference in wound complication rates in smokers versus nonsmokers (11.9% vs 12.2%, p = .55). CONCLUSION Operative management of displaced intra-articular calcaneus fractures through the sinus tarsi approach allows restoration of calcaneal height with a low rate of wound complications, even among active smokers.
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Affiliation(s)
- Blake Wallace
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - David O'Neill
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Van Pelt
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - George Liu
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Drew Sanders
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Trapper Lalli
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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Khurana A, Sethi A, Gupta SC, Malik K, Arora S, Jain V. Expanding Indications of Primary Arthrodesis in Selected Individuals for Managing Complex Hindfoot Trauma During COVID-19 Pandemic. Indian J Orthop 2022; 56:485-491. [PMID: 34667332 PMCID: PMC8517065 DOI: 10.1007/s43465-021-00535-x] [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: 08/19/2021] [Accepted: 09/17/2021] [Indexed: 02/04/2023]
Abstract
Background During the COVID-19 pandemic, public health measures to encourage social distancing have been implemented, including cancellation of outdoor activities, organized sports, and schools/colleges. Neglected hindfoot fractures have emerged as a consequence with increased frequency. Similarly, complex ankle and pilon fractures that require staged management, prolonged hospital stay, and soft-tissue care have emerged as a potential concern as prolonged exposure to healthcare setting adds to risk of acquiring as well as transmitting COVID-19 infection. The authors present their experience with expanding these indications for hindfoot arthrodesis as they encounter a greater number of neglected ankle and hindfoot trauma. Methods This was a retrospective observational study of collected data from the trauma unit of our hospital. Inclusion criteria included all trauma classified by the AO/OTA as occurring at locations 43, and who underwent subtalar and ankle arthrodesis. This included distal tibia, malleolar, talus, and calcaneus fractures. These patients were followed up to at least 6 months till complete fracture union. Results A total of 18 patients underwent arthrodesis of either the ankle or subtalar joint between March and October 2020. Mean age of patients undergoing arthrodesis of the hindfoot was 69.2 years (43-84 years). Indications for the procedure included Displaced and comminuted intra-articular distal tibia fractures in elderly (6 patients), Malunited ankle fractures (2 patients), Neglected Ankle fractures managed conservatively (3 patients), Calcaneus fractures (5 patients), and neglected Talus body fracture (2 patients). All patients were followed up to at least 6 months and everyone went onto successful painless union between 3 and 6 months of the arthrodesis procedure without any significant complications. Conclusion In summary, COVID-19 pandemic has led to a change in paradigm of trauma management and foot and ankle management is no different than other musculoskeletal trauma systems. The authors propose an expansion of indications for hindfoot arthrodesis in managing complex hindfoot trauma in pandemic situation.
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Affiliation(s)
- Ankit Khurana
- Department of Orthopaedics, ESI Hospital Rohini, Delhi, India
| | - Ankita Sethi
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | | | - Kuldeep Malik
- Department of Orthopaedics, ESI Hospital Rohini, Delhi, India
| | - Sakshi Arora
- Department of Anaesthesia, ESI Hospital Rohini, Delhi, India
| | - Vishal Jain
- Department of Orthopaedics, ESI Hospital Rohini, Delhi, India
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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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Zhang Y, Weng Q, Gu Y, Chen J, Yang Y. Calcaneal fractures: 3D-printing model to assist spatial weaving of percutaneous screws versus conventional open fixation-a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2021; 45:2337-2346. [PMID: 34117504 DOI: 10.1007/s00264-021-05094-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study compared the clinical effectiveness and wound complications of a three-dimensional model-assisted spatial weaving screw fixation (3D-SWSF) versus open reduction and internal fixation (ORIF) via an L-shaped extensile lateral approach for calcaneal fractures. METHODS This single-centre retrospective cohort study was conducted with two cohort groups in which patients with Sanders II and III calcaneal fractures underwent 3D-SWSF or conventional ORIF. The clinical outcome measures included operation duration, time to operation, wound complications, blood loss volume, hospital stays, American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and visual analog scale (VAS) score. The pre-operative, post-operative, and one-year follow-up Gissane's angle (GA), Böhler's angle (BA), height, and width and length of the calcaneal fractures were also compared between the two groups. RESULTS From Oct 2015 to Oct 2019, 31 patients received 3D-SWSF and 41 received conventional ORIF. A total of 11 (26.8%) patients in ORIF group had wound complications, compared with only two (6.5%) in 3D-SWSF group (p = 0.032). Operative time, blood loss, and hospital stay in 3D-SWSF group were lesser than those in ORIF group. The patients treated with 3D-SWSF had better AOFAS and VAS scores than those treated with ORIF at the last follow-up. The post-operative and one-year follow-up radiographic indexes as well as the GA, BA, length, width, and height of the calcaneal fractures were relatively comparable between the two groups. CONCLUSION Our study revealed that 3D-SWSF could effectively decrease the risk of wound complications, shorten operation time, reduce length of hospitalization, and improve post-operative rehabilitation.
