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Eelsing R, Hemke R, van Oudenaarde K, Halm JA, Schepers T. Radiographic assessment of calcaneal fractures; A new approach to Böhler's angle using computed tomography. Foot (Edinb) 2024; 60:102119. [PMID: 39083853 DOI: 10.1016/j.foot.2024.102119] [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: 10/12/2022] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Böhler's angle (BA) is used for identifying calcaneal fractures and evaluating calcaneal collapse after reconstruction. This study investigates whether it is possible to determine BA with the help of Computed Tomography (CT). METHODS A retrospective study was performed to compare the BA on conventional radiograph (Gold Standard, GS) versus measurements on CT. Two groups were studied: one group consisted of 11 subjects with a diagnosed calcaneal fracture, the other group of 11 subjects with a fracture of the lower extremities but no calcaneal fracture. A lateral Böhler angle (LBA), central Böhler angle (CBA) and a medial Böhler angle (MBA) were defined on CT. Furthermore, BA was reconstructed out of a 3D reconstruction (3DBA). RESULTS CBA approached the GS with a mean difference of 3.78° (95 %CI: 2.82-4.75) with no significant difference in variance (p = 1.000). 3DBA approached the GS with a mean difference of 2.14° (95 %CI: 1.57-2.70) with a significant difference in variance (p = 0.014). No relevant correlations were found between LBA/MBA and the GS. ICC between raters was considered as good or excellent for both CBA and 3DBA. CONCLUSION Giving the high accuracy and better capability to visualize the anatomy in the case of severe injury, measuring BA on 3D reconstruction is a suggested alternative to the traditional technique. LEVEL OF EVIDENCE III, Retrospective.
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Affiliation(s)
- Robin Eelsing
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| | - Kim van Oudenaarde
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| | - Jens A Halm
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands.
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2
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Matuszewski PE, Phillips SA, Ulrich GL, Hautala GS, Bloomer AK, Hsu JR. Minimally invasive technique for acute fixation and subtalar fusion of displaced intra-articular calcaneus fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3355-3363. [PMID: 38831052 DOI: 10.1007/s00590-024-03879-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/18/2024] [Indexed: 06/05/2024]
Abstract
Displaced intra-articular calcaneus fractures (DIACFs) are difficult injuries to treat and are often encountered by orthopedic surgeons. For DIACFs treated nonoperatively or with open reduction internal fixation (ORIF), a common complication is painful subtalar arthritis and the need for a secondary subtalar fusion, which prolongs the overall recovery time. One treatment option to address this sequela involves ORIF with subtalar fusion as the primary treatment. We describe a reproducible, minimally invasive surgical technique for primary ORIF with subtalar fusion when the calcaneal tuberosity is amendable to cannulated screw fixation to treat these complex calcaneal fractures. Our technique offers advantages compared to other techniques in that it avoids screw traffic, allows easy bony compression of the subtalar joint, and minimizes soft tissue damage via percutaneous screw fixation. Fourteen fractured calcanei in 12 patients underwent our technique and all achieved bony union with a median time to fusion of 107.5 days (range, 54-530 days). Eight patients returned to work with the remaining 4 patients having an unknown work status at last follow-up, although 2 of these 4 patients resumed normal activities. Only 1 patient experienced a complication, which was an infection after achieving bony union, and was treated with successful hardware removal and our infection protocol. Overall, we conclude our surgical technique offers a successful option in the treatment of DIACFs when the calcaneal tuberosity is amendable to cannulated screw fixation.
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Affiliation(s)
- Paul E Matuszewski
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, 740 S. Limestone, Suite K401, Lexington, KY, USA
| | - Seth A Phillips
- Department of Orthopaedic Surgery, Mercy Health St. Vincent Medical Center, Toledo, OH, USA
| | - Gary L Ulrich
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, 740 S. Limestone, Suite K401, Lexington, KY, USA
| | - Gavin S Hautala
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, 740 S. Limestone, Suite K401, Lexington, KY, USA
| | - Ainsley K Bloomer
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
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3
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Schleunes S, Lobos E, Saltrick K. Current Management of Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2024; 41:473-490. [PMID: 38789165 DOI: 10.1016/j.cpm.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Intra-articular calcaneal fractures are debilitating injuries that can result in a dramatic effect on quality of life post-injury. Surgical intervention is generally advised when significant displacement or comminution is present but can present a host of complications secondary to the limited blood supply and fragility to the soft tissues following injury. Surgical approaches to calcaneal fractures generally include the lateral extensile approach, minimal incision (sinus tarsi approach), or percutaneous approach. Each approach presents risks and benefits; therefore, determining the optimal incisional approach should be based on patient comorbidities, fracture pathoanatomy, soft tissue envelope concerns, and patient pre-injury functional status.
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Affiliation(s)
- Scott Schleunes
- Division of Foot and Ankle Surgery, Department of Orthopedics, West Penn Hospital, Pittsburgh, PA, USA
| | - Emily Lobos
- Division of Foot and Ankle Surgery, Department of Orthopedics, West Penn Hospital, Pittsburgh, PA, USA
| | - Karl Saltrick
- Department of Orthopedics, West Penn Hospital Foot & Ankle Surgery, Allegheny Health Network, Pittsburgh, PA, USA.
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4
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Mingo-Robinet J, González-García L, González-Alonso C. Treatment of displaced intra-articular calcaneal fractures using a sinus tarsi approach. Surgical technique. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00060-2. [PMID: 38403112 DOI: 10.1016/j.recot.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024] Open
Abstract
Calcaneal articular fractures are fractures classically associated with a high rate of complications and poor outcomes. Osteosynthesis of the calcaneus through a sinus tarsi approach has shown results equal to or superior to those of the extended approach, having become the new gold standard. The objective of this article is to detail step by step the surgical technique of osteosynthesis of intra-articular fractures of the calcaneus through a sinus tarsi approach, from the selection of the fracture, positioning of the patient, layout of the operating room and the fluoroscope, the entire surgical process until postoperative treatment. The surgical technique described below is described in 6 steps. Anatomical reduction of complex calcaneal fractures through an Sinus Tarsi Approach requires an understanding of the fracture and its associated deformities. Following the described sequence step by step will help to achieve a better reduction in order to achieve better functional results.
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Affiliation(s)
- J Mingo-Robinet
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de Palencia, Palencia, España.
| | - L González-García
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - C González-Alonso
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de Palencia, Palencia, España
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5
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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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6
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Naguib BE, Abdelrahman AF, ElShazly OA, Abd-Ella MM. Functional outcomes of primary subtalar arthrodesis in sanders type IV calcaneal fractures, a case series. Trauma Case Rep 2023; 48:100951. [PMID: 37915537 PMCID: PMC10616545 DOI: 10.1016/j.tcr.2023.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/03/2023] Open
Abstract
Background Primary subtalar arthrodesis (PSTA) is a valid option in treating Sanders IV calcaneal fractures with few studies to assess its outcomes. Methods Seventeen patients with Sanders IV calcaneal fractures were managed by open reduction and primary subtalar arthrodesis. Functional outcomes were measured by AOFAS-AHS and FAAM-ADL. We also documented time to return to work, union rate, wound complications and the need for second surgeries. Results Fourteen patients were followed for two years. At final follow-up, the mean AOFAS-AHS score was 74.42 ± 1.95, while the mean FAAM- ADL score was 59.21 ± 1.6. Conclusion PSTA is a valid option in treating these severe fractures. It may reduce the overall disability time.
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7
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Mastracci JC, Dombrowsky AR, Cohen BE, Ellington JK, Ford SE, Shawen SB, Irwin TA, Jones CP. Prospective Clinical and Computed Tomography Evaluation of Calcaneus Fractures Treated Through Sinus Tarsi Approach. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231216985. [PMID: 38145275 PMCID: PMC10748696 DOI: 10.1177/24730114231216985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
Background The traditional lateral extensile approach to the calcaneus allows for excellent visualization but is associated with high wound complication rates. The sinus tarsi approach has been shown to produce similar radiographic outcomes with much lower rates of wound complications. The purpose of this study is to prospectively determine clinical and radiographic outcomes in calcaneus fractures treated with a sinus tarsi approach. Methods Twenty-nine patients with 30 calcaneus fractures underwent operative fixation through a sinus tarsi approach and were prospectively evaluated. Routine pre- and postoperative radiographs were obtained, in addition to computed tomography (CT) scans at 6 weeks and 12 months after surgery. Patient-reported outcomes including American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) pain score, Veterans Rand 12-Item Health Survey (VR-12), and Foot Functional Index (FFI) were recorded. Patients were followed for a minimum of 1 year postoperation. Results Twenty-one patients with 22 calcaneus fractures completed 1 year of follow-up. At 12 months postoperation, 20 of 22 patients (91%) had 0 to 2 mm of fracture displacement at the posterior facet on CT scans whereas 2 of 22 patients had 2 to 4 mm of fracture displacement. There was no significant change in posterior facet fracture displacement comparing 6-week and 12-month postoperative CT scans (P > .99). Mean postoperative Bohler angle was 26.1 degrees compared to 13.2 degrees preoperatively. All patients had complete union of fracture site. There were no major wound complications. Four of 22 patients (18.2%) had minor wound complications. AOFAS, FFI, and VAS pain scores improved postoperatively but were not found to correlate with Bohler angle or critical angle of Gissane. Conclusion We found that in select patients excellent anatomic alignment and good clinical outcomes with low wound complication rates can be achieved when fixing calcaneus fractures through the sinus tarsi approach. Level of Evidence Level II, prospective cohort study.
