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Attenasio A, Heiman E, Hong IS, Bhalla AP, Jankowski JM, Yoon RS, Liporace FA, Dziadosz D. Postoperative wound complications in extensile lateral approach versus sinus tarsi approach for calcaneal fractures: Are we improving? Updated meta-analysis of recent literature. Injury 2024; 55:111560. [PMID: 38729077 DOI: 10.1016/j.injury.2024.111560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION To analyze recent literature comparing clinical outcomes of displaced intra-articular calcaneal fractures (DIACF) treated with open reduction and internal fixation using the extensile lateral approach (ELA) vs the minimally invasive sinus tarsi approach (STA), with a focus on wound complications. MATERIALS AND METHODS A comprehensive literature search was conducted utilizing PubMed, EMBASE, and Cochrane Library databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 2013 and 2022, level of evidence (LOE) I-III, head-to-head comparative studies reporting on clinical outcomes after DIACFs treated with ORIF using ELA versus STA, and literature with full-text written in English were included. Data collection included: publication year, study design, number of surgeons, number of participants, demographic data (mean age at time of surgery, percent male, body mass index, medical co-morbidities), preoperative data (mechanism of injury, Sanders classification, time from injury to surgical fixation), intraoperative data, and postoperative clinical and radiographic outcomes (Böhler angle, angle of Gissane, calcaneal height/length/width). RESULTS A total of 21 articles (4 randomized control trials, 17 cohort studies) comprising of 2086 patients with calcaneal fractures, treated with either ELA (n = 1129) or STA (n = 957) met inclusion criteria. The risk of postoperative wound-related complications (RR 2.82, 95 % CI: 2.00-3.98, I2=27 %) and the risk of reoperation (RR 1.85, 95 % CI: 0.69-5.00, I2=67 %) was higher in ELA patients comparted to STA patients. However, the increased risk of postoperative wound-related complications with an ELA vs. STA was shown to be trending downward in recent publications. The ELA group also experienced longer time to surgery, extended operative times, and prolonged hospital stays when compared to the STA group. Radiographic measurements at final follow-up, including Böhler angle, angle of Gissane, as well as calcaneal height, length, and width, showed no statistically significant differences between the two groups. CONCLUSION Surgical treatment of calcaneal fractures utilizing the ELA continues to have an increased rate of complications and reoperation when compared to the less invasive STA, yet recent trends in the literature show that this rate is decreasing. Operative treatment of calcaneal fractures via either an ELA or STA can both achieve comparable postoperative radiographic outcomes. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Andrea Attenasio
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
| | - Erick Heiman
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
| | - Ian S Hong
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
| | - Aditya Paul Bhalla
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
| | - Jaclyn M Jankowski
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
| | - Richard S Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA.
| | - Frank A Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
| | - Daniel Dziadosz
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, Livingston, NJ/Jersey City, NJ, USA
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Rebbert S, Pflüger P, Crönlein M. [Surgical treatment of intra-articular calcaneus fractures with plate osteosynthesis via the sinus tarsi approach]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:370-376. [PMID: 37311920 DOI: 10.1007/s00064-023-00816-8] [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: 06/15/2022] [Revised: 09/15/2022] [Accepted: 10/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Surgical treatment of intra-articular calcaneus fractures via a minimally invasive approach. INDICATIONS Intra-articular dislocated calcaneus fractures. CONTRAINDICATIONS Fracture older than 14 days; poor soft tissue quality in the surgical area. SURGICAL TECHNIQUE Patient in lateral position. Identifying the anatomic landmarks. Incision (3-5 cm) from the tip of the fibula to metatarsal IV. Preparation through the subcutis. Retraction of the peroneal tendons. Preparation of the lateral calcaneal wall and later plate position via raspatory. Placement of a Schanz screw in the calcaneal tuberosity from lateral or posterior as a reduction aid for restoring of the calcaneal length and reduction of the hindfoot varus. Reduction of the sustentaculum fragment with the help of fluoroscopy from lateral. Elevation of the subtalar articular surface. Positioning of the calcaneal plate and fixation of the sustentaculum fragment by placing a cannulated screw through the long hole. Afterwards, definite internal fixation of the reduction with locking screws. Completion of the operation with final X‑rays and, if available, an intraoperative computed tomography. Wound closure with closing of the peroneal sheath. POSTOPERATIVE MANAGEMENT Lower leg-foot orthoses. Mobilization with partial weight-bearing of the injured foot with 15 kg for 6-8 weeks; subsequently increased load bearing. RESULTS Due to the smaller incision and the associated lower soft tissue trauma, the risk of wound healing complications can be reduced. Radiographic and functional outcomes are comparable to the outcomes of calcaneal fractures treated via the extended lateral approach.