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Affiliation(s)
- Yong Zhang
- Department of Foot and Ankle Surgery, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.,Department of Trauma Orthopedics Surgery, Ningbo No.6 Hospital, Medical School of Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Qiuyan Weng
- Department of Neurology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang, China
| | - Yang Gu
- Department of Trauma Orthopedics Surgery, Ningbo No.6 Hospital, Medical School of Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Jianming Chen
- Department of Trauma Orthopedics Surgery, Ningbo No.6 Hospital, Medical School of Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Yunfeng Yang
- Department of Foot and Ankle Surgery, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
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Seat A, Seat C. Lateral Extensile Approach Versus Minimal Incision Approach for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: A Meta-analysis. J Foot Ankle Surg 2021; 59:356-366. [PMID: 32131003 DOI: 10.1053/j.jfas.2019.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 08/12/2019] [Indexed: 02/03/2023]
Abstract
Treatment of displaced intra-articular calcaneal fractures remains controversial. Therefore, the purpose of this large meta-analysis was to report the outcomes of the lateral extensile approach versus the minimal incision approach including complications, anatomic reduction, functional outcomes, and timing and to report results when only randomized control trials were compared. Five electronic databases were searched for articles directly comparing the 2 above approaches. Inclusion criteria included articles published from January 2007 to April 2017, adults (>18 years old) with closed, Sanders type II or III fractures, mean follow-up time of ≥12 months, and ≥1 primary outcome reported. Seventeen randomized control trials and 10 retrospective studies were included. There were 2179 participants with 2274 fractures, and mean follow-up of 22.41 months. Our results revealed no statistically significant difference in Gissane's angle, calcaneal width, calcaneal length, deep infection, or subtalar stiffness. When taking into consideration only randomized control trials, there was no statistically significant difference between groups comparing postoperative Bohler's or Gissane's angle. There was a statistically significant difference in wound complications, superficial infection, sural nerve injury, visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scores, operative time, time to operating room, calcaneal height, and postoperative Bohler's angle (when all studies were considered), all in favor of the minimal incision approach. These results remained statistically significant when only the randomized controlled trials were compared, with the exception of Bohler's angle and VAS and AOFAS scores. The results of this meta-analysis indicate that the minimal incision approach is a good alternative to the standard lateral extensile approach.
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Affiliation(s)
- Andrea Seat
- Resident PGY-3, Department of Podiatry, Jesse Brown VA Medical Center, Chicago, IL.