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Affiliation(s)
- Julia C. Mastracci
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Alexander R. Dombrowsky
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Bruce E. Cohen
- OrthoCarolina Foot and Ankle Institute, Charlotte, NC, USA
| | | | - Samuel E. Ford
- OrthoCarolina Foot and Ankle Institute, Charlotte, NC, USA
| | | | - Todd A. Irwin
- OrthoCarolina Foot and Ankle Institute, Charlotte, NC, USA
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8
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Rayes J, Sharplin P, Maalouf P, Willms S, Dodd A. A Stepwise Minimally Invasive Sinus Tarsi Approach to Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: Technique Tip. Foot Ankle Int 2023; 44:565-573. [PMID: 37096690 PMCID: PMC10248302 DOI: 10.1177/10711007231165765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- Johnny Rayes
- Division of Orthopedic Trauma surgery,
University of Calgary, Foothills Medical Center, Calgary, AB, Canada
| | - Paul Sharplin
- Division of Orthopedic Trauma surgery,
University of Calgary, Foothills Medical Center, Calgary, AB, Canada
| | - Peter Maalouf
- Division of Orthopedic Trauma surgery,
University of Paris-Descartes, Cochin Hospital, Paris, France
| | - Scott Willms
- Division of Orthopedic Trauma surgery,
University of Calgary, Foothills Medical Center, Calgary, AB, Canada
| | - Andrew Dodd
- Division of Orthopedic Trauma surgery,
University of Calgary, Foothills Medical Center, Calgary, AB, Canada
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9
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Kubo M, Yasui Y, Sasahara J, Miki S, Takao M, Kawano H, Miyamoto W. Two-portal posterior arthroscopic reduction with percutaneous fixation for intra-articular calcaneal fracture in an 11-year-old boy: A case report. J Orthop Sci 2023; 28:499-502. [PMID: 32819789 DOI: 10.1016/j.jos.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/03/2020] [Accepted: 07/16/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Maya Kubo
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan.
| | - Jun Sasahara
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Shinya Miki
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, 341-1, Mangoku, Kisarazu, Chiba, 292-0003, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
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Gomes FF, Maranho DA, Gomes MS, de Castro IM, Mansur H. Effects of Hyaluronic Acid With Intra-articular Corticosteroid Injections in the Management of Subtalar Post-traumatic Osteoarthritis - Randomized Comparative Trial. J Foot Ankle Surg 2022; 62:14-20. [PMID: 35752551 DOI: 10.1053/j.jfas.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/27/2022] [Accepted: 03/03/2022] [Indexed: 02/03/2023]
Abstract
We investigated the potential of exogenous hyaluronic acid (HA) associated with corticosteroid injections to improve pain and function for the treatment of post-traumatic subtalar osteoarthritis, in comparison with isolated intra-articular corticosteroid. Twenty-five symptomatic participants (50 ± 8 years) with a minimum follow-up of 1 year after surgery for calcaneus fractures were enrolled. Participants were randomly assigned into a therapeutic group that underwent isolated corticosteroid intra-articular subtalar injection (Corticosteroid Group, n = 12) or a combination of HA plus corticosteroid (HA+C Group, n = 13). All participants underwent three repeated injections with intervals of 1 week. We assessed the visual analog scale of pain (VAS) and the AOFAS scores at 4 moments: before treatment (pre), 4-, 12-, and 24-weeks following the last injection. HA+C Group showed lower VAS at the 12th (p = .003) and 24th weeks (p = .003) and greater AOFAS at the 4th (p = 0.040), 12th (p = .014), and 24th weeks (p = .021), in comparison to Corticosteroid Group. We observed a reduction in VAS in the Corticosteroid Group only at the 4th week (p = .007), compared with pretreatment values. In the HA+C Group, VAS presented lower levels at the 4- (p < .001), 12- (p < .001), and 24 weeks (p < .001). In the Corticosteroid Group, participants presented higher AOFAS score only at the 4th week (p < .001), while in the HA+C Group, the AOFAS scores were greater at the 4th, 12th, and 24th weeks compared to baseline (p < .001). The combination of exogenous HA and corticosteroid showed greater and longer analgesic effects and function improvement in comparison with isolated intra-articular corticosteroids.
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Affiliation(s)
- Fernanda Ferreira Gomes
- Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, RJ, Brazil
| | | | - Mariana Silva Gomes
- Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, RJ, Brazil
| | - Isnar Moreira de Castro
- Head of the Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, RJ, Brazil
| | - Henrique Mansur
- Department of Orthopedic Surgery, Hospital Santa Helena, Brasília, DF, Brazil.
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11
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Kang SW, Jung SW, Woo SH. Factors associated with nonunion of the posttraumatic subtalar arthrodesis after displaced intra-articular calcaneal fractures. Foot Ankle Surg 2022; 29:188-194. [PMID: 36732154 DOI: 10.1016/j.fas.2022.12.005] [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: 08/09/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study investigated the incidence of and risk factors for nonunion in patients with posttraumatic subtalar arthrodesis (SA). METHODS We retrospectively reviewed 165 posttraumatic SA cases. Nonunion was diagnosed at 6 months after surgery based on the findings of clinical evaluations, plain radiographs, and CT scans. Patient-specific factors and surgeon-specific factors were evaluated as potential risk factors. RESULTS The overall nonunion rate was 13.3 % (22 of 165 cases). In the final multivariate logistic regression analysis, smoking (odds ratio [OR] = 3.64; 95 % confidence interval [CI] = 1.23-10.75), parallel screw configuration (OR = 5.70; 95 % CI = 1.62-20.06), and freeze dried iliac crest (OR = 9.16; 95 % CI = 2.28-36.79) were demonstrated as risk factors for nonunion of posttraumatic SA. CONCLUSION Patients with a history of smoking, parallel screw configuration fixation, and those who received freeze dried iliac crest as an interpositional graft, had a significantly higher rate of nonunion.
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Affiliation(s)
- Suk-Woong Kang
- Department of Orthopaedic Surgery, Pusan National University School of Medicine, Yangsan, the Republic of Korea
| | - Sung Won Jung
- Department of Orthopaedic Surgery, Pusan National University School of Medicine, Yangsan, the Republic of Korea
| | - Seung Hun Woo
- Department of Orthopaedic Surgery, Pusan National University School of Medicine, Yangsan, the Republic of Korea.
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12
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Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion: a retrospective study. J Orthop Surg Res 2022; 17:526. [PMID: 36476296 PMCID: PMC9730565 DOI: 10.1186/s13018-022-03413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This retrospective study aimed to introduce a novel method for simultaneous Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion and to evaluate the feasibility of this method. METHODS We retrospectively analysed the clinical and imaging data of 11 patients with calcaneus malunion treated using Y-shape osteotomy and subtalar arthrodesis who were admitted to our hospital from June 2018 to October 2020. The patients included 9 males and 2 females aged from 24 to 69 years old, with an average age of 42.18 years. The clinical and radiological results were assessed with the Visual Analogue Scale (VAS) pain score and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. In addition, functional recovery and general quality of life were evaluated using the 12-Item Short-Form Survey (SF-12). RESULTS All radiological parameters were significantly improved at the last follow-up, with increases of 14.37°, 9.18°, and 4.51 mm in the Böhler's angle, calcaneal pitch angle, and talocalcaneal height, respectively, and decreases of 6.39 mm and 6.18° in the calcaneal width and Hindfoot alignment angle (p < 0.05). The mean AOFAS and VAS scores at the last follow-up improved compared with those preoperatively, from 34.18 ± 9.53 to 84.18 ± 11.59 and from 6.90 ± 1.22 to 1.90 ± 1.13, respectively (p < 0.05). The SF-12 physical and mental health scores were 49.65 ± 6.84 and 52.68 ± 7.88, respectively. Furthermore, the early postoperative complications included skin necrosis in one and sural neuralgia in one patient, and the late postoperative complication included ankle pain in one patient. No other complications, such as implant discomforts, malunion, nonunion and re-fracture, were presented. CONCLUSION These results indicate that Y-shape osteotomy combined with subtalar arthrodesis is an effective new method for the treatment of calcaneal malunion. Advantages include improvement of the anatomic shape of the calcaneus and union rates for subtalar arthrodesis.