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Affiliation(s)
- Sophie Rebbert
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Patrick Pflüger
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Moritz Crönlein
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Lewis SR, Pritchard MW, Solomon JL, Griffin XL, Bruce J. Surgical versus non-surgical interventions for displaced intra-articular calcaneal fractures. Cochrane Database Syst Rev 2023; 11:CD008628. [PMID: 37933733 PMCID: PMC10628987 DOI: 10.1002/14651858.cd008628.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Fractures of the calcaneus (heel bone) comprise up to 2% of all fractures. These fractures are mostly caused by a fall from a height, and are common in younger adults. Treatment can be surgical or non-surgical; however, there is clinical uncertainty over optimal management. This is an update of a Cochrane Review first published in 2013. OBJECTIVES To assess the effects (benefits and harms) of surgical versus conservative treatment of displaced intra-articular calcaneal fractures. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL, MEDLINE, Embase, and clinical trials registers in November 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs comparing surgical versus non-surgical management of displaced intra-articular calcaneal fractures in skeletally mature adults (older than 14 years of age). For surgical treatment, we included closed manipulation with percutaneous wire fixation, open reduction with internal fixation (ORIF) with or without bone graft, or primary arthrodesis. For non-surgical treatment, we included ice, elevation and rest, or plaster cast or splint immobilisation. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. We collected data for the following outcomes: function in the short term (within three months of injury) or long term (more than three months after injury), chronic pain, health-related quality of life (HRQoL) and ability to return to normal activities, as well as complications which may or may not have led to an unplanned return to theatre. MAIN RESULTS We included 10 RCTs and two quasi-RCTs with 1097 participants. Sample sizes in studies ranged from 29 to 424 participants. Most participants were male (86%), and the mean age in studies ranged from 28 to 52 years. In the surgical groups, participants were mostly managed with ORIF with plates, screws, or wires; one study used only minimally invasive techniques. Participants in the non-surgical groups were managed with a plaster cast, removable splint or a bandage, or with rest, elevation, and sometimes ice. Risk of performance bias was unavoidably high in all studies as it was not possible to blind participants and personnel to treatment; in addition, some studies were at high or unclear risk of other types of bias (including high risk of selection bias for quasi-RCTs, high risk of attrition bias, and unclear risk of selective reporting bias). We downgraded the certainty of all the evidence for serious risk of bias. We also downgraded the certainty of the evidence for imprecision for all outcomes (except for complications requiring return to theatre for subtalar arthrodesis) because the evidence was derived from few participants. We downgraded the evidence for subtalar arthrodesis for inconsistency because the pooled data included high levels of statistical heterogeneity. We found that surgical management may improve function at six to 24 months after injury when measured using the American Orthopaedic Foot and Ankle Society (AOFAS) score (mean difference (MD) 6.58, 95% confidence interval (CI) 1.04 to 12.12; 5 studies, 319 participants; low-certainty evidence). We are not aware of a published minimal clinically important difference (MCID) for the AOFAS score for this type of fracture. Previously published MCIDs for other foot conditions range from 2.0 to 7.9. No studies reported short-term function within three months of injury. Surgical management may reduce the number of people with chronic pain up to 24 months after injury (risk ratio (RR) 0.56, 95% CI 0.37 to 0.84; 4 studies, 175 participants; low-certainty evidence); this equates to 295 per 1000 fewer people with pain after surgical management (95% CI 107 to 422 per 1000). Surgical management may also lead to improved physical HRQoL (MD 6.49, 95% CI 2.49 to 10.48; 2 studies, 192 participants; low-certainty evidence). This outcome was measured using the physical component score of the 36-Item Short Form Health Survey. We used a change in effect of 5% to indicate a clinically important difference for this scoring system and thus judged that the difference in HRQoL between people treated surgically or non-surgically includes both clinically relevant and not relevant changes for those treated surgically. There may be little or no difference in the number of people who returned to work within 24 months (RR 1.26, 95% CI 0.94 to 1.68; 5 studies, 250 participants; low-certainty evidence) or who require secondary surgery for subtalar arthrodesis (RR 0.38, 95% CI 0.09 to 1.53; 3 studies, 657 participants; low-certainty evidence). For other complications requiring return to theatre in people treated surgically, we found low-certainty evidence for amputation (2.4%; 1 study, 42 participants), implant removal (3.4%; 3 studies, 321 participants), deep infection (5.3%; 1 study, 206 participants), and wound debridement (2.7%; 1 study, 73 participants). We found low-certainty evidence that 14% of participants who were treated surgically (7 studies, 847 participants) had superficial site infection. AUTHORS' CONCLUSIONS Our confidence in the evidence is limited. Although pooled evidence indicated that surgical treatment may lead to improved functional outcome but with an increased risk of unplanned second operations, we judged the evidence to be of low certainty as it was often derived from few participants in studies that were not sufficiently robust in design. We found no evidence of a difference between treatment options in the number of people who needed late reconstruction surgery for subtalar arthritis, although the estimate included the possibility of important harms and benefits. Large, well-conducted studies that attempt to minimise detection bias and that measure functional outcomes using calcaneal-specific measurement tools would increase the confidence in these findings. Given that minimally invasive surgical procedures are already becoming more prevalent in practice, research is urgently needed to determine whether these newer surgical techniques offer better outcomes with regard to function, pain, quality of life, and postoperative complications for intra-articular displaced calcaneal fractures.
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Affiliation(s)
- Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Michael W Pritchard
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | | | - Xavier L Griffin
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Julie Bruce
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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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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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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Delmon R, Vendeuvre T, Pries P, Aubert K, Germaneau A, Severyns M. Percutaneous balloon calcaneoplasty versus open reduction and internal fixation (ORIF) for intraarticular SANDERS 2B calcaneal fracture: Comparison of primary stability using a finite element method. Injury 2023:S0020-1383(23)00272-3. [PMID: 36997362 DOI: 10.1016/j.injury.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/25/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Fractures of the calcaneus are common, with 65% being intra-articular, which can lead to a major impairment of the patient's quality of life. Open reduction and internal fixation with locking plates can be considered as gold-standard technique but has a high rate of post-operative complications. Minimally invasive calcaneoplasty combined with minimally invasive screw osteosynthesis is largely drawn from the management of depressed lumbar or tibial plateau fractures. The hypothesis of this study is that calcaneoplasty associated with minimally invasive percutaneous screw osteosynthesis presents biomechanical characteristics comparable with conventional osteosynthesis. MATERIALS AND METHODS Eight hind feet were collected. A SANDERS 2B fracture was reproduced on each specimen, while four calcanei were reduced by a balloon calcaneoplasty method and fixed with a lateral screw, four others were manually reduced and fixed with conventional osteosynthesis. Each calcaneus was then segmented for 3D finite element modeling. A vertical load was applied to the joint surface in order to measure the displacement fields and the stress distribution according to the type of osteosynthesis. RESULTS Analyses of the intra-articular displacement fields showed lower overall displacements in calcaneal joints treated with calcaneoplasty and lateral screw fixation. Better stress distribution was found in the calcaneoplasty group with lower equivalent joint stresses. These results could be explained by the role of the PMMA cement as a strut, enabling better load transfer. CONCLUSION Balloon Calcaneoplasty combined with lateral screw osteosynthesis has biomechanical characteristics at least comparable to locking plate fixation in the treatment of SANDERS 2B calcaneal joint fractures in terms of displacement fields and stress distribution under the premise of anatomical reduction.