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Xue D, Lou B, Tan R, Yu H. Comparison between open reduction and internal fixation and minimally invasive surgery in management of Sanders type II calcaneal fracture: A randomized controlled trial protocol. Medicine (Baltimore) 2020; 99:e23813. [PMID: 33371160 PMCID: PMC7748367 DOI: 10.1097/md.0000000000023813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The minimally invasive surgery possesses an essential and growing function in treating the calcaneal fractures, but the related literature on this topic is limited. For our study, the main purpose was to compare the early prognosis of a group of the patients with Sanders type II fracture of calcaneus treated via minimally invasive surgery and open reduction and internal fixation (ORIF). METHODS This is a prospective randomized controlled trial in the patients who suffer from displaced intra-articular calcaneal fractures. This current study was carried out in accordance with the guidelines of "CONSORT statement" for the randomized controlled studies. All patients were randomly assigned into 2 groups on the basis of a random number table, namely the minimally invasive treatment group and the ORIF group using conventional methods. Inclusion criteria included the followings: aged between 18 to 59 years old; closed and unilateral fracture; patients with displaced intra-articular calcaneal fracture (>2 mm) involving Sanders Type IIC and Type IIB; and patients have enough mental capacity to understand and answer questions in the evaluation scale. In the process of outpatient follow-up, the radiographs were taken at 1, 3, 6, and 12 months. The functional results involved the American Orthopaedic Foot and Ankle Score, Foot Function Index, and the pain score. CONCLUSIONS This protocol will give us research directions in future work. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry6261).
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Affiliation(s)
| | - Baozhen Lou
- Department of Anesthesiology, PLA Army 80th Group Military Hospital, Shandong, China
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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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Surgically treated calcaneal joint fractures: What does postoperative computed tomography give us? Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Whittaker GA, Munteanu SE, Roddy E, Menz HB. Measures of Foot Pain, Foot Function, and General Foot Health. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:294-320. [PMID: 33091250 DOI: 10.1002/acr.24208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/02/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Glen A Whittaker
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Shannon E Munteanu
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, Chesterfield, UK, School of Primary, Community and Social Care, Keele University, Keele, UK, and Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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Ojeda-Jiménez J, Rendón-Díaz D, Martín-Vélez P, González-Martín D, Boluda-Mengod J, Méndez-Ojeda M, Pais-Brito JL, Herrera-Pérez M. Surgically treated calcaneal joint fractures: what does postoperative computed tomography give us? Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:393-400. [PMID: 32792284 DOI: 10.1016/j.recot.2020.06.001] [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: 01/02/2020] [Revised: 04/18/2020] [Accepted: 06/14/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION There is currently great controversy about the ideal treatment of intraarticular calcaneal fractures. The objective of this study is to determine the usefulness of postoperative computed tomography (CT). PATIENTS AND METHODS We conducted a retrospective descriptive study of patients operated on in the period 2007 to 2015 in our center. Epidemiological variables, specific fracture data, surgical intervention as well as results and complications were collected. The radiological evaluation was performed using simple radiology (Böhler angle) and coronal CT (congruence of posterior subtalar joint). For the functional results we use the AOFAS hindfoot scale and the EVA scale for the level of pain. RESULTS We included 46 fractures in 43 patients (three bilateral). Thirty-five were male and eight female, with an average age of 42 years (18-79) and an average follow-up of 57.39 months (33-129). Preoperative CT was performed in all cases, of which 11 were Sanders ii, 23 type iii and 12 type iv. Postoperative CT was only performed in 17 cases. The subsequent subtalar reduction measured by CT was satisfactory (articular step < 2 mm) in 12 cases. The average presurgical Böhler angle was 6.45 ± 10.21 ([-22]-25) and the post-surgical angle of 20.46 ± 7.09 (4-38). Subtalar osteoarthritis developed in 19 cases (symptomatic in 12) and calcaneo-cuboid osteoarthritis in six cases (only one symptomatic). The AOFAS was 74.28 ± 18.98 (27-100) and the EVA was 4.14 ± 2.98 (2-9). A CT scan with a step of less than 2 mm was statistically significant, with a higher result on the AOFAS scale (77.17 average points) as well as lower EVA on average (2.83) (p = 0.002). Regarding the Böhler, it was statistically significant the relationship of an angle > 20° post-surgical with higher AOFAS (80.82) and lower VAS (3.18) (p = 0.001). The literature search obtained a total of 117 articles that met the search criteria, of which only 29 requested postoperative CT. CONCLUSIONS The indication of postoperative CT in patients operated by intraarticular calcaneal fracture is the best technique to corroborate the correct reduction of the subtalar joint surface, although it is not universally accepted, according to the literature.
