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Kong D, Fan X, Song C, Wu M, Wu L, Yang T, Zhang Y. A Comparative Analysis of Between Percutaneous Cannulated Screw Fixation and Traditional Plate Internal Fixation in Treatment of Sanders II and III Calcaneal Fractures. J Foot Ankle Surg 2024; 63:327-332. [PMID: 38151111 DOI: 10.1053/j.jfas.2023.12.004] [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: 02/22/2023] [Revised: 08/17/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
The objective of this study is to compare the clinical efficacy of percutaneous cannulated screw fixation and traditional plate internal fixation in the treatment of Sanders II and III calcaneal fractures. The records of 64 patients were retrospectively analyzed. Thirty-three cases were fixed by percutaneous cannulated screws. Thirty-one cases were fixed with traditional steel plates. The preoperative preparation time of the screw group and plate group was 3 ± 1.7 days and 4.6 ± 2.1 days. The surgery time was 118.9 ± 43.8 minutes and 146.9 ± 47.6 minutes. The length of hospitalization was 8.7 ± 3.9 days and 17.0 ± 7.9 days. Intraoperative blood loss was 38.2 ± 27.7 mL and 67.1 ± 58.8 mL. The postoperative drainage volume of the plate group was 85.1 ± 53.7 mL, and no wound drainage was needed in the screw group after surgery. Postoperative wound complications occurred in 2 cases of the screw group and 8 cases of the plate group. The recovery effects of Gissane angle and Bohler angle are similar in the 2 groups. The excellent and good rate of the American Orthopaedic Foot and Ankle Society ankle-hindfoot Scale in the screw group was 96.8% at 12 months after surgery, whereas the rate was 93.5% in the plate group. Compared with the traditional plate internal fixation, the percutaneous cannulated screw group achieved a similar excellent and good rate of clinical treatment. It has the advantages of less trauma, less bleeding, low incidence of complications, short preoperative preparation, and hospitalization time.
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Affiliation(s)
- Dewei Kong
- Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, China
| | - Xinbin Fan
- Department of Orthopedics, Shanghai Pudong New District Gongli Hospital, Shanghai, China
| | - Chao Song
- Department of Orthopedics, Shanghai Pudong New District Gongli Hospital, Shanghai, China
| | - Ming Wu
- Department of Orthopedics, Shanghai Pudong New District Gongli Hospital, Shanghai, China
| | - Liang Wu
- Department of Orthopedics, Shanghai Pudong New District Gongli Hospital, Shanghai, China
| | - Tieyi Yang
- Department of Orthopedics, Shanghai Pudong New District Gongli Hospital, Shanghai, China
| | - Yan Zhang
- Department of Orthopedics, Shanghai Pudong New District Gongli Hospital, Shanghai, China.
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Ren W, Zhang K, Zhao Z, Zhang X, Lin F, Li Y, Bao K, Yang J, Chang J, Li J. Biomechanical characteristics of Sanders type II and III calcaneal fractures fixed by open reduction and internal fixation and percutaneous minimally invasive fixation. J Orthop Surg Res 2024; 19:166. [PMID: 38443993 PMCID: PMC10916136 DOI: 10.1186/s13018-024-04606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND This work investigated the differences in the biomechanical properties of open reduction and internal fixation (ORIF) and percutaneous minimally invasive fixation (PMIF) for the fixation of calcaneal fractures (Sanders type II and III calcaneal fractures as examples) through finite element analysis. METHODS Based on CT images of the human foot and ankle, according to the principle of three-point fixation, namely the sustentaculum tali, the anterior process and the calcaneal tuberosity were fixed. Three-dimensional finite element models of Sanders type II and III calcaneal fractures fixed by ORIF and PMIF were established. The proximal surfaces of the tibia, fibula and soft tissue were constrained, and ground reaction force and Achilles tendon force loads were added to simulate balanced standing. RESULTS The maximum stress was 80.54, 211.59 and 113.88 MPa for the calcaneus, screws and plates in the ORIF group and 70.02 and 209.46 MPa for the calcaneus and screws in the PMIF group, respectively; the maximum displacement was 0.26, 0.21 and 0.12 mm for the calcaneus, screws and plates in the ORIF group and 0.20 and 0.14 mm for the calcaneus and screws in the PMIF group, respectively. The values obtained from the simulation were within the permissible stress and elastic deformation range of the materials used in the model, and there was no significant stress concentration. The maximum stress and displacement of the calcaneus and implants were slightly lower in the PMIF group than in the ORIF group when fixing Sanders type II and III calcaneal fractures. CONCLUSIONS This study may provide a reference for optimising the design of implants, the development of individualised preoperative plans and the choice of clinical surgical approach.