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Affiliation(s)
- Romain Delmon
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France
| | - Tanguy Vendeuvre
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France; Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Pierre Pries
- Orthopedic and Traumatology department, University Hospital of Poitiers, Poitiers, France
| | - Kevin Aubert
- Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Arnaud Germaneau
- Pprime Institut UPR 3346, CNRS - University of Poitiers - ENSMA, Poitiers, France
| | - Mathieu Severyns
- Orthopedic and traumatology department, Clinique Porte Océane, Les Sables d'Olonne, France.
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ŞAHAN K, POLAT A, KILIÇ F, KAZDAL C, FİDAN F, ÖZKAYA U. Comparison of clinical and radiological outcomes between extended lateral and sinus tarsi approach in the surgical treatment of displaced intraarticular calcaneal fractures surgery. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1164835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: The aim of this stud was to compare the clinical and radiological results between Sinus-tarsi (ST) and Extended-Lateral (EL) approaches in open reduction internal fixation of intra-articular calcaneal fractures.
Materials and Methods: 51 calcaneal fractures of 48 patients surgically treated between 2012 and 2017 were retrospectively analyzed. The patients were divided into two groups. Preoperative CT, early postoperative and postoperative 1st-year radiographs, and The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score scores were evaluated.
Results: According to the Sanders classification, nine patients in the EL group were type 2(36%), 16 patients type 3 (64%), 8 patients in ST group type 234.8%), 13 patients (56.5%) type 3, 2 patients (8.7%) type 4. The mean AOFAS-Hindfoot score was 85(63-100) in the ST group and 83(52-93) in the LE group at one year. Mean preoperative waiting time was shorter, with an average of 2(1-4) days in ST and 6(3-12) days in LE.
Conclusion: ST approach shortens the preoperative waiting time in intra-articular calcaneal fracture surgery, provides a sufficient vision for anatomical restoration, and effectively avoids complications.
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Affiliation(s)
- Kemal ŞAHAN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL GAZİOSMANPAŞA SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Abdulkadir POLAT
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL GAZİOSMANPAŞA SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Feyzi KILIÇ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL GAZİOSMANPAŞA SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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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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Prather J, Wilson J, Abyar E, Young S, McGwin G, Crocker CC, Patch DA, Johnson MD. Exposure of the Calcaneus in the Sinus Tarsi Approach Versus the Lateral Extensile Approach: A Cadaveric Study. Foot Ankle Spec 2022:19386400221114488. [PMID: 35880349 DOI: 10.1177/19386400221114488] [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: 11/15/2022]
Abstract
BACKGROUND The lateral extensile approach (LEA) is an operative approach for calcaneal fractures. High rates of wound complications have led to alternative approaches such as the sinus tarsi approach to grow in popularity. The LEA affords substantial visualization of the calcaneus. This visualization has never been compared in a quantitative manner with the sinus tarsi approach (STA). We aim to quantify the calcaneal visualization afforded by STA and LEA. METHODS Seven pair-matched, fresh-frozen, below-knee cadaver extremities were included. For each pair, one side received an LEA and the other side received an STA. RESULTS There were no statistically significant differences in the articular surfaces accessible between the 2 approaches. The total calcaneal surface area accessible was 3107.08 mm2 for LEA and 1444.19 mm2 for STA (P = .02). The LEA allowed better exposure to the lateral wall (P = .01) and the dorsal tuberosity of the calcaneus (P = .04). CONCLUSION The STA allows for equivalent articular surface exposure when compared with the LEA. Although LEA allows for greater exposure of the lateral wall and dorsal tuberosity, direct visualization of these structures may not warrant the higher risk of wound complications. Surgeons should consider these differences when choosing an operative approach in the treatment of calcaneal fractures. Level III.
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Affiliation(s)
- John Prather
- University of Alabama at Birmingham, Birmingham, Alabama
| | - John Wilson
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Eildar Abyar
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Sean Young
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Gerald McGwin
- University of Alabama at Birmingham, Birmingham, Alabama
- Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
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Reed LA, Mihas A, Andrews NA, Agarwal A, Wall KC, Spitler CA, Johnson MD. Complication Rates Are Similar Between Patients Aged <50 and >50 Years in Calcaneus Fractures Treated With the Sinus Tarsi Approach. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221115678. [PMID: 35959140 PMCID: PMC9358586 DOI: 10.1177/24730114221115678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The sinus tarsi (ST) approach for calcaneus fractures has gained popularity in recent years with an increased interest in shifting to less invasive approaches for calcaneal fracture fixation allowing for adequate fixation if complications do not arise. Although the ST approach has gained acceptance as standard for calcaneus fracture fixation, the literature surrounding early complications rates based on age differences for this specific approach and pathology is lacking. The objective of this study was to determine if rates of complications based on age varied for patients undergoing open reduction and internal fixation (ORIF) of closed calcaneus fractures using the ST approach. Methods: A retrospective review of patients undergoing ORIF for closed calcaneus fractures from 2012 to 2020 was performed. Inclusion criteria were based on an age greater than 18 years, surgical management of a closed calcaneus fracture using a ST approach, requirement of a preoperative computed tomographic scan, and a minimum of 180 days’ follow-up. Patients were divided into 2 groups: those aged <50 years and those aged >50 years. Results: A total of 196 fractures were included with 114 fractures in the <50-year age group and 82 fractures in the >50-year age group. Mean age was 34.2 and 59.7 years in the younger and older groups, respectively. The older group had similar rates of wound dehiscence (1.2% vs 4.4%, P = .204), superficial surgical site infection (1.2% vs 2.6%, P = .490), deep infection (9.8% vs 7.9%, P = .648), and nonunion (4.9% vs 3.5%, P = .633) compared with the younger group. Rates of 30-day readmission, unplanned reoperation, and symptomatic hardware were not significantly different. Postoperative Bohler and Gissane angles were not significantly different between both groups. Conclusion: Older patients with intraarticular calcaneus fractures treated via the ST approach maintain complication rates similar to those in younger individuals. Level of Evidence: Level III, retrospective study.