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Affiliation(s)
- J Ojeda-Jiménez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España; Unidad Docente Acreditada de Pie y Tobillo, Hospital Universitario de Canarias, Tenerife, España
| | - D Rendón-Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España; Unidad Docente Acreditada de Pie y Tobillo, Hospital Universitario de Canarias, Tenerife, España
| | - P Martín-Vélez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España
| | - D González-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España
| | - J Boluda-Mengod
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España
| | - M Méndez-Ojeda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España
| | - J L Pais-Brito
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España; Facultad de Medicina, Universidad de La Laguna, Tenerife, España
| | - M Herrera-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España; Unidad Docente Acreditada de Pie y Tobillo, Hospital Universitario de Canarias, Tenerife, España; Facultad de Medicina, Universidad de La Laguna, Tenerife, España.
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Grün W, Molund M, Nilsen F, Stødle AH. Results After Percutaneous and Arthroscopically Assisted Osteosynthesis of Calcaneal Fractures. Foot Ankle Int 2020; 41:689-697. [PMID: 32412812 PMCID: PMC7294532 DOI: 10.1177/1071100720914856] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Operative treatment of calcaneal fractures using the extensile lateral approach is associated with high rates of soft tissue complications. In the past years, there has been a trend toward less invasive surgical approaches. Percutaneous and arthroscopically assisted calcaneal osteosynthesis (PACO) combines the advantages of visualization of the posterior facet of the subtalar joint with a minimally invasive approach. METHODS We conducted a follow-up of 25 patients with 26 calcaneal fractures (Sanders II and III), treated with PACO with a minimum follow-up of 12 months. The median age was 44 years (range, 21-72) and the follow-up period 15 months (12-33). Our clinical outcomes were the Manchester-Oxford Foot Questionnaire (MOxFQ), the Calcaneus Fracture Scoring System (CFSS), the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, the Short-Form-36 (SF-36), the visual analog scale (VAS) for pain, and the number of complications. Radiographs on follow-up were obtained to evaluate the reduction of the fractures as well as osteoarthritis of the subtalar joint. RESULTS The median MOxFQ score was 26.6 (0-76.6), the CFSS score 85 (26-100), and the AOFAS score 85 (50-100). The VAS pain score was 0 (0-5.7) at rest and 4.1 (0-8.2) during activity. The Böhler angle improved from a mean (SD) of 3.5 (12.3) degrees preoperatively to 27.7 (10.5) degrees postoperatively. The follow-up radiographs showed subsidence of the fractures and a Böhler angle of 20.3 (12.9) degrees. There were no wound-healing complications. Two patients had additional surgery with screw removal due to prominent hardware. CONCLUSION Our results suggest that PACO gives good clinical outcomes and a low risk of complications in selected calcaneal fractures. Prospective long-term studies will be necessary to better document the potential advantages and limitations of this operating technique. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Wolfram Grün
- Department of Orthopaedic Surgery, Østfold Hospital, Grålum, Norway,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway,Wolfram Grün, MD, Ortopedisk avdeling, Oslo universitetssykehus, Kirkeveien 166, Oslo, 0450, Norway.
