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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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The Comparison of Clinical Efficacy of Minimally Invasive Tarsal Sinus Approach and L-Type Incision Approach Combined with 3D Printing Technology in Calcaneal Fracture. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5706341. [PMID: 35860186 PMCID: PMC9293505 DOI: 10.1155/2022/5706341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022]
Abstract
Purpose To explore the comparison of the reduction of the subtalar articular surface and other postoperative effects of the minimally invasive tarsal sinus approach and lateral L-shaped incision conventional approach for the treatment of calcaneal fracture with 3D printing technology. Methods Patients who received surgical treatment for calcaneal fractures in the First Affiliated Hospital of Henan University of Science and Technology from June 2019 to December 2020 were collected. 3D printing equipment produced the affected side reduction heel bone fracture model and navigation template model. The tarsal sinus approach was used in the experimental group, and the lateral L-shaped incision approach was used in the control group. Patients were followed up 3 days, 1 month, 3 months, 6 months, and 12 months after the operation. Imaging indicators were measured 12 months after surgery, and scores from American Foot and Ankle Orthopaedic Society (AOFAS) and MSF were performed. Results Operation time was 70.52 ± 13.16 in the control group and 55.24 ± 12.25 minutes in the experimental group (P < 0.001). Intraoperative blood loss was 98.77 ± 18.65 in the control group and 89.56 + 17.54 in the experimental group (P > 0.05). The duration of antibiotic use was 5.53 ± 3.24 days in the control group and 5.48 ± 4.18 days in the experimental group (P > 0.05). The frequency of fluoroscopy was 6.56 ± 1.72 in the control group and 3.88 ± 1.05 in the experimental group (P < 0.001). Fracture healing time was 3.24 ± 0.52 months in the control group and 3.08 ± 0.58 months in the experimental group (P > 0.05). The postoperative Böhler angle was 28.31 ± 3.14 in the control group and 29.24 ± 2.76 in the experimental group (P > 0.05). Postoperative subtalar articular displacement (step > 2 mm) was observed in 4 patients in the control group and 1 in the experimental group (P < 0.05). MSF score was 90.12 ± 4.85 in the control group and 91.36 ± 2.58 in the experimental group (P > 0.05). Conclusion The study found that the experimental group was significantly better than the control group in terms of the operation time, intraoperative fluoroscopy times, and success rate of reduction of the subtalar articular surface. 3D printing technology can shorten the operation time, accurately reduce the fracture block, and reduce the secondary trauma, which is conducive to the functional recovery of the affected foot.
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Herlyn A, Brakelmann A, Herlyn PK, Gradl G, Mittlmeier T. Calcaneal fracture fixation using a new interlocking nail reduces complications compared to standard locking plates - Preliminary results after 1.6 years. Injury 2019; 50 Suppl 3:63-68. [PMID: 31378540 DOI: 10.1016/j.injury.2019.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical treatment of displaced intra-articular calcaneal fractures using a standard extended lateral approach for plate fixation is frequently associated with substantial wound healing complications and infections. This matched pairs analysis compares the new minimally-invasive calcaneal interlocking nailing technique to standard locking plate fixation in terms of reduction capacity, complication rates, and functional outcomes. METHODS Forty feet in 38 patients (mean patient age 52.5 years, range 27-78) were treated with calcaneal locking nail (LN)(n=20) or locking plate (LP)(n=20) and followed clinically and radiologically for 20 months. Follow-up included radiological assessments and functional evaluations including the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Foot Function Index (R-FFI). RESULTS Times for surgery were similar for both techniques (LN 93min, range 34 to 175 vs. LP 101min, range 53 to 305). Length of hospital stay was significantly lower in the LN group (7.6 days, range 3 to 14 vs. LP 11 days, range 6 to 37). Time away from work was shorter by 3.5 days in LN group. LP group had superior range of motion in plantarflexion, eversion, and inversion at follow-up, while LP patients were superior in demonstrating a secure heelstrike (79% vs. LN 58%) and fewer needed permanent walking aids. AOFAS and FFI scores revealed no differences for both groups. Radiographs indicated an adequate reconstruction in both groups, followed by a slight loss of reduction at follow-up (LP 4.7° postoperative vs. follow-up; LN 5.1°). The overall complication rate between groups was significant with 5% complications in the LN group vs. 50% in the LP group (5% deep infection, 35% impaired wound healing, 5% hardware breakage, 5% superficial wound infection; LN: 5% superficial wound infection). CONCLUSIONS The new calcaneal interlocking nail shows promising results in terms of reduction capacity and safety. Use of the minimally invasive locking nail technique minimized the risk of postoperative wound complications and achieved superior functional outcomes compared with standard locking plate fixation via the extended lateral approach.
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Affiliation(s)
- Anica Herlyn
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany.
| | - Anna Brakelmann
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany
| | - Philipp Ke Herlyn
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany
| | - Georg Gradl
- Dept. of Trauma, Orthopedic and Reconstructive Surgery, Klinikum München Harlaching, Sanatoriumsplatz 2, D-81545 München, Germany
| | - Thomas Mittlmeier
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, D-18057 Rostock, Germany
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Bulut T, Gursoy M, Ozturk T, Ozcan C, Sener M. Sanders type 3-4 calcaneal fractures fixed with locking plate: does tri-cortical iliac bone autograft provide extra benefit for stabilization? Ther Clin Risk Manag 2018; 14:1665-1670. [PMID: 30254447 PMCID: PMC6140723 DOI: 10.2147/tcrm.s146530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of this study was to determine whether tri-cortical iliac bone autografting provided extra benefit for the stabilization in Sanders Type 3–4 calcaneal fractures fixed with locking plate. Materials and methods The study included 29 calcaneal fractures (Sanders Type 3/4=15/14). All fractures were fixed with locking plate using the extended lateral approach. Bone grafts were used in 16 (Group A; Sanders Type 3/4=7/9) and not used in 13 (Group B; Sanders Type 3/4=8/5) calcaneal fractures. As a grafting material, only tri-cortical iliac crest bone autograft was used. All operations were performed by the same surgeon. The same locking plate was used in all fractures. Calcaneal height and angle of Bohler and Gissane were measured in early postoperative and final control radiographs in both groups. Clinical evaluations were performed using the American Orthopedic Foot and Ankle Society ankle hind foot scale. Results There was no difference between the groups in terms of clinical results. Radiologically, the degree of change in Bohler’s angle, Gissane’s angle, and calcaneal height was not different between the groups. Conclusion Bone grafting does not affect the clinical and radiologic outcomes in Sanders Type 3–4 calcaneal fractures fixed with locking plate, and they provide no extra benefit to the stabilization. We think that fixation using locking plate is adequate and there is no need for bone grafting.
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Affiliation(s)
- Tugrul Bulut
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey,
| | - Merve Gursoy
- Department of Radiology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Tahir Ozturk
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey,
| | - Cem Ozcan
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey,
| | - Muhittin Sener
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey,
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