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Affiliation(s)
- Logan A. Reed
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexander Mihas
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicholas A. Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abhinav Agarwal
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin C. Wall
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Clay A. Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael D. Johnson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Rafaqat W, Ahmad T, Ibrahim MT, Kumar S, Bluman EM, Khan KS. Is minimally invasive orthopedic surgery safer than open? A systematic review of systematic reviews. Int J Surg 2022; 101:106616. [PMID: 35427798 DOI: 10.1016/j.ijsu.2022.106616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND To assess the safety of minimally invasive surgery (MIS) for orthopedic spinal, upper limb and lower limb procedures, this systematic review of systematic reviews compared their complications with open procedures. MATERIALS AND METHODS A literature search was conducted electronically (PubMed, Cochrane library and Web of Science; May 8, 2021) without language restriction in the past five years. Reviews that consulted at least two databases, compared MIS with open orthopedic surgery, and reported the following: intraoperative, post-operative or total complications, function, ambulation, pain, hospital stay, reoperation rate and operation time were included. Article selection, quality assessment using AMSTAR-2, and data extraction were conducted in duplicate on predesigned forms. In each review, a subset analysis focusing on prospective cohort and randomized studies was additionally performed. PROSPERO CRD42020178171. RESULTS The search yielded 531 articles from which 76 reviews consisting of 1104 primary studies were included. All reviews were assessed as being low quality. Compared to open surgery, MIS had fewer total, postoperative and intraoperative complications in 2/10, 2/11 and 2/5 reviews of spinal procedures respectively, 1/3, 1/4 and 1/2 reviews of upper limb procedures respectively, and 4/6, 2/7 and 0/2 reviews of lower limb procedures respectively. CONCLUSIONS MIS had greater overall safety compared to open surgery in spinal procedures. In upper limb and lower limb procedures, MIS was not outright superior to open procedures in terms of safety hence a general preference of MIS is not justified on the premise of a better safety profile compared to open procedures.
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Management of displaced intra-articular calcaneal fractures; current concept review and treatment algorithm. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:779-785. [PMID: 35429277 DOI: 10.1007/s00590-022-03264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
Calcaneum fractures are debilitating injuries with high complication rates and poor functional outcomes after both operative and non-operative management. The optimal management of such fractures is still highly debated in the literature with conflicting evidence on the preferred management of displaced intra-articular calcaneum fractures (DICAF). This article reviews the current concepts in the management of DIACF.
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Surgical Treatment Using Sinus Tarsi Approach with Anterolateral Fragment Open-Door Technique in Sanders Type 3 and 4 Displaced Intraarticular Calcaneal Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910400. [PMID: 34639700 PMCID: PMC8508352 DOI: 10.3390/ijerph181910400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022]
Abstract
Although various outcomes of the sinus tarsi approach have been reported, these are limited to the Sanders type 2 displaced intraarticular calcaneal fractures (DIACF) because of the limited visibility of the posterior facet joint. In this study we aimed to (1) introduce a sinus tarsi approach combined with an anterolateral fragment open-door technique that enables adequate visibility of the innermost and middle portion of the posterior facet joint, and (2) evaluate the radiographic and clinical outcomes of the patients treated with that technique. This is a retrospective case-series study performed on medical records of 25 patients who presented with the Sanders type 3 or 4 DIACF and were treated with the sinus tarsi approach. The radiologic measurements showed significant corrections of the Bohler’s angle, calcaneal width, length, height, and articular step-off in both X-rays and CTs in the last follow-up period. The mean AOFAS score was 90.08 ± 6.44 at the last follow-up. Among all the follow-up patients, two cases (8%) had acute superficial infections, and no other wound complications occurred. Therefore, we suggest that the Sanders type 3 or 4 DIACF could be successfully treated with the proposed technique with low complications and bring out effective clinical and radiologic outcomes.
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15
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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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16
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Peng C, Yuan B, Guo W, Li N, Tian H. Extensile lateral versus sinus tarsi approach for calcaneal fractures: A meta-analysis. Medicine (Baltimore) 2021; 100:e26717. [PMID: 34397810 PMCID: PMC8341246 DOI: 10.1097/md.0000000000026717] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Calcaneal fractures are the most common tarsal bone fracture, and are often accompanied by heel pain, local swelling, tenderness, and inability to walk or stand. Surgical intervention results in better reconstruction of the calcaneal anatomy and reduces future complications; however, the optimal incision approach is still controversial. The incision is exposed better with extensile lateral approach (ELA), while the sinus tarsi approach (STA) causes fewer complications. The purpose of this meta-analysis is to compare the outcomes of STA and ELA. MATERIALS AND METHODS Published trials comparing ELA and STA in calcaneal fractures were included in our analysis. The quality of each study was assessed using the revised Jadad scale and the Newcastle-Ottawa scale. Two researchers (CP and BY) independently extracted data from all selected studies. Fixed- or random-effects models with mean differences and odds ratios were used to pool the continuous and dichotomous variables to determine the heterogeneity of the included studies. RESULTS Calcaneal height and calcaneal width had high heterogeneity. Results showed that the incidence of incision complications in STA was lower than that in ELA (P < .001). There was high heterogeneity in operative time (I2 = 97%), length of hospital stay (I2 = 98%), Böhler angle (I2 = 80%), Gissane angle (I2 = 98%), and American Orthopaedic Foot & Ankle Society scores (I2 = 73%). No source of heterogeneity was found by sensitivity analysis, subgroup analysis, or regression analysis, and the random-effects model was used. STA operative time was significantly shorter than ELA (P < .001). Length of hospital stay after STA was significantly shorter than after ELA (P = .002). There was no statistical difference in the Böhler and Gissane angles between STA and ELA. Postoperative American Orthopaedic Foot & Ankle Society scores after STA were higher than after ELA (P = .01). CONCLUSIONS Results show that, compared with ELA, STA is superior for treating calcaneal fractures due to anatomical reduction of the calcaneus, reduction of incision complications incidence, and shortened operative time and postoperative stay.