| | - Marius Molund
- Department of Orthopaedic Surgery, Østfold Hospital, Grålum, Norway
| | - Fredrik Nilsen
- Department of Orthopaedic Surgery, Østfold Hospital, Grålum, Norway
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Nosewicz TL, Dingemans SA, Backes M, Luitse JSK, Goslings JC, Schepers T. A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures. Foot Ankle Surg 2019; 25:580-588. [PMID: 30321924 DOI: 10.1016/j.fas.2018.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/26/2018] [Accepted: 08/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal surgical approach for displaced intra-articular calcaneal fractures (DIACF) is subject of debate. The primary aim of this systematic review and meta-analysis was to assess wound-healing complications following the sinus tarsi approach (STA) compared to the extended lateral approach (ELA). Secondary aims were to assess time to surgery, operative time, calcaneal anatomy restoration, functional outcome, implant removal and injury to the peroneal tendons and sural nerve. METHODS MEDLINE, EMBASE and Cochrane databases were searched for clinical studies comparing the STA and the ELA (until September 2017). RESULTS Nine studies were included (two randomized controlled trials; seven comparative studies). 326 patients (331 fractures) were treated by the STA and 383 patients (390 fractures) by ELA. Ninety-nine per cent were Sanders type II/III fractures. Wound healing complications in the STA and ELA occurred in 11/331 and 82/390 fractures, respectively. Weighted means were 4.9% and 24.9%, respectively. Meta-analysis showed significantly less wound healing complications in the STA compared to ELA (risk ratio 0.20; 95% CI 0.11-0.36; P<0.00001; I2=0%). In general, time to surgery and operative time were shorter in the STA. Meta-analysis was not possible due to heterogeneity between studies. No differences were found in remaining secondary outcomes. CONCLUSIONS The STA is associated with significantly less wound healing complications. With similar functional outcome and calcaneal anatomy restoration, the STA may be the preferred approach in the operative treatment of Sanders type II/III DIACF.
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Affiliation(s)
- Tomasz L Nosewicz
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Siem A Dingemans
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Manouk Backes
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Jan S K Luitse
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Tim Schepers
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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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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17
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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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18
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Prabhakar S, Dhillon MS, Khurana A, John R. The "Open-Envelope" Approach: A Limited Open Approach for Calcaneal Fracture Fixation. Indian J Orthop 2018; 52:231-238. [PMID: 29887624 PMCID: PMC5961259 DOI: 10.4103/ortho.ijortho_576_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) has a significant and evolving role in the treatment of displaced intra articular calcaneal fractures (DIACFs), but there is limited literature on this subject. The objective was hence to assess the clinicoradiological outcomes of DIACFs fixed with an innovative open-envelope MIS technique. MATERIALS AND METHODS 42 closed Sanders Type 2 and 3; DIACFs were included in this study. The Open-envelope approach was developed, which is essentially a limited open, dual incision, modified posterior longitudinal approach allowing excellent visualisation and direct fragment manipulation. The main outcome measures were American Orthopaedic Foot and Ankle Score (AOFAS) hindfoot score and preoperative and postoperative radiological angles. RESULTS The Bohler angle improved from a preoperative mean of 14.3° (range 0°-28°) to a postoperative mean of 32.46° (range 22°-42°). The Gissane angle improved from a preoperative mean of 135.83° to a postoperative mean of 128.33°. The postoperative improvement in Bohler and Gissane angles was highly significant (P < 0.001). The AOFAS scores at 6 months were excellent in nine patients, good in 15 patients, and fair in six patients. Three patients had residual valgus deformity of the heel. CONCLUSIONS Open-envelope technique minimized soft tissue complications and achieved acceptable radiological reductions with good clinical outcomes.