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13
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Ebben BJ, Myerson M. Management of the Subtalar Joint Following Calcaneal Fracture Malunion. Foot Ankle Clin 2022; 27:787-803. [PMID: 36368797 DOI: 10.1016/j.fcl.2022.08.001] [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: 11/09/2022]
Abstract
Subtalar joint arthrosis is common following intra-articular calcaneus fractures. The appropriate management of pain secondary to posttraumatic arthritis depends on the status of the remaining posterior facet articular cartilage, the magnitude of any residual joint displacement and distortions in the overall morphology of the calcaneus. In select circumstances, joint-preserving surgical techniques may be considered including lateral wall exostectomy, far lateral posterior facet joint debridement, and intra-articular osteotomies. When the subtalar joint is not salvageable, some form of arthrodesis procedure is pursued. Occasionally, an extra-articular osteotomy may be necessary in combination with arthrodesis to correct deformity.
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Affiliation(s)
- Benjamin J Ebben
- Department of Orthopedic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA; Bellin Health Titletown Sports Medicine and Orthopedics, 1970 South Ridge Road, Green Bay, WI 54304, USA.
| | - Mark Myerson
- University of Colorado, Foot and Ankle Clinics of N. America, Steps2Walk, 11026 East Crestline Circle, Englewood, CO 80111, USA
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14
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Neumaier M, Kohring J, Ciufo D, Ketz JP. Technique and Early Outcomes for High-Energy Calcaneus Fractures Treated With Staged External Fixation to Combined Open Reduction Internal Fixation and Subtalar Arthrodesis. J Orthop Trauma 2022; 36:e412-e417. [PMID: 36239617 DOI: 10.1097/bot.0000000000002424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE (1) To present an effective surgical technique for the treatment of open and high-energy calcaneal fractures with significant soft tissue injuries. (2) To present complications with this technique and to evaluate patient-reported outcomes of staged external fixation followed by delayed reconstruction with open reduction internal fixation (ORIF) and subtalar arthrodesis. DESIGN Retrospective case series. SETTING Level I trauma center. PATIENTS/PARTICIPANTS Twelve patients with 13 calcaneus fractures associated with open traumatic wounds (10 patients) or other severe soft tissue injury (ie, fracture blisters) between April 2013 and December 2019. INTERVENTION All patients were treated with staged ankle-spanning external fixation and delayed reconstruction with ORIF with subtalar arthrodesis. MAIN OUTCOME MEASURES Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes are presented via the domains of physical function (PF), pain interference (PI), and depression (D) in addition to visual analog score. Complications with the injury and surgical procedure were reported as well. RESULTS Patients underwent initial stabilization on average 1.3 days (range, 0-12 days) from injury with stage II occurring on average 31.1 days (range, 18-42 days) from external fixation. Mean time to radiographic union was 5.6 months (range, 4-10 months). One-year mean PROMIS outcomes were as follows: PF final average of 37.4 with an average improvement of 12.2 (P < 0.01), PI final average of 62.2 with average improvement of 5.6 (P = 0.01), and D final average of 52.1 with average improvement of 6 (P = 0.12). Mean final visual analog score pain score was 3.6 with an average improvement of 2.25 (P = 0.01). CONCLUSION Staged treatment with initial external fixation followed by ORIF and subtalar arthrodesis in the setting of highly comminuted calcaneus fractures with significant soft tissue compromise effectively addresses both bony and soft tissue concerns while providing for positive outcomes postoperatively with regards to pain and function. There were minimal complications noted for this complex injury. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mackenzie Neumaier
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY
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Peng Y, Wang J, Feng B, Li Y, Zhu Y, Yuan W, Teng L, Zhu C, Shi B, Zhang L. Calcaneous interlocking nail treatment for calcaneous fracture: a multiple center retrospective study. BMC Musculoskelet Disord 2022; 23:911. [PMID: 36229809 PMCID: PMC9558390 DOI: 10.1186/s12891-022-05871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Minimally invasive treatments for calcaneous fractures have the same outcomes and fewer complications. However, they are technically demanding, and there are a lack reduction tools. To overcome these problems, a calcaneous interlocking nail system was developed that can make reduction and fixation minimally invasive and effective. We retrospectively studied the calcaneous fracture variables intraoperatively and followed up to evaluate the outcomes of patients treated with the calcaneous interlocking nail system. METHODS All patients in 7 institutions between October 2020 and May 2021 who had calcaneous fractures treated with calcaneous interlocking nails were retrospectively analyzed. The patient characteristics, including age, sex, injury mechanism, Sanders type classification, smoking status, and diabetes were recorded. The calcaneous interlocking nail and standard surgical technique were introduced. The intraoperative variables, including days waiting for surgery, surgery time, blood loss, incision length, and fluoroscopy time, were recorded. The outcomes of complications, AOFAS scores and VAS scores were recorded and compared with other similar studies. RESULTS Fifty-nine patients were involved in this study; 54 were male; 5 were female; and they had an average age of 47.5 ± 9.2 years (range 25-70). 2 of these fractures were Sanders type I, 28 of these fractures were Sanders type II, 27 of these fractures were Sanders type III, and 2 of these were Sanders type IV. The surgery time was 131.9 ± 50.5 (30-240) minutes on average. The blood loss was 36.9 ± 41.1 (1-250) ml. The average incision length was 3.5 ± 1.8 (1-8) cm; 57 were sinus tarsi incisions; and 2 were closed fixations without incisions. The average fluoroscopy time was 12.3 ± 3.6 (10-25) seconds during the surgery. The VAS score of patients on the day after surgery was 2.4 ± 0.7 (1-3). The AOFAS ankle-hindfoot score in patients who had a follow-up of at 12 months was 93.3 ± 3.6(85-99). During the follow-up, all patients' functional outcomes were good. One patient had a superficial infection. The rate of complications of the 59 patients was 1.7% (1/59). CONCLUSION The calcaneous interlocking nail system can have satisfactory reduction and fixation in calcaneous fractures, even in Sanders type IV. The outcomes of follow-up showed good function. The calcaneous interlocking nail could be an alternative method for minimally invasive calcaneous fracture fixation.
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Affiliation(s)
- Ye Peng
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Junsong Wang
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, Beijing, China.,Department of Joint Surgery, Beijing Shijitan Hospital Capital Medical University, Beijing, China
| | - Bo Feng
- Department of orthopaedic clinical medicine, the Third Affiliated Medical College of Inner Mongolia Medical University, Baotou, China
| | - Yunshou Li
- Department of Hand and Foot Surgery, People's Hospital of Juxian, Rizhao, China
| | - Yunlong Zhu
- Department of Orthopaedic Surgery, Beijing fengtai hospital of traditional Chinese and western medicine, Beijing, China
| | - Weiqing Yuan
- Department of Orthopaedic Surgery, Guangxi Orthopedic Hospital, Nanning, China
| | - Lei Teng
- Department of Orthopedics, Mayang County People's Hospital, Huaihua, China
| | - Chengming Zhu
- Department of Orthopedics, Liuzhou workers hospital orthopedic/the fourth affiliated hospital of guangxi medical university orthopaedic, Liuzhou, China
| | - Bin Shi
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Lihai Zhang
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, Beijing, China.
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Cianni L, Vitiello R, Greco T, Sirgiovanni M, Ragonesi G, Maccauro G, Perisano C. Predictive Factors of Poor Outcome in Sanders Type III and IV Calcaneal Fractures Treated with an Open Reduction and Internal Fixation with Plate: A Medium-Term Follow-Up. J Clin Med 2022; 11:5660. [PMID: 36233528 PMCID: PMC9572188 DOI: 10.3390/jcm11195660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Consensus on the treatment for severely comminuted calcaneus fractures has yet to be found. This study aims to analyze the functional and radiological short- and medium-term outcomes of displaced calcaneus fractures of type III and IV treated with ORIF, and to identify, if present, the early predictors of unfavorable outcomes. METHODS Thirty-three calcaneal fractures were included, 23 type III and 10 type IV, according to Sanders classification. AOFAS scales for ankle and hindfoot and SF-12 were used. Böhler and Gissane angles were analyzed before and after surgery. RESULTS The minimum follow-up was six years. The mean AOFAS score at six months was 16.5 points (24.2 ± 10.8 vs 10.8 ± 9.5; p = 0.03) with better outcomes in patients with Sanders type III fractures. This difference decreased in the subsequent follow-up. Likewise, the mental and physical score of SF-12 had the same trend. Two wound infections and no deep infections were recorded in the Sanders type III fracture group. Instead, in the Sanders type IV group, there were four wound infections and one deep infection. CONCLUSIONS Clinical and radiological outcomes in Sanders Type III and Type IV calcaneus fractures treated with plate and screws were very similar in long-term follow-up. If ORIF provided better short- to medium-term follow-up in Sanders type III fracture, these benefits have been lost in six years. Polytrauma and psychiatric patients showed significantly lower clinical outcomes in long-term follow-up, appearing as the most reliable negative predictors.