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Affiliation(s)
- Chuangang Peng
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Baoming Yuan
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wenlai Guo
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Na Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, China
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Heng Tian
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
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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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18
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Davey MS, Staunton P, Lambert LA, Davey MG, Walsh JC. Evaluating Short-Term Outcomes Post-Intra-Articular Calcaneal Fracture Fixation via a Sinus Tarsi Approach in a Non-Exclusively Selected Cohort. J Foot Ankle Surg 2021; 60:302-306. [PMID: 33168444 DOI: 10.1053/j.jfas.2020.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 03/29/2020] [Accepted: 04/21/2020] [Indexed: 02/03/2023]
Abstract
Management of intra-articular calcaneal fractures remains a debated topic in orthopedics, with operative fixation often held in reserve due to concerns regarding perioperative morbidity and potential complications. The purpose of this study was to identify the characteristics of patients who developed surgical complications to inform the future stratification of patients best suited to operative treatment for intra-articular calcaneal fractures. All patients who underwent open reduction and internal fixation of calcaneal fractures utilizing the Sinus Tarsi approach between March 2014 and July 2018 were identified using theatre records. Patient imaging was used to assess pre- and postoperative fracture geometry with computed tomography used for preoperative planning. Each patient's clinical presentation was established through retrospective analysis of medical records. Patients provided verbal consent to participation and patient reported outcome measures were recorded using the Maryland Foot Score. Fifty-eight intra-articular calcaneal fractures (53 patients; 5 bilateral, mean age = 46.91 years) with a mean follow-up of 35.4 months (6-57) were included. Five patients (9.4%) had wound complications; 2 superficial (3.7%), 3 deep (5.6%); 4 of whom were smokers. Smokers were statistically more likely to have wound infections than nonsmokers (p = .04). Intra-articular fractures of the calcaneus should be considered for surgical intervention in order to improve long-term functional outcomes. The Sinus Tarsi approach provides the potential to decrease the operative complication rate whilst maintaining adequate fixation, however, the decision to surgically manage these fractures should be carefully balanced against the risk of postoperative complications. This increased risk of complication associated with smoking may tip the balance against benefit from surgical management.
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Affiliation(s)
- Martin S Davey
- Trauma & Orthopaedic Surgeon, Department of Trauma & Orthopaedics, Beaumont Hospital, Dublin, Ireland; Trauma & Orthopaedic Surgeon, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Peter Staunton
- Trauma & Orthopaedic Surgeon, Department of Trauma & Orthopaedics, Beaumont Hospital, Dublin, Ireland; Trauma & Orthopaedic Surgeon, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Laura Ann Lambert
- Trauma & Orthopaedic Surgeon, Department of Trauma & Orthopaedics, Beaumont Hospital, Dublin, Ireland
| | - Matthew G Davey
- Trauma & Orthopaedic Surgeon, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James C Walsh
- Trauma & Orthopaedic Surgeon, Department of Trauma & Orthopaedics, Beaumont Hospital, Dublin, Ireland
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Emre F, Çağlar C, Kaya Ö. Open reduction internal fixation versus minimally invasive percutaneous fixation for calcaneus fractures: Mid-term outcomes and social consequences. Jt Dis Relat Surg 2021; 32:825. [PMID: 34145821 PMCID: PMC8343830 DOI: 10.52312/jdrs.2021.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/26/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aims to evaluate the mid-term clinical, functional, radiological, and socioeconomic outcomes of calcaneus fractures treated with open reduction-internal fixation (ORIF) versus minimally invasive percutaneous fixation (MIPF). PATIENTS AND METHODS A total of 48 patients (34 males, 14 females; mean age: 44.05 years; range, 19 to 64 years) who underwent either ORIF or MIPF for calcaneus fractures between January 2010 and January 2016 were retrospectively analyzed. The patients were divided into two groups as the ORIF group (n=36) and MIPF group (n=12). The American Orthopaedic Foot & Ankle Society (AOFAS) score, Maryland Foot Score (MFS), and the Short Form-36 (SF-36) scores were assessed for the clinical assessment. The mean duration of operation, mean length of hospitalization, pedobarographic gait analysis, the incidence of contralateral knee pain, increased shoe size, and change of profession due to significant heel pain were also evaluated. The Böhler's angle, Gissane angle, and calcaneal varus were measured for radiological assessment. RESULTS There was a significant difference in the mean operation time (p=0.001) and length of hospitalization (p=0.001) between the two groups. There was no significant difference between the pre- and postoperative third-year Böhler's and Gissane angles (p=0.05, p=0.07, p=0.09, respectively). There were no significant differences between the postoperative first-, second-, and third-year AOFAS, MFS, and SF-36 scores (p=0.57, p=0.55 p=0.85, p=0.64, p=0.21, p=0.51, p=0.20, p=0.15, p=0.22, respectively). Thirteen patients in the ORIF group and five patients in the MIPF group changed their job due to significant heel pain. The increased shoe size was correlated with the residual calcaneal varus (p=0.001). CONCLUSION Both methods have pros and cons in the treatment of calcaneal fractures. Although MIPF is more advantageous in terms of operation duration and length of hospitalization, more favorable radiological results can be obtained with ORIF. Calcaneal varus should be corrected to prevent the increased shoe size and contralateral knee pain.