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Affiliation(s)
- Wu Ren
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China
| | - Kailu Zhang
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China
| | - Ziya Zhao
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China
| | - Xueling Zhang
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China
| | - Fei Lin
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Yawei Li
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Ke Bao
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Jun Yang
- Hunan Normal University, Changsha, 410000, Hunan, China
| | - Jinlong Chang
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China.
| | - Jia Li
- The First Affiliated Hospital of Xinxiang Medical University, School of Medical Engineering, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang Engineering Technology Research Center of Intelligent Rehabilitation Equipment, Xinxiang, 453003, Henan, China.
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Yeomans D, Lewis TL, Pearkes T, Stone B, Hepple S, Riddick A, Harries W, Kelly M, Winson I, Robinson P. Radiological outcomes following open versus percutaneous fixation versus arthroscopically assisted percutaneous fixation of calcaneal fractures: a ten-year retrospective observational study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:823-832. [PMID: 37715837 DOI: 10.1007/s00590-023-03716-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/27/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Calcaneal fractures are often major injuries associated with considerable morbidity. The optimal surgical management of displaced calcaneal fractures remains contentious with open, percutaneous and arthroscopically assisted percutaneous approaches all offering potential benefits for patients. The aim of this study was to assess which of these three separate surgical approaches to the management of displaced calcaneal fractures provides the best radiographic deformity correction. METHODS This is a retrospective observational study of all calcaneal fractures undergoing operative fixation at a single major trauma centre in the UK. The primary outcome was pre- and post-operative assessment of the deformity correction using radiographic parameters (angle of Gissane and Bohler's angle). Secondary outcomes included fracture configuration, complications and re-operation rate. RESULTS Between 01/01/2009 and 31/12/2019, 152 calcaneal fractures in 134 patients underwent operative management via either an open or percutaneous approach. One-way ANOVA testing of the pre- and post-operative radiographic parameters demonstrated that an open approach offered superior post-operative correction of Bohler's angle when compared to percutaneous alone (p < 0.05); however, there was no difference in post-operative angle of Gissane (p > 0.05). The mean follow-up for complication and re-operation data was 3.5 years (range 0.1-12.4). Overall complication rate following all surgical fixation was 7.2% with a further 32.2% requiring further long-term surgical intervention for subtalar arthritis or removal of metalwork. CONCLUSION Arthroscopically assisted percutaneous fixation does not offer superior radiographic deformity correction compared to percutaneous technique alone. Open fixation yielded improved correction of Bohler's angle when compared to percutaneous alone; however, there was no difference in post-operative angle of Gissane. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daniel Yeomans
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.
| | | | - Tim Pearkes
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Bradley Stone
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Steve Hepple
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Andrew Riddick
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | | | - Michael Kelly
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Ian Winson
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Peter Robinson
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
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Shams A, Gamal O, Mesregah MK. Minimally Invasive Reduction of Intraarticular Calcaneal Fractures With Percutaneous Fixation Using Cannulated Screws Versus Kirschner Wires: A Retrospective Comparative Study. Foot Ankle Spec 2023; 16:28-35. [PMID: 33511858 DOI: 10.1177/1938640020987750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several minimally invasive techniques were developed for management of intraarticular calcaneal fractures. This study aimed to compare the functional and radiological outcomes of 2 minimally invasive reduction and fixation techniques using cannulated screws or Kirschner wires (K-wires) for fixation. METHODS This study was a retrospective comparative review of patients with displaced intraarticular calcaneal fractures, who were treated with cannulated screws or K-wires techniques. Clinical and radiological data were collected and compared between both groups. Functional outcomes and patient satisfaction using the Maryland Foot Score (MFS) and the visual analogue scale (VAS) of pain, in addition to the complications, were compared between both groups. RESULTS In total, 70 patients were included in the study: 34 in the cannulated screws group, with a mean age of 35.2 ± 4 years, and 36 in the K-wires groups, with a mean age of 33.4 ± 3 years. The operative time was shorter in the K-wires group (40.5 ± 5.6 minutes) compared to the cannulated screw group (49.5 ± 4.5 minutes), P < .001. There were no statistically significant differences between both groups regarding the radiological parameters, including Bohler's angle, angle of Gissane, calcaneal width, height, or length. The mean MFS, mean VAS, and complications were not different between the 2 groups. CONCLUSION Treatment of displaced intraarticular calcaneal fractures with minimally invasive reduction and fixation using either cannulated screws or K-wires can achieve similar excellent functional and radiological outcomes, with high patient satisfaction. The use of K-wires has the advantage of reduced operative time than cannulated screws. LEVELS OF EVIDENCE Level III: Retrospective comparative study.