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Affiliation(s)
- Luigi Cianni
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Raffaele Vitiello
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Tommaso Greco
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Mattia Sirgiovanni
- Department of Pneumology, Allergology and Intensive Care Medicine, University of Saarland, 66421 Homburg, Germany
| | - Giulia Ragonesi
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulio Maccauro
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carlo Perisano
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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A Direct Posterior Approach for Subtalar Distraction Arthrodesis. J Orthop Trauma 2022; 36:S29-S30. [PMID: 35838575 DOI: 10.1097/bot.0000000000002383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 02/02/2023]
Abstract
Because of soft tissue constraints, definitive management of hindfoot trauma occasionally requires a direct posterior approach via a coronal split of the Achilles tendon. This article and the accompanying video demonstrate a direct posterior approach for subtalar distraction arthrodesis and review treatment decisions involved with management of these complex cases.
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18
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Almeida JF, Vale C, Gonzalez T, Gomes TM, Oliva XM. Osteosynthesis or primary arthrodesis for displaced intra-articular calcaneus fractures Sanders type IV - A systematic review. Foot Ankle Surg 2022; 28:281-287. [PMID: 33893034 DOI: 10.1016/j.fas.2021.04.006] [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: 03/05/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Displaced intra-articular calcaneus fractures (DIACF) Sanders type IV represent a challenge in its management and questions remain about the best treatment option available. This study aimed to compare the outcomes of primary subtalar arthrodesis (PSTA) and osteosynthesis in these fractures. METHODS Studies concerning DIACF Sanders type IV, from 2005 to 2020 were systematically reviewed. Only studies evaluating functional outcomes with American Orthopaedic Foot & Ankle Society ankle-hindfoot (AOFAS) score were admitted allowing for results comparison. RESULTS In total, 9 studies met the inclusion criteria. These reported on the results of 142 patients, from which 41 submitted to PSTA and 101 to osteosynthesis, with an average follow-up period over 2 years. We found a significant moderate negative correlation between the reported AOFAS score and the Coleman Methodology Score obtained. Late subtalar arthrodesis was 13.63% of the total osteosynthesis performed. CONCLUSIONS Clinical outcomes after PSTA and osteosynthesis, for the treatment of Sanders type IV fractures, do not seem very different, yet careful data interpretation is crucial. Additional powered randomized controlled trials are necessary to assess which surgical strategy is better.
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Affiliation(s)
- João F Almeida
- Department of Orthopaedics, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal.
| | - Cláudia Vale
- Department of Orthopaedics, Hospital Distrital da Figueira da Foz, Figueira da Foz, Portugal
| | - Tânia Gonzalez
- Department of Orthopaedics, Clinica del Remei, Barcelona, Spain
| | - Tiago M Gomes
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Spain
| | - Xavier Martin Oliva
- Department of Orthopaedics, Clinica del Remei, Barcelona, Spain; Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Spain
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Bloomer AK, McKnight RR, Johnson NR, Macknet DM, Wally MK, Yu Z, Seymour RB, Hsu JR. Screws-Only Primary Subtalar Arthrodesis for Calcaneus Fractures. Foot Ankle Int 2022; 43:509-519. [PMID: 34996306 DOI: 10.1177/10711007211058689] [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: 02/01/2023]
Abstract
BACKGROUND The management of displaced intraarticular calcaneus fractures (DIACFs) is a difficult problem with disappointing results from open reduction internal fixation (ORIF). Alternatively, ORIF with primary subtalar arthrodesis (PSTA) has gained increasing popularity. The purpose of this study is to review patient-centered and radiographic outcomes of ORIF plus PSTA using only screws through a sinus tarsi approach. METHODS A retrospective study of patients who underwent ORIF+PSTA for DIACFs was conducted. The same surgical technique was used in all cases consisting of only screws; no plates were used. Delayed surgeries past 8 weeks were excluded. Demographic and radiographic data were collected including worker's compensation claims. Plain radiographs were used to characterize injuries and review outcomes. RESULTS Seventy-nine DIACFs underwent PSTA with a median follow-up of 200 days (n = 69 patients). Median time to weightbearing was 57.5 days postoperatively. Ten fractures were documented as Sanders II, 36 as Sanders III, and 32 as Sanders IV. Sixty-eight fractures (86.1%) achieved fusion on radiographs at a median of 126.5 (range, 54-518) days. Thirty-nine fractures (57.3%) demonstrated radiographic fusion in all 3 predefined locations. Nine of the 14 worker's compensation patients returned to work within the period of observation. There were 8 complications: 3 requiring a secondary operation. Eleven of 79 fractures treated did not go on to achieve radiographic union. CONCLUSION In this retrospective case series, we found that screws-only primary subtalar arthrodesis for the treatment of DIACFs through a sinus tarsi approach was associated with relatively high rates of return to work and radiographic fusion. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ainsley K Bloomer
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - R Randall McKnight
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Nicholas R Johnson
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - David M Macknet
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Meghan K Wally
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Ziqing Yu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Rachel B Seymour
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
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20
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Khurana A, Sethi A, Gupta SC, Malik K, Arora S, Jain V. Expanding Indications of Primary Arthrodesis in Selected Individuals for Managing Complex Hindfoot Trauma During COVID-19 Pandemic. Indian J Orthop 2022; 56:485-491. [PMID: 34667332 PMCID: PMC8517065 DOI: 10.1007/s43465-021-00535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/17/2021] [Indexed: 02/04/2023]
Abstract
Background During the COVID-19 pandemic, public health measures to encourage social distancing have been implemented, including cancellation of outdoor activities, organized sports, and schools/colleges. Neglected hindfoot fractures have emerged as a consequence with increased frequency. Similarly, complex ankle and pilon fractures that require staged management, prolonged hospital stay, and soft-tissue care have emerged as a potential concern as prolonged exposure to healthcare setting adds to risk of acquiring as well as transmitting COVID-19 infection. The authors present their experience with expanding these indications for hindfoot arthrodesis as they encounter a greater number of neglected ankle and hindfoot trauma. Methods This was a retrospective observational study of collected data from the trauma unit of our hospital. Inclusion criteria included all trauma classified by the AO/OTA as occurring at locations 43, and who underwent subtalar and ankle arthrodesis. This included distal tibia, malleolar, talus, and calcaneus fractures. These patients were followed up to at least 6 months till complete fracture union. Results A total of 18 patients underwent arthrodesis of either the ankle or subtalar joint between March and October 2020. Mean age of patients undergoing arthrodesis of the hindfoot was 69.2 years (43-84 years). Indications for the procedure included Displaced and comminuted intra-articular distal tibia fractures in elderly (6 patients), Malunited ankle fractures (2 patients), Neglected Ankle fractures managed conservatively (3 patients), Calcaneus fractures (5 patients), and neglected Talus body fracture (2 patients). All patients were followed up to at least 6 months and everyone went onto successful painless union between 3 and 6 months of the arthrodesis procedure without any significant complications. Conclusion In summary, COVID-19 pandemic has led to a change in paradigm of trauma management and foot and ankle management is no different than other musculoskeletal trauma systems. The authors propose an expansion of indications for hindfoot arthrodesis in managing complex hindfoot trauma in pandemic situation.