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Affiliation(s)
| | - Ceyhun Çağlar
- Ankara Şehir Hastanesi Ortopedi ve Travmatoloji Kliniği, 06800 Çankaya, Ankara, Türkiye
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Quality of Reduction of Displaced Intra-articular Calcaneal Fractures Using a Sinus Tarsi Versus Extensile Lateral Approach. J Orthop Trauma 2021; 35:285-288. [PMID: 32976180 DOI: 10.1097/bot.0000000000001971] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the difference in the quality of fracture reduction between the sinus tarsi approach (STA) and extensile lateral approach (ELA) using postoperative Computed Tomography (CT) scans in displaced intra-articular calcaneal fractures (DIACFs). DESIGN Retrospective. SETTING Level 1 and level 2 academic centers. PATIENTS Consecutive patients undergoing operative fixation of DIACFs with postoperative CT scans and standard radiographs. METHODS Patients were identified based on Current Procedural Terminology code and chart review. All operative calcaneal fractures treated between 2012 and 2018 by fellowship-trained orthopaedic trauma surgeons were evaluated. Those with both postoperative CT scans and radiographs were included. Exclusion criteria included extra-articular fractures, malunions, percutaneous fixation, ORIF and primary fusion, and those patients without a postoperative CT scan. The Sanders classification was used. Cases were divided into 2 groups based on ELA versus STA. Bohler angle and Gissane angle were evaluated on plain radiographs. CT reduction quality grading included articular step off/gap within the posterior facet, and varus angulation of the tuberosity: CT reduction grading included: excellent (E): no gap, no step, and no angulation; good (G): <1 mm step, <5 mm gap, and/or <5° of angulation, fair (F): 1-3 mm step, 5-10 mm gap, and/or 5-15° angulation; and poor (P): >3 mm step, >10 mm gap, and/or >15° angulation. RESULTS Seventy-seven patients with 83 fractures were included. Average age was 42 years (range, 18-74 years), with 57 men. Four fractures were open. There were 37 Sanders II and 46 Sanders III fractures; 36 fractures were fixed using the STA, whereas 47 used the ELA. Average days to surgery were 5 for STA and 14 for ELA (P < 0.001). A normal Bohler angle was achieved more often with the ELA (91.5%) than with STA (77.8%) (P < 0.001). There was no difference by approach for Gissane angle (P = 0.5). ELA had better overall reduction quality (P = 0.02). For Sanders II, there was no difference in reduction quality with STA versus ELA (P = 0.51). For Sanders III, ELA trended toward better reduction quality (P = 0.06). CONCLUSIONS The ELA had a better overall reduction of Bohler angle on plain radiographs and of the posterior facet and tuberosity on postoperative CT scans. For Sanders type II DIACFs, there was no difference between STA and ELA. Importantly, for Sanders III DIACFs, ELA trended toward better reduction quality. In addition to fracture reduction, surgeon learning curve, early wound complications, and long-term outcomes must be considered in future studies comparing the ELA and STA. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Joseph NM, Benedick A, McMellen C, Napora J, Wetzel R, Sontich J, Ochenjele G. Acute Fixation of Displaced Intra-articular Calcaneus Fractures Is Safe Using the Sinus Tarsi Approach. J Orthop Trauma 2021; 35:289-295. [PMID: 33967224 DOI: 10.1097/bot.0000000000002085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze the correlation between surgical timing and outcomes for calcaneus fractures treated using a sinus tarsi approach (STA). SETTING Single Level-1 trauma center. DESIGN Retrospective. PATIENTS/PARTICIPANTS Seventy consecutive intra-articular calcaneus fractures (OTA/AO 82C; Sanders II-IV) treated operatively using STA with a minimum of 1-year follow-up. INTERVENTION Open management using STA. MAIN OUTCOME MEASUREMENT Surgery timing, wound complications, American Orthopaedic Foot and Ankle Society ankle and hindfoot and Patient-reported Outcomes Measurement System scores. RESULTS Patients were primarily men (68.6%) averaging 46 years (range, 18-77 years). Nineteen (27%) were obese, 27 (38.6%) were smokers, and 3 (4.3%) were diabetic, and 10 (14.3%) had open fractures. Sanders III fracture patterns were most common (45.7%). Mean time to surgery was 4.9 days (range, 0-23 days). Three patients (4.2%) developed postoperative infections requiring surgical debridement and antibiotics. Forty patients (57%) underwent operative repair within 72 hours of injury, 9 (22.5%) of which had open fractures. Of this group, only one patient developed wound necrosis. Restoration of Bohler angle and angle of Gissane and reductions in calcaneal varus angle and heel width were achieved (all P < 0.001). No differences in Ankle Society ankle and hindfoot or Patient-reported Outcomes Measurement System scores were noted between patients treated within or beyond 72 hours from injury. CONCLUSION Intra-articular calcaneus fractures can be treated acutely within 72 hours of injury using STA with minimal wound complications and without compromising short-term functional outcome. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Noah M Joseph
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
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22
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Budair B, Fenton P. A Development of the Essex-Lopresti Maneuver: Minimally Invasive Reduction and Fixation of Tongue-Type Calcaneal Fractures via a Single Incision. Foot Ankle Spec 2021; 14:164-169. [PMID: 33401924 DOI: 10.1177/1938640020982811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tongue-type calcaneal fractures are a subset of displaced intraarticular calcaneal fractures. A reduction maneuver for this fracture pattern was described by Essex-Lopresti. The aim of this article is to describe a modification of this technique that allows reduction and fixation of tongue-type calcaneal fractures via a single, minimally invasive incision. We retrospectively reviewed all patients undergoing fixation utilizing this technique at our institution. We identified 13 fractures in 12 patients with a median follow-up of 12 months. Median Böhler angle was 3.5° preoperatively and 26.5° at final follow-up. The median AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot score was 78. There were no complications or further surgeries in this series. We believe that reduction and fixation of tongue-type calcaneal fractures using this minimally invasive technique is safe and reliable and avoids the potential soft tissue problems of fixation with more extensive incisions.Levels of Clinical Evidence: Level IV.
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Affiliation(s)
- Basil Budair
- Trauma and Orthopaedics Department, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Fenton
- Trauma and Orthopaedics Department, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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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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24
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Wang C, Xu C, Li M, Li H, Xiao H, Zhong D, Liu H. Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study. BMC Musculoskelet Disord 2020; 21:407. [PMID: 32593302 PMCID: PMC7321547 DOI: 10.1186/s12891-020-03439-3] [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: 02/05/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Traditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan. Methods We retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available. Results Mean intraoperative fluoroscopy time was 3.95 ± 1.78 h; IFAU in 16 patients (16 ft) was the same as the preoperative plan; mean surgery time was 28.16 ± 10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2% ± 2.3%. AOFAS scores increased with time, with significant differences in the score at each time point. Conclusions The newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.