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Affiliation(s)
- Ahmed Shams
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Osama Gamal
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt.,Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Wang J, Han W, Su Y, Wang J, Jiang X. Comparison of Robot-Assisted Percutaneous Cannulated Screws Versus Open Reduction and Internal Fixation in Calcaneal Fractures. Orthop Surg 2023; 15:724-730. [PMID: 36600634 PMCID: PMC9977583 DOI: 10.1111/os.13650] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Accurate placement of the screws is challenging in percutaneous cannulated screw fixation of calcaneal fractures, and robot-assisted (RA) surgery enhances the accuracy. We investigated the outcome of percutaneous cannulated screw fixation of Sander's type II and III calcaneal fractures. METHODS This retrospective study analyzed clinical data of 26 patients with fresh closed calcaneal fractures (28 fractures) who were admitted to our center from January 2022 to July 2022. All fractures were divided into the RA group and the open reduction and internal fixation (ORIF) group according to the surgeries performed. RA surgery was performed by closed reduction or open reduction combined with a tarsal sinus approach. Age, sex, operation time, preoperative waiting time, length of postoperative hospital stay, wound complications, and American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale (AOFAS) at 3 months postoperatively were compared. Preoperative and postoperative radiographic parameters (calcaneal length, width, height, Böhler angle, and fixation rate of the sustentaculum tali) were documented. The chi-square test, one-way analysis of variance, and Wilcoxon test were used for the comparison of categorical, normally distributed, and nonnormally distributed continuous variables, respectively. RESULTS The calcaneal width, height, and Böhler angle were significantly corrected postoperatively in both groups. The postoperative calcaneal lengths in both groups were also corrected. However, no significant difference was found. No significant differences in calcaneal length, width, height, and Böhler angle were observed between the two groups. The operation time (p < 0.001), preoperative waiting time (p < 0.001), and length of postoperative hospital stay (p = 0.003) in the RA surgery group were significantly shorter than those in the ORIF group. The fixation rate of the sustentaculum tali (p < 0.001) in the RA surgery group was significantly superior to that in the ORIF group. All wound complications occurred in the ORIF group. All fractures healed within 3 months. The AOFAS scores at 3 months postoperatively were not significantly different. CONCLUSION RA percutaneous screw fixation of the calcaneal fracture is a safe, effective, rapid, and minimally invasive surgical option for surgeons.
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Affiliation(s)
- Jing Wang
- Department of Orthopaedic TraumaBeijing Jishuitan HospitalBeijingChina
| | - Wei Han
- Department of Orthopaedic TraumaBeijing Jishuitan HospitalBeijingChina
| | - Yonggang Su
- Department of Orthopaedic TraumaBeijing Jishuitan HospitalBeijingChina
| | - Junqiang Wang
- Department of Orthopaedic TraumaBeijing Jishuitan HospitalBeijingChina
| | - Xieyuan Jiang
- Department of Orthopaedic TraumaBeijing Jishuitan HospitalBeijingChina
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Cao Y, Xu X, Guo Y, Cui Z, Zhao Y, Gao S, Tian Y, Lv Y, Zhou F. Percutaneous Cannulated Screw Fixation vs. Plating With Minimally Invasive Longitudinal Approach After Closed Reduction for Intra-Articular Tongue-Type Calcaneal Fractures: A Retrospective Cohort Study. Front Surg 2022; 9:854210. [PMID: 35445076 PMCID: PMC9013838 DOI: 10.3389/fsurg.2022.854210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Displaced intra-articular tongue-type fractures are often treated with surgical interventions, and there is a lack of consensus regarding the surgical approach. This retrospective cohort study aimed to compare percutaneous cannulated screw (PCS) fixation and plating with a minimally invasive longitudinal approach (MILA) after closed reduction for the treatment of tongue-type calcaneal fractures. Materials and Methods A total of 77 patients with intra-articular tongue-type calcaneal fractures between September 2015 and July 2019 were included in this study. They were randomly allocated into two groups: PCS fixation (n = 32) and MILA (n = 45). The outcome measures included demographic variables, operation time (OT), preoperative time (POT), hospital stay time (HST), blood loss, visual analog scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, postoperative complications, and imaging parameters. The patients were clinically examined at 1, 3, 6, and 12 months, with a final follow-up period of 27 months. Results No significant differences were observed during the follow-up in calcaneal length, height, Gissane's and Böhler's angles, VAS scores, AOFAS hindfoot scores, or complication rates between the two groups. However, the postoperative VAS scores in the PCS group were significantly lower than those in the MILA group (p < 0.05). Furthermore, the OT, POT, and HST in the PCS group were significantly shorter than those in the MILA group (p < 0.05). Blood loss was lower in the PCS group than those in the other group (p = 0.044). However, postoperative calcaneal widening was significantly smaller in the MILA group than that in the PCS group (p < 0.001). Conclusions After closed reduction for the treatment of tongue-type calcaneal fractures, PCS fixation was superior to MILA in terms of OT, POT, HST, blood loss, pain, and degree of comfort. Meanwhile, MILA has the advantage of restoring the calcaneal width. Under the same rehabilitation program, the two approaches showed similar abilities in maintaining the closed reduction.
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Affiliation(s)
- Yuan Cao
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Xiangyu Xu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Yan Guo
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Zengzhen Cui
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Yang Zhao
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Shan Gao
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Yun Tian
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Yang Lv
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Fang Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
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