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Affiliation(s)
- Ankit Khurana
- Department of Orthopaedics, ESI Hospital Rohini, Delhi, India
| | - Ankita Sethi
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | | | - Kuldeep Malik
- Department of Orthopaedics, ESI Hospital Rohini, Delhi, India
| | - Sakshi Arora
- Department of Anaesthesia, ESI Hospital Rohini, Delhi, India
| | - Vishal Jain
- Department of Orthopaedics, ESI Hospital Rohini, Delhi, India
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21
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Mansur H, Maranho DA, de Castro Junior IM, Gomes FF. May the Symptomatic Subtalar Joint Be Conservatively Treated With Intra-Articular Hyaluronic Acid Injections After a Calcaneus Fracture? Foot Ankle Spec 2022:19386400211068256. [PMID: 35125018 DOI: 10.1177/19386400211068256] [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 Subtalar pain following intra-articular calcaneus fractures may be associated with disability, pain, and a negative impact on the quality of life. Salvage procedures as subtalar fusion are associated with further consequences as stiffness, altered ankle biomechanics, and adjacent articular overloading with degenerative changes. The objective of the present study is to evaluate the short-term effects of viscosupplementation with intra-articular hyaluronic acid (HA) on function and pain, in patients with painful subtalar joint after calcaneus fracture. METHODS We searched for patients who underwent osteosynthesis of intra-articular calcaneus fracture between January 2011 and July 2015 and were diagnosed during the follow-up with pain and subtalar osteoarthritis. Between January and December of 2018, 13 patients (50 ± 10 years) accepted to participate in this study and received intra-articular HA injections. Three consecutive doses of 20 mg of HA were administered within a week interval, through anterolateral injections into the subtalar joint. We prospectively evaluated the function using the ankle/hindfoot American Orthopaedic Foot & Ankle Society score (AOFAS) and level of pain using the visual analog scale (VAS) before the intervention and 4, 12, and 24 weeks after the first injection. RESULTS Hindfoot function improved with an increase of AOFAS from 55 ± 19 before the intervention to 88 ± 20 at the 24th week (P = .001). Similarly, we observed relief of pain during the 24 weeks following intra-articular hyaluronic acid injection, with a decrease in VAS from 8.3 ± 1.3 before treatment to 2.2 ± 3.0 at the 24th week (P = .001). CONCLUSION For patients experiencing pain and dysfunction with subtalar osteoarthritis after intra-articular calcaneus fracture, viscosupplementation with intra-articular HA may be associated with improvement in function and pain in the short term. Furthermore, patients with higher grades of osteoarthritis may have limited benefit in pain relief and function improvement. LEVEL OF EVIDENCE IV, Case series.
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Affiliation(s)
- Henrique Mansur
- Department of Orthopedic Surgery, Hospital DF Star and Santa Helena, Brasília, Brazil
- Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | | | | | - Fernanda Ferreira Gomes
- Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
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Park KH, Oh CW, Kim JW, Kim HJ, Kim DH, Kim TS. Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy. Foot Ankle Int 2021; 42:1439-1446. [PMID: 34130528 DOI: 10.1177/10711007211013012] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. METHODS We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. RESULTS The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of -22 degrees (range, -109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. CONCLUSION Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Kyeong-Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Jung-gu, Daegu, Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Jung-gu, Daegu, Korea
| | - Joon-Woo Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Jung-gu, Daegu, Korea
| | - Hee-June Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Jung-gu, Daegu, Korea
| | - Dong-Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Jung-gu, Daegu, Korea
| | - Tae-Seong Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Jung-gu, Daegu, Korea
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Varol A, Oc Y, Kilinc BE. An evaluation of the efficacy of the locked plate with bone grafting in Sanders type III and IV intra-articular calcaneus fractures. SAGE Open Med 2021; 9:20503121211040954. [PMID: 34434558 PMCID: PMC8381430 DOI: 10.1177/20503121211040954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/30/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: To demonstrate the efficacy of locking plate osteosynthesis performed by an
L-shaped lateral approach in patients with Sanders type III and IV
intra-articular calcaneal fractures with posterior facet displacement. Methods: Fifty-three patients with Sanders type III or IV unilateral calcaneal
fractures treated with locking plates and additional bone grafting were
included in the study. Böhler and Gissane angles, and heel height values
were measured on the radiological examinations. Clinical results of the
patients were evaluated using the American Orthopaedic Foot and Ankle
Society and Maryland evaluation criteria. The presence of arthrosis was
investigated with Broden’s view. Preoperative and postoperative values were
evaluated. Results: The mean Gissane angle was 119.32°, the mean Böhler angle was 9.47° and the
mean heel height was 40.82 mm on radiographs at initial presentation of the
patients. The mean Gissane angle was 114.63°, the mean Böhler angle was
23.33° and the mean heel height was 47.84 mm on the early postoperative
radiographs of the patients. In patients, a mean 4.69° recovery was achieved
in the Gissane angle, 13.86° in Böhler angle and 7.02 mm in heel height. On
the most recent follow-up, Böhler angle was 21.49°, Gissane was 114.88° and
the mean heel height was 46.95 mm. The mean American Orthopaedic Foot and
Ankle Society score and Maryland score were 86.91 and 86.53, respectively,
on the last follow-up. Conclusion: Internal fixation and grephonage using low-profile locking plates provides
good functional results to patients since it facilitates anatomic
restoration of the subtalar joint and correction of calcaneal height, width
and varus/valgus heel.
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Affiliation(s)
- Ali Varol
- Department of Orthopaedics and
Traumatology, Health Science University, Istanbul Fatih Sultan Mehmet Training and
Research Hospital, Istanbul, Turkey
| | - Yunus Oc
- Department of Orthopaedics and
Traumatology, Beykent University Faculty of Medicine, Istanbul, Turkey
| | - Bekir Eray Kilinc
- Department of Orthopaedics and
Traumatology, Health Science University, Istanbul Fatih Sultan Mehmet Training and
Research Hospital, Istanbul, Turkey
- Bekir Eray Kilinc, Department of
Orthopaedics and Traumatology, Health Science University, Istanbul Fatih Sultan
Mehmet Training and Research Hospital, Icerenkoy District Zubeyde Hanim Street
No: 1 B-43 PC:34752, Atasehir, Istanbul, Turkey.
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Gültekin A, Acar E, Uğur L, Yıldız A, Serarslan U. The importance of Böhler's angle in calcaneus geometry: A finite element model study. Jt Dis Relat Surg 2021; 32:420-427. [PMID: 34145820 PMCID: PMC8343831 DOI: 10.52312/jdrs.2021.81251] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/14/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Calcaneal fractures are the most common tarsal fractures following a foot-ankle trauma. The Böhler's angle is an important measurable angle before, during, and after surgery. In this study, we aimed to investigate correlation between Böhler's angle, calcaneal strength, and subtalar joint stress using a finite element analysis (FEA). PATIENTS AND METHODS Between January 2016 and December 2016, computed tomography (CT) scans were used with MIMICS® software for FEA. The ankle and foot of a 23-year-old male person with a height of 180 cm and weighing 80 kg was modeled as reference. Raw coronal CT images were obtained in Digital Imaging and Communications in Medicine format with the resolution of 512X512 pixels and 0.3-mm slice intervals in 135 kV. The structures including tibia, fibula and 26 other bones (talus, calcaneus, cuboid, navicular, three cuneiforms, five metatarsals, and 14 components of phalanges), cartilage and ligamentous tissues were modeled to form ankle joint. After determining Böhler's angle as 35 degrees for the reference model, a fracture line was created on calcaneus. Calcaneus was remodeled with the Böhler's angle of 45, 40, 30, 25, 20, 10, and 0 degrees respectively. All models were transferred to ANSYS software for FEA and the loads on the lower extremities with normal posture were applied on models. RESULTS Analysis of all models based in the reference model revealed that maximum tension values on calcaneus increased, while the Böhler's angle decreased, indicating a statistically significant difference. The decreased Böhler's angle indicated statistically significantly higher maximum tension values (p=0.04). Action force in subtalar joint was evaluated by comparing with the forces in reference model. The increased Böhler's angle was found to be associated with statistically significantly decreased amount of load on subtalar joint. The decreased Böhler's angle was related to the statistically significantly increased amount of load on subtalar joint. CONCLUSION Our study results suggest that decreased Böhler's angle increases the possibility of subtalar arthrosis, although overcorrection of the Böhler's angle seems not to increase the risk of subtalar arthrosis.
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Affiliation(s)
| | - Erdinç Acar
- Ankara Şehir Hastanesi Ortopedi ve Travmatoloji Kliniği, El ve Üst Ekstremite Cerrahisi Bölümü, 06800 Çankaya, Ankara, Türkiye.