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Affiliation(s)
- Chenggong Wang
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Can Xu
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Mingqing Li
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hui Li
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Han Xiao
- Department of Sports Medicine, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Da Zhong
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hua Liu
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China. .,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.
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Zhan J, Hu C, Zhu N, Fang W, Jing J, Wang G. A modified tarsal sinus approach for intra-articular calcaneal fractures. J Orthop Surg (Hong Kong) 2020; 27:2309499019836165. [PMID: 30885093 DOI: 10.1177/2309499019836165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Plate fixation using traditional lateral L-shape approach for intra-articular calcaneal fractures is complicated by 30% of wound complications, and the lateral small incision techniques with a tarsal sinus approach cannot sufficiently address all the fragments. A modified tarsal sinus approach with combined advantages of traditional lateral L-shape and tarsal sinus approaches for the treatment of intra-articular calcaneal fractures was developed. METHOD This prospective study included 29 patients (13 Sanders type II and 16 type III) with calcaneal fractures were managed with this technique. Calcaneal height, width, length, Bohler's angle, and Gissane angle were measured preoperatively, postoperatively, and at 1-year follow-up. Functional outcomes were assessed based on American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score. RESULTS Twenty-nine patients with average follow-up time of 18 (range 13-29) months were included. The radiographs demonstrated significant corrections of the Bohler's angle and Gissane angle, calcaneal width, length, and height from preoperation to postoperation and 1-year follow-up. Among all follow-up patients, one case had skin necrosis but healed after dressing. Another case had symptoms of numbness in the sural innervation area, which disappeared after 5 months of physical therapy and drug therapy. One case showed degenerative changes of subtalar joint at 1-year follow-up. No other wound complications like incision infection (superficial or deep) and wound dehiscence occurred. At 1-year follow-up, the mean AOFAS score was 90.2 ± 17.7 (range 70-98) and the good and excellent rate was 89.7%. CONCLUSION The modified tarsal sinus approach in the treatment of Sander's type II and III calcaneal fractures allowed adequate reduction and rigid fixation with low incidence of wound complications. Compared to sinus tarsi approach, this technique required shorter learning curve and was more easily mastered by young orthopedic surgeons. Thus, it was worthy of application clinically.
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Affiliation(s)
- Junfeng Zhan
- 1 Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.,2 Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Chuanzhen Hu
- 3 Department of Orthopaedics Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Nan Zhu
- 2 Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Wang Fang
- 2 Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Juehua Jing
- 2 Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Gang Wang
- 1 Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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26
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Xu J, He Z, Zhang G, Chen Y, Wei C, Zheng Y, Lin H, Li W, Huang W. An experimental study on the digital precision of internal fixation via the sinus tarsi approach for calcaneal fractures. J Orthop Surg (Hong Kong) 2020; 27:2309499019834072. [PMID: 30866744 DOI: 10.1177/2309499019834072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the effectiveness and accuracy of internal fixation of calcaneal fractures with a three-dimensional (3-D) printing navigation module via the sinus approach. METHODS Eleven lateral lower extremity specimens were used in the experiment and divided into the digital design (DD) group ( n = 11) and the real surgery (RS) group ( n = 11). For the DD group, thin-section computed tomography (CT) scans, virtual fracture modeling, virtual bone plate fixation, sinus occlusal module design, and navigation module design were performed for the cadaver specimens. A 3-D navigation module was printed using a 3-D printer. For the RS group, the sinus approach incision was made, and the navigation module was used to assist the placement of screw fixation and anatomically locked bone plate fixation. Thin-layer CT scans, 3-D reconstructions, and reconstruction of the nail paths were performed in the RS group and 3-D registered with the DD group. 3-D coordinate values for the screw entry and exit points in the RS and DD groups were recorded, and the corresponding offset values of the screw points were calculated. The number of qualified nails at different accuracy levels was counted. The χ2 test was used to compare the data for the DD and RS groups to obtain the accuracy level for both groups when p > 0.05, which is the critical value for experimental accuracy. RESULTS A total of 11 bone plates were placed and 120 screws were locked. None of them protruded from the inferior articular surface. The screw entry and exit point offsets were 1.71 ± 0.11 mm and 3.10 ± 0.19 mm, respectively. When the accuracy requirement for the entry point was 3.8 mm, there was no statistically significant difference between the two groups ( p > 0.05). Similarly, the accuracy of the exit point of the screw could only reach 6.6 mm. CONCLUSION Internal fixation of calcaneal fractures via the sinus tarsi approach with an anatomical locking plate based on the 3-D printing navigation module can achieve accurate screw placement and good overall internal fixation.