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Affiliation(s)
- Sharad Prabhakar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Mandeep S Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Ankit Khurana
- Department of Orthopaedics, All India Institute of Medical Sciences, India
| | - Rakesh John
- Department of Orthopaedics, Delhi Institute of Trauma and Orthopaedics, Sant Parmanand Hospital, New Delhi, India
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Angthong C. Treatment of Malunited Calcaneal Fracture With Posttraumatic Subtalar Osteoarthritis Using Lateral Endoscopic Calcaneoplasty With Posterior Arthroscopic Subtalar Arthrodesis. Arthrosc Tech 2018; 7:e245-e249. [PMID: 29881696 PMCID: PMC5989732 DOI: 10.1016/j.eats.2017.08.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/29/2017] [Indexed: 02/03/2023] Open
Abstract
Malunion of calcaneal fractures is a common complication after improper nonoperative treatment. It may develop into posttraumatic subtalar osteoarthritis, lateral calcaneal wall prominence, and severe foot deformities. This Technical Note reports the technical aspects of lateral endoscopic calcaneoplasty with posterior arthroscopic subtalar arthrodesis for the treatment of malunited calcaneal fracture with lateral calcaneal wall prominence and posttraumatic subtalar osteoarthritis. This technique was chosen because it can reduce the risk of wound complication compared with a conventional lateral extensile approach. This Technical Note describes the use of the technique in a patient with prone position. This offers the advantages of easier access to the lateral surface of the calcaneus and posterior facet of the subtalar joint, and is less invasive to the soft tissue envelope on the lateral side of the foot. Moreover, the concomitant bone void area of the subtalar joint can be dealt with by an arthroscopic procedure.
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Affiliation(s)
- Chayanin Angthong
- Address correspondence to Chayanin Angthong, M.D., Ph.D., Department of Orthopaedics, Faculty of Medicine, Thammasat University, Kunakorn Building fl.7, Klong Luang, Pathum Thani 12120, Thailand.
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Minimally invasive versus extensile lateral approach for sanders type II and III calcaneal fractures: A meta-analysis of randomized controlled trials. Int J Surg 2018; 50:146-153. [DOI: 10.1016/j.ijsu.2017.12.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/19/2017] [Accepted: 12/25/2017] [Indexed: 11/19/2022]
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21
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Dhillon MS. Complex Hindfoot and Ankle Trauma: The Management Status in 2018. Indian J Orthop 2018; 52:217-219. [PMID: 29887622 PMCID: PMC5961257 DOI: 10.4103/ortho.ijortho_216_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Mandeep S Dhillon
- Guest Editor, Department of Orthopedic Surgery, PGIMER, Chandigarh, India,Address for correspondence: Dr. Mandeep S Dhillon, 1027, Sector 24 B, Chandigarh, India. E-mail:
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Park CH, Lee DY. Author's reply. Indian J Orthop 2018; 52:210-212. [PMID: 29576652 PMCID: PMC5858218 DOI: 10.4103/ortho.ijortho_621_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Chul Hyun Park
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea,Address for correspondence: Prof. Chul Hyun Park Department of Orthopaedic Surgery, Yeungnam University Hospital, 317-1, Daemyong-Dong, Nam-Gu, Daegu 705-717, South Korea. E-mail:
| | - Dong Yeol Lee
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea
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Dhillon MS, Prabhakar S. Treatment of displaced intra-articular calcaneus fractures: a current concepts review. SICOT J 2017; 3:59. [PMID: 29034875 PMCID: PMC5642053 DOI: 10.1051/sicotj/2017044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/28/2017] [Indexed: 11/15/2022] Open
Abstract
Displaced Intra-Articular Calcaneus fractures (DIACFs) represent a source of tremendous disability to the patient, economic burden to the society and a treatment challenge to the average orthopaedic surgeon. To date, no single approach is universally applicable to all calcaneus fractures. Despite a plethora of published meta-analyses and recent randomized controlled trials, the literature is still unclear and offers conflicting recommendations. The aim of this current concepts review is to assess the latest available data and offer pragmatic and practical recommendations to address some of the issues surrounding DIACFs.
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Affiliation(s)
- Mandeep S. Dhillon
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Department of Orthopaedics, Post Graduate Institute of Medical Education and Research Sector 12 Chandigarh
160012 India
| | - Sharad Prabhakar
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Department of Orthopaedics, Post Graduate Institute of Medical Education and Research Sector 12 Chandigarh
160012 India
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