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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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Driessen M, Edwards M, Biert J, Hermans E. Long-term results of displaced intra-articular calcaneal fractures treated with minimal invasive surgery using percutaneous screw fixation. Injury 2021; 52:1054-1059. [PMID: 33388150 DOI: 10.1016/j.injury.2020.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/09/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Over the last 20 years, minimally invasive surgery using Percutaneous Screw Fixation (PSF) has been performed increasingly frequently in the treatment of Displaced Intra-Articular Calcaneal Fractures (DIACFs). The purposes of this study were to assess the long-term postoperative outcomes of mobility, foot function, stability, pain and patient satisfaction. METHODS All patients had DIACFs and underwent PSF between 1998 and 2006 according to the method reported by Forgon and Zadravecz. Functional outcomes, range of motion and change in footwear were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Maryland Foot Score (MFS). All patients completed a general health status form (Short Form-36 [SF-36]) and visual analogue scale (VAS) for patient satisfaction. Anatomical restoration was assessed based on the pre- and postoperative radiographic images. RESULTS Sixty-six patients with an DIACF were observed in the period 1998-2006. Patients who had open fractures, died or were <18 years of age at trauma were excluded. A total of 46 patients were asked to complete the questionnaires, during the last quarter of 2018. Of these patients, 27 with 29 DIACFs responded (58%). Nineteen were males, and the mean age at trauma was 45 years. Seven cases were classified as Sanders type II, 14 as Sanders type III, and 8 as Sanders type IV. The mean pre- and postoperative Böhler angles were 10 ͦ and 26 ͦ, respectively. The average follow-up period was 16 years, and at the follow-up, the mean AOFAS, MFS, SF-36 and VAS scores were 76, 74, 63 and 7.7 points, respectively. In comparison to the results at 5-10 years postoperatively in a previous study, we observed a decline in the average AOFAS and MFS scores by 8 and 11 points, respectively. Patient satisfaction decreased by 0.1 points and general health by 14 points. CONCLUSION The long-term results of this study show relatively good functional outcomes is two-thirds of the treated patients. According to the reported scores, patients described their level of function as essentially normal. PSF should therefore be considered as a good option in patients with DIAC fractures, especially in patients with Sanders II and III fractures. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Mls Driessen
- Department of surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Mjr Edwards
- Department of surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J Biert
- Department of surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E Hermans
- Department of surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Gougoulias N, McBride D, Maffulli N. Outcomes of management of displaced intra-articular calcaneal fractures. Surgeon 2020; 19:e222-e229. [PMID: 33262043 DOI: 10.1016/j.surge.2020.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022]
Abstract
Despite the advances in operative management, displaced intra-articular calcaneal fractures (DIAFCs) are often associated with long term sequelae, permanent disability, a considerable reduction in quality of life, and a high socio-economic cost. Randomized controlled trials have shown that patient reported outcomes of surgery are no better than those of nonoperative management. Methodological flaws and selection bias may have influenced the results, however, and subgroup analysis showed that some patients could benefit from surgery, whilst patients' preference can be the decisive factor in choosing a management modality. Fractures with significant lateral wall displacement predisposing to impingements often require surgery, and management has to be individualized and tailored to the patient. Surgery does not usually achieve excellent results, though it exposes the patient to potential risks and complications. Wound healing problems and infections affect around 20% of patients when the extensile lateral approach has been used. Sinus tarsi approach and minimally invasive surgery may be viable alternatives, offering similar results with fewer wound complications, but most of the available studies are of low to moderate quality. Late subtalar joint arthrodesis is often required: however, such procedure would be less technically difficult and could result in better foot function should the shape of the calcaneus have been anatomically restored with surgery in the acute phase.
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Affiliation(s)
- Nikolaos Gougoulias
- Frimley Health NHS Foundation Trust, Frimley, United Kingdom; Foot & Ankle Clinic, Iaso Thessalias Hospital, Larisa, Greece
| | - Donald McBride
- University Hospital of North Midlands, Stoke on Trent, United Kingdom
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy; Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, United Kingdom; Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke-on-Trent, Staffordshire, ST4 7QB, United Kingdom.
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Schepers T. Fixation by Open Reduction and Internal Fixation or Primary Arthrodesis of Calcaneus Fractures: Indications and Technique. Foot Ankle Clin 2020; 25:683-695. [PMID: 33543723 DOI: 10.1016/j.fcl.2020.08.008] [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: 02/02/2023]
Abstract
The quest for the best treatment of displaced intraarticular calcaneal fractures continues. The open reduction and internal fixation of displaced intraarticular calcaneal fractures yields the best results if anatomic reduction is obtained and complications are avoided. The sinus tarsi approach is becoming the new gold standard. In cases with severe comminution or when anatomic reduction cannot be obtained, a primary subtalar arthrodesis is a valuable option, if the overall anatomy of the calcaneus is corrected first. This review discusses the open reduction and internal fixation of displaced intraarticular calcaneal fractures and the indications and technique of the primary arthrodesis.
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Affiliation(s)
- Tim Schepers
- Trauma Unit, Amsterdam UMC Location AMC, Room G5-250, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Rodemund C, Krenn R, Kihm C, Leister I, Ortmaier R, Litzlbauer W, Schwarz AM, Mattiassich G. Minimally invasive surgery for intra-articular calcaneus fractures: a 9-year, single-center, retrospective study of a standardized technique using a 2-point distractor. BMC Musculoskelet Disord 2020; 21:753. [PMID: 33189140 PMCID: PMC7666766 DOI: 10.1186/s12891-020-03762-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A fracture of the calcaneus can be a painful and disabling injury. Treatment modalities may be conservative or operative. Surgical treatment strategies include open reduction and internal fixation (ORIF) techniques, as well as a variety of minimally invasive methods. The aim of this study was to evaluate the treatment options and post-treatment complication rates for intra-articular calcaneal fractures at the Traumacenter Linz over a 9-year period. METHODS All patients with calcaneal fractures treated at the Traumacenter Linz between 2007 and 2015 were included in this study. The patients records were retrospectively reviewed, and the data, including demographic parameters, cause of injury, and the time between injury and operative treatment were analyzed. The number of secondary operative interventions due to soft-tissue complications, hardware removal, and the long-term arthrodesis rate were evaluated. RESULTS A minimally invasive 2-point-distractor method was used in 85.8% (n = 182) of all operatively managed calcaneal fractures (n = 212) in our department. The majority of the operations (88.7%) were performed within 2 days after the accident. The secondary operation rate resulting from wound complications was 2.7% in the 2-point distractor group and 16.7% in the ORIF group. A secondary arthrodesis was performed in 4.7% (n = 9) of the subtalar joints in the entire study population. CONCLUSIONS Our data supported the assumption that severe wound complications would be less likely to occur after minimally invasive treatment compared to ORIF treatment. The rate of secondary arthrodesis in the study cohort was comparable to that in the literature. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Christian Rodemund
- AUVA - Traumacenter (UKH) Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Ronny Krenn
- AUVA - Traumacenter (UKH) Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Carl Kihm
- Norton Audubon Hospital, Attending Podiatric Surgeon, Louisville, KY, USA
| | - Iris Leister
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria.,Research Unit of Orthopedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Hall in Tirol, Austria
| | - Werner Litzlbauer
- AUVA - Traumacenter (UKH) Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Angelika M Schwarz
- AUVA - Traumacenter (UKH) Styria
- Graz, Teaching Hospital of the Medical University Graz, Göstinger Straße 24, 8020, Graz, Austria
| | - Georg Mattiassich
- AUVA - Traumacenter (UKH) Styria
- Graz, Teaching Hospital of the Medical University Graz, Göstinger Straße 24, 8020, Graz, Austria.
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Open reduction and internal fixation (ORIF) versus ORIF and primary subtalar arthrodesis for complex displaced intraarticular calcaneus fractures: An expected value decision analysis. OTA Int 2020; 1:e005. [PMID: 33937643 PMCID: PMC7953466 DOI: 10.1097/oi9.0000000000000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/20/2018] [Indexed: 11/26/2022]
Abstract
Objectives: To determine the optimal patient-oriented treatment between open reduction and internal fixation (ORIF) with or without primary subtalar arthrodesis (PSTA) for patients with displaced intraarticular calcaneus fractures (DIACFs, OTA 82-C3 and C4). Design: Expected value decision analysis. Setting: Academic military treatment facility Participants: One hundred randomly selected volunteers. Intervention: Hypothetical clinical scenario involving ORIF versus ORIF with PSTA. Main outcome measurements: Decision analysis was used to elucidate the superior treatment option based on expected patient values, composed of: the product of the average outcome probabilities established by previously published studies and the average ascribed patient utility values for each outcome probability. One-way sensitivity analysis was performed to quantify the amount of change required for the inferior treatment to equal or surpass the superior option. Results: Expected values for ORIF and ORIF with PSTA were 8.96 and 18.06, respectively, favoring ORIF with PSTA. One-way sensitivity analysis was performed by artificially decreasing the rate of secondary fusion following isolated ORIF thus increasing its overall expected value. Adjusting the rate of secondary fusion to 0%, the expected value of ORIF with PSTA nearly doubled that of ORIF (18.06 vs 9.45). Similarly, when adjusting the moderate and severe complication rates following ORIF with PSTA to 100%, the expected value of ORIF with PSTA still exceeded that of ORIF (15.45 vs 8.96, and 13.52 vs 8.96, respectively). Conclusion: Expected value decision analysis favors ORIF with PSTA as the optimal treatment for complex DIACF.