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Affiliation(s)
- Jing Xu
- 1 National Key Discipline of Human Anatomy, School of Basic Medical Science, Southern Medical University, Guangdong Province, China.,Jing Xu, Zaopeng He and Guodong Zhang contributed equally to this work, which Jing Xu is the first author, Zaopeng He and Guodong Zhang are the Co-first authors
| | - Zaopeng He
- 2 Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, Shunde District, Foshan, China.,Jing Xu, Zaopeng He and Guodong Zhang contributed equally to this work, which Jing Xu is the first author, Zaopeng He and Guodong Zhang are the Co-first authors
| | - Guodong Zhang
- 3 Department of Orthopedics, Affiliated Hospital of Putian University, Licheng District, Putian City, China.,Jing Xu, Zaopeng He and Guodong Zhang contributed equally to this work, which Jing Xu is the first author, Zaopeng He and Guodong Zhang are the Co-first authors
| | - Yongshao Chen
- 4 Affiliated Shunde Hospital of Guangzhou Medical University, Shunde District, Foshan, China
| | - Chunrong Wei
- 2 Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, Shunde District, Foshan, China
| | - Yudong Zheng
- 2 Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, Shunde District, Foshan, China
| | - Haibin Lin
- 3 Department of Orthopedics, Affiliated Hospital of Putian University, Licheng District, Putian City, China
| | - Wei Li
- 2 Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, Shunde District, Foshan, China
| | - Wenhua Huang
- 1 National Key Discipline of Human Anatomy, School of Basic Medical Science, Southern Medical University, Guangdong Province, China
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Percutaneous reduction and screw fixation for all types of intra-articular calcaneal fractures. Musculoskelet Surg 2020; 105:97-103. [PMID: 31907753 DOI: 10.1007/s12306-019-00635-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study compares the outcomes of consecutive of patients with Sanders II and III and IV calcaneal fractures that were stabilized by either close reduction and internal fixation (CRIF) or open reduction and internal fixation (ORIF). MATERIALS AND METHODS Group I (N = 49) underwent close reduction internal fixation (CRIF). Group II (N = 39) underwent open reduction internal fixation (ORIF). The clinical outcomes included time to operation, operative duration, visual analog score (VAS), length of hospital stay, wound-related complications and AOFAS SF-36 score. Preoperative and postoperative radiographic measures also were compared. RESULTS The duration of operation in the CRIF group was considerably shorter than in ORIF group (P = 0.0001). Postoperatively, at seventh day, the VAS in the CRIF group (4.2 ± 1.1) was meaningfully lower than those of the ORIF patients group (4.7 ± 1.2, P = 0.04). Totally, the prevalence of wound complications in CRIF group was significantly lower than in ORIF group. In final follow-up visit after one year, AOFAS scores and SF-36 scores between groups were comparable. Comparable radiographic measures were found in both groups. There was no significant difference between groups regarding preoperative radiographic measures (P > 0.05), while in postoperative imaging acceptable calcaneal fracture reduction was found in both groups. CONCLUSION We believed that for treatment of various types of calcaneal fracture compared with ORIF the percutaneous reduction and screw fixation may lead to shorter hospital stay, decreased subtalar joint stiffness and earlier weight bearing along with much favorable patients' satisfaction.
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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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Landsman A, Melick G, Pundu A. Intra-Articular Calcaneal Fractures: A Literature Review of Atraumatic Incisional Considerations. Clin Podiatr Med Surg 2019; 36:185-195. [PMID: 30784530 DOI: 10.1016/j.cpm.2018.10.014] [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
When calcaneal fractures occur, the treating physician is faced with many decisions that are required to bring about a good clinical outcome. From a surgical perspective, decisions must be made regarding whether or not fixation is necessary, and if so, what will be used. Implicit in that thought process is planning of the surgical approach. This article shows that there are numerous considerations, including the level of edema, condition of the soft tissue envelope, posttrauma time, and circulation. These factors should play a significant role in planning the surgical incision, and may dictate the repair options available to the surgeon.
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Affiliation(s)
- Adam Landsman
- Division of Podiatric Surgery, Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139, USA.
| | - Garrett Melick
- Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA
| | - Anusha Pundu
- Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA
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30
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Mehta CR, An VVG, Phan K, Sivakumar B, Kanawati AJ, Suthersan M. Extensile lateral versus sinus tarsi approach for displaced, intra-articular calcaneal fractures: a meta-analysis. J Orthop Surg Res 2018; 13:243. [PMID: 30249288 PMCID: PMC6154938 DOI: 10.1186/s13018-018-0943-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 09/05/2018] [Indexed: 01/28/2023] Open
Abstract
Background Operative management of displaced, intra-articular calcaneal fractures is associated with improved functional outcomes but associated with frequent complications due to poor soft tissue healing. The use of a minimally invasive sinus tarsi approach to the fixation of these fractures may be associated with a lower rate of complications and therefore provide superior outcomes without the associated morbidity of operative intervention. Methods We reviewed four prospective and seven retrospective trials that compared the outcomes from the operative fixation of displaced intra-articular calcaneal fractures via either an extensile lateral approach or minimally invasive fixation via a sinus tarsi approach. Results Patients managed with a sinus tarsi approach were less likely to suffer complications (OR = 2.98, 95% CI = 1.62–5.49, p = 0.0005) and had a shorter duration of surgery (OR = 44.29, 95% CI = 2.94–85.64, p = 0.04). Conclusion In displaced intra-articular calcaneal fractures, a minimally invasive sinus tarsi approach is associated with a lower complication rate and quicker operation duration compared to open reduction and internal fixation via an extensile lateral approach.
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Affiliation(s)
- Cyrus Rashid Mehta
- Orthopaedics Department, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, Sydney, Australia.
| | - Vincent V G An
- Orthopaedics Department, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, Sydney, Australia
| | - Kevin Phan
- Orthopaedics Department, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, Sydney, Australia
| | - Brahman Sivakumar
- Orthopaedics Department, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, Sydney, Australia
| | - Andrew J Kanawati
- Orthopaedics Department, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, Sydney, Australia
| | - Mayuran Suthersan
- Orthopaedics Department, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, Sydney, Australia
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Abstract
PURPOSE OF REVIEW To review literature published in the last 3 years related to minimally invasive approaches to calcaneal fracture fixation. RECENT FINDINGS Numerous randomized control trials, cohort studies, and meta-analyses have been done in the last 3 years comparing surgical treatment of calcaneus fractures. These studies indicate minimally invasive procedures decrease wound complication rates and achieve similar radiographic and clinical outcomes to open reduction internal fixation. In comparing different surgical treatment methods to non-operative treatment, operative management has increased complication rates but may lead to better functional outcomes in certain patient populations. Optimal treatment for displaced intra-articular calcaneus fractures continues to be debated. Current literature would suggest that the decision to operate be based on patient and fracture characteristics and surgeon capabilities. Minimally invasive techniques aim to improve patient reported outcomes and quality of life while decreasing complications and offer another option for surgeons in the treatment of displaced intra-articular calcaneal fractures.
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Affiliation(s)
- Emily A Wagstrom
- Hennepin County Medical Center, Minneapolis, MN, USA.
- Department of Orthopaedic Surgery, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55415, USA.
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