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Allegra PR, Rivera S, Desai SS, Aiyer A, Kaplan J, Gross CE. Intra-articular Calcaneus Fractures: Current Concepts Review. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420927334. [PMID: 35097384 PMCID: PMC8564939 DOI: 10.1177/2473011420927334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures include intra-articular involvement of the posterior facet of the calcaneus. Intra-articular calcaneal fractures are challenging injuries to manage for both patients and surgeons given their association with both early and late complications. This article aims to review the management, classification systems, surgical approaches, and care regarding intra-articular calcaneal fractures. A review of the current literature yielded treatment strategies that aim to reduce complications such as soft tissue injury or loss of articular reduction while maintaining satisfactory clinical outcomes. The purpose of this article is to review these current concepts in the management of intra-articular calcaneal fractures. Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Paul R Allegra
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sebastian Rivera
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sohil S Desai
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Amiethab Aiyer
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jonathan Kaplan
- Miller School of Medicine, University of Miami, Miami, FL, USA
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Cost-Effectiveness of Operative Versus Nonoperative Management of Patients With Intra-articular Calcaneal Fractures. J Orthop Trauma 2020; 34:382-388. [PMID: 31917759 DOI: 10.1097/bot.0000000000001731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the costs, health gains, and cost-effectiveness of operative versus nonoperative treatment of calcaneal fractures over a 5-year time horizon from both US societal and payer perspectives. METHODS The societal perspective analysis included both direct medical costs and costs for missed work, whereas the health care payer perspective analysis included only direct medical costs associated with treatment and complications. A decision tree simulation model was developed to estimate the direct medical and indirect costs (2018 US$) and quality-adjusted life-years (QALYs) for treatment of patients sustaining intra-articular calcaneal fractures fixed with an extensile lateral approach. Direct medical costs were obtained from a large US health care system in Utah, Intermountain Healthcare, and indirect costs from the literature. Utility and probability parameters were also derived from the literature. Parameter uncertainty was explored using both one-way and probabilistic sensitivity analysis. RESULTS From a US societal perspective, operative treatment costs less ($35,110 vs. $39,870) and yielded more QALYs (3.89 vs. 3.51) over 5 years compared with nonoperative treatment. At a willingness-to-pay threshold of $50,000 per QALY, operative fixation had an 89% probability of being cost-effective. From a health care payer perspective, operative management remained cost-effective as the incremental cost-effectiveness ratio is below the willingness-to-pay threshold of $50,000/QALY. CONCLUSION From both US societal and health care payer perspectives, operative treatment of displaced intra-articular calcaneal fractures utilizing an extensile lateral approach is cost-effective at commonly accepted willingness-to-pay thresholds compared with nonoperative treatment over a 5-year time horizon. Patient variability may impact cost-effectiveness and should be explored in future research. LEVEL OF EVIDENCE Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Fletcher AN, Liles JL, Steele JJ, Pereira GF, Adams SB. Systematic Review of Subtalar Distraction Arthrodesis for the Treatment of Subtalar Arthritis. Foot Ankle Int 2020; 41:437-448. [PMID: 31958992 DOI: 10.1177/1071100719899050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subtalar distraction arthrodesis (SDA) was developed as a means of treating the symptoms of subtalar arthritis. Despite almost 30 years of research in this field, many controversies still exist regarding SDA. The objective of this study was to present an overview of outcomes following SDA, focusing on surgical technique as well as clinical and radiographic results. METHODS MEDLINE and EMBASE were queried and data abstraction was performed by 2 independent reviewers. Inclusion criteria for the articles were (1) English language, (2) peer-reviewed clinical studies with evidence levels I to IV, (3) with at least 5 patients, and (4) reporting clinical and/or radiographic outcomes of SDA. RESULTS Twenty-five studies matched the inclusion criteria (2 Level III and 23 Level IV studies) including 492 feet in 467 patients. The most common indication for SDA was late complications of calcaneus fractures. Many different operative techniques have been described, and there is no proven superiority of one method over the other. The most commonly reported complications were nonunion, hardware prominence, wound complications, and sural neuralgia. All studies showed both radiographic and clinical improvement at the last follow-up visit compared with the preoperative evaluation. Pooled results (12 studies, 237 patients) demonstrated improved American Orthopaedic Foot & Ankle Society ankle-hindfoot scores with a weighted average of 33 points of improvement. CONCLUSION SDA provides good clinical results at short-term and midterm follow-up, with improvement in ankle function as well as acceptable complication and failure rates. Higher quality studies are necessary to better assess outcomes between different operative techniques. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Amanda N Fletcher
- Department of Orthopaedics, Orthopaedic Surgery Resident, Duke University Medical Center, Durham, NC, USA
| | - Jordan L Liles
- Department of Orthopaedics, Orthopaedic Surgery Resident, Duke University Medical Center, Durham, NC, USA
| | - Johnathan J Steele
- Department of Orthopaedics, Orthopaedic Surgery Resident, Duke University Medical Center, Durham, NC, USA
| | - Gregory F Pereira
- Department of Orthopaedics, Orthopaedic Surgery Resident, Duke University Medical Center, Durham, NC, USA
| | - Samuel B Adams
- Department of Orthopaedics, Duke Medical Center, Durham, NC, USA
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Late Treatment of Displaced Intra-Articular Calcaneus Fractures: Successful Management With Anatomic Reduction. J Orthop Trauma 2020; 34 Suppl 1:S21-S25. [PMID: 31939776 DOI: 10.1097/bot.0000000000001694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the results of displaced intra-articular calcaneus fractures treated more than 25 days after injury by open reduction and internal fixation (ORIF) using a lateral extensile surgical approach. METHODS Twenty patients identified by retrospective review of our trauma database were treated with ORIF for a displaced intra-articular calcaneus fracture more than 25 days after injury. OTA/AO 82-B and 82-C fracture patterns were included. All had ORIF by a lateral extensile approach. Bohler's angle was measured on injury radiographs, after operative fixation and the final follow-up and compared with the Bohler's angle of the contralateral uninjured extremity. Patients completed a Musculoskeletal Function Assessment (MFA) to evaluate the functional outcome. RESULTS The mean number of days from injury to fixation was 33.4 days (range, 26-58 days). A total of 18/20 patients were available for follow-up (mean 26.1 months; range 12.5-100 months). Eleven injuries were joint depression (82-C), and 7 injuries were tongue type (82-B) fracture patterns. The reason for delayed presentation was delayed transfer to our institution (11 patients), hemodynamic instability from polytrauma (2 patients), excessive fracture blisters (2 patients), and sepsis (1 patient). Bohler's angle at the time of injury was a mean of 10.9 degrees, which corrected to a mean of 33.3 after operative fixation but decreased to a mean of 28.1 at the time of the final follow-up. The mean Bohler angle was 32.3 on the contralateral uninjured side. The mean MFA score was 16.5 (range, 1-34). There were no wound infections or subtalar arthrodesis procedures performed. CONCLUSIONS ORIF by a lateral extensile approach is a safe and viable option for patients presenting in a delayed fashion with a displaced intraarticular calcaneus fracture. Marked improvement in the Bohler angle, acceptable functional outcome, and low complication rates can be expected when surgery is performed by an experienced surgeon. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Evers J, Oberste M, Wähnert D, Grüneweller N, Wieskötter B, Milstrey A, Raschke MJ, Ochman S. [Outcome after surgical treatment of calcaneal fractures]. Unfallchirurg 2019; 122:778-783. [PMID: 30402689 DOI: 10.1007/s00113-018-0578-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND After controversial discussions in the literature about therapy regimens for calcaneal fractures, a retrospective study of patients operatively treated in a maximum care trauma center was conducted. OBJECTIVE Investigation of the influencing factors on the treatment quality of operatively treated patients with calcaneal fractures. MATERIAL AND METHODS Between 2005 and 2013 a total of 90 patients with calcaneal fractures were surgically treated in this hospital with locking plate osteosynthesis. A total of 48 patients with 55 fractures were retrospectively investigated. The assessment with respect to posttraumatic arthrosis was made radiologically and Böhler's and Gissane's angles were also determined. Clinically AOFAS and SF-36 scores were documented. The results were statistically tested with respect to possible risk factors. RESULTS A total of 9 patients (18.8%) were found with complications necessitating operative revision, with 8 patients requiring subtalar arthrodesis and 1 patient with a deep wound infection. Nicotine abuse and a long interval between trauma and reconstructive surgery were identified as factors that influenced the development of wound healing problems. The average AOFAS score was 68 points and the SF-36 was 58.86 points. A poor result in the scores was caused by the development of symptomatic arthritis and the type of insurance. In this cohort factors, such as age and complexity of fractures were not correlated with a poor result. CONCLUSION In this patient collective nicotine abuse and a long interval between trauma and surgery were risk factors for development of wound infections. Other factors with an influence on the outcome were the postoperative development of arthritis and the type of health insurance; however, patient age had no impact on the outcome.
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Affiliation(s)
- J Evers
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland.
| | - M Oberste
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - D Wähnert
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - N Grüneweller
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - B Wieskötter
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - A Milstrey
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - M J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
| | - S Ochman
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland
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Labronici PJ, Faria GGPD, Pedro BM, Serra MDFDA, Pires RES, Tamontini JL. Böhler's Angle-Comparison Between the pre- and Postoperative in Displaced Intra-Articular Calcaneal Fractures. Rev Bras Ortop 2019; 54:156-164. [PMID: 31363261 PMCID: PMC6529326 DOI: 10.1016/j.rbo.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/07/2017] [Indexed: 11/24/2022] Open
Abstract
Objective To compare pre- and postoperative variation of radiographic measurements of the Böhler angle (BA) in fractures with two types of deviations: severe and moderate. Methods Pre- and postoperative BAs in 31 calcaneal fracture radiographs were retrospectively analyzed. A total of 4 patients were female (6.5%) and 26 were male (83.9%), with age ranging from 23 to 72 years old, and a mean age of 44.5 years old. Results The results show that the postoperative BA was significantly larger than the preoperative BA ( p = 0.000). At the intraevaluator and overall assessments, the postoperative BA was, on average, 10.6° higher than the preoperative measure. The postoperative angle was, on average, 108% higher than the preoperative angle. In the global assessment, the agreement between evaluators was excellent, both regarding the estimated point value (0.98) and the intraclass correlation (ICC) confidence interval (CI). Conclusion In the global analysis, the postoperative BAs were, on average, significantly higher than the preoperative measurements. The farther from the normal range (20° to 40°) the preoperative angle is, the greater the difference after the surgery. When the preoperative angle was normal, the postoperative angle was, on average, 1.28 times the preoperative measurement. If the preoperative BA was abnormal, the postoperative angle was, on average, 17.3 times the preoperative measurement. It was demonstrated that more severe fractures present better anatomic results when compared with moderate fractures. The present study also confirms a good interobserver correlation for the BA.
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Affiliation(s)
- Pedro José Labronici
- Serviço de Ortopedia e Traumatologia, Hospital Santa Teresa, Petrópolis, RJ, Brasil
- Universidade Federal Fluminense, Niterói, RJ, Brasil
| | | | - Bruno Miranda Pedro
- Serviço de Ortopedia e Traumatologia, Hospital Santa Teresa, Petrópolis, RJ, Brasil
| | | | | | - Jorge Luiz Tamontini
- Instituto de Ortopedia e Traumatologia, Hospital Dr. Bartolomeu Tacchini, Bento Gonçalves, RS, Brasil
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Roukis TS. Joint-Sparing Surgical Management of Sanders IV Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:251-268. [PMID: 30784535 DOI: 10.1016/j.cpm.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Displaced intra-articular calcaneal fractures represent life-altering injuries. Difficulty obtaining and maintaining calcaneal morphology and the significant risk of wound healing complications with an extensile lateral incision exist. Open reduction with internal fixation as a joint-sparing approach has been studied. Closed manipulation to restore calcaneal morphology, intra-osseous fracture reduction, and rigid locked CALCANAIL fracture nail fixation have recently been applied to Sanders IV fracture patterns. Spontaneous conversion to primary subtalar joint arthrodesis using the same instrumentation remains unique to this system. This article reviews open and percutaneous approaches for joint-sparing and primary arthrodesis procedures to treat Sanders IV fracture patterns.
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Affiliation(s)
- Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, 1900 South Avenue, La Crosse, WI 54601, USA.
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Surgical Management of Displaced Intra-Articular Calcaneal Fractures: What Matters Most? Clin Podiatr Med Surg 2019; 36:173-184. [PMID: 30784529 DOI: 10.1016/j.cpm.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Displaced intra-articular calcaneal fractures are severe, complex injuries that can cause significant long-term functional impairment. Despite the controversies of whether these fractures should be treated operatively or nonoperatively, functional improvement can be seen with confounding variables that can be controlled by the surgeon. This article reviews prognostic factors that are associated with good functional outcomes following operatively treated displaced intra-articular calcaneal fractures.
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Lee HS, Kim WJ, Park ES, Kim JY, Kim YH, Lee YK. Mid-term follow-up results of calcaneal reconstruction for calcaneal malunion. BMC Musculoskelet Disord 2019; 20:43. [PMID: 30696419 PMCID: PMC6352372 DOI: 10.1186/s12891-019-2419-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/14/2019] [Indexed: 11/28/2022] Open
Abstract
Background We hypothesized that calcaneal reconstruction can relieve chronic pain due to calcaneal malunion. We report the mid-term follow-up results of calcaneal reconstruction for calcaneal malunion. Methods We reviewed the records of 10 male patients (10 ft) who underwent calcaneal reconstruction for calcaneal malunion between January 2009 and July 2014 at the mid-term follow-up. Talocalcaneal height and angle, calcaneal pitch, calcaneal width, Böhler angle, Stephens classification, and Zwipp classification were evaluated by three orthopedic doctors at each visit (pre-reconstruction, post-reconstruction, and at the last follow-up). Results The mean follow-up period was 67.1 months (range, 48–101 months). The sites of pain before reconstruction were lateral aspect (4 patients), plantar aspect (3 patients), diffuse pain (2 patients), and anterior aspect (1 patient). There was a significant difference in talocalcaneal height, talocalcaneal angle, calcaneal pitch, calcaneal width, and Böhler angle before and after reconstruction (p < 0.05). There was no significant difference between reconstruction and the last follow-up. Radiological measurement agreement was calculated to be moderate to strong (intraclass correlation coefficient: 0.659–0.988). Mean American Orthopedic Foot & Ankle Society Ankle and Hindfoot score improved from 66.50 ± 9.37 pre-reconstruction to 80.30 ± 8.52 at the last follow-up (p < 0.05). The mean visual analog scale score improved from 8.60 ± 1.43 before reconstruction to 3.40 ± 0.84 at the last follow-up (p < 0.05). Most patients were satisfied with the outcome postoperatively. Conclusions Our results showed substantial improvement in the clinical and radiological outcomes after calcaneal reconstruction of calcaneal malunion. This outcome was maintained until the mid-term follow-up. Therefore, calcaneal reconstruction may be a good option for the treatment of chronic pain caused by the malunion of a calcaneal fracture without severe subtalar arthritis. Further prospective studies are needed to test this theory. Level of Evidence: Level IV, Retrospective Case Series.
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Affiliation(s)
- Hong Seop Lee
- Department of Foot and Ankle Surgery, Eulji Medical Center, Eulji University, 68, Hangeulbiseok-ro, Nowoungu, Seoul, 01830, Korea
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan, Korea
| | - Eun Seok Park
- Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, 1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-do, 420-767, Republic of Korea
| | - Jun Young Kim
- Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, 1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-do, 420-767, Republic of Korea
| | - Young Hwan Kim
- Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, 1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-do, 420-767, Republic of Korea
| | - Young Koo Lee
- Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, 1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-do, 420-767, Republic of Korea.
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Minimally invasive fixation for displaced intra-articular fractures of calcaneum: a short-term prospective study on functional and radiological outcome. Musculoskelet Surg 2018; 103:181-189. [PMID: 30353311 DOI: 10.1007/s12306-018-0575-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Studies have demonstrated a decrease in the incidence of late consequences and the socio-economic burden of intra-articular fractures of calcaneum when treated by surgical fixation. Operative management of displaced intra-articular calcaneal fractures (DIACF) pose significant challenges such as technical difficulty, wound healing and long-term pain and disability. MATERIALS AND METHODS All patients presenting to the ER with DIACF over a period of 2 years and matching the inclusion criteria were enrolled in the study. Percutaneous fixation with 4 mm CC screw was undertaken with a minimally invasive sinus tarsi approach. All patients were available for a minimum follow-up of 24 months. Six radiological parameters were assessed, and functional outcome was evaluated using AOFAS score. RESULTS Thirty-four patients with 42 calcaneal fractures were included in the study, and all patients were available for minimum follow-up period. All radiological parameters were attained within anatomic normal range and maintained at 24 months of follow-up. AOFAS score showed a mean value of 90.10 which is considered an excellent outcome. Superficial wound infection was seen in two patients, but no patients required a revision surgery. CONCLUSION Displaced intra-articular fractures pose a treatment dilemma, more so in cases of soft tissue complications like open injury or blisters. Percutaneous screw fixation with limited sinus tarsi incision has shown good functional and radiological outcome with minimal complications and can be undertaken without delay.
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Diranzo-García J, Bertó-Martí X, Castillo-Ruiperez L, Estrems-Díaz V, Hernández-Ferrando L, Villodre-Jiménez J, Bru-Pomer A. Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Takeuchi N, Mae T, Fukushi JI, Tsukamoto N, Mizu-Uchi H, Momii K, Nakashima Y. Management of Intra-Articular Calcaneal Fractures: Clinical Results of Reduction Technique Using a Bone Spreader. J Foot Ankle Surg 2018; 56:1025-1030. [PMID: 28842087 DOI: 10.1053/j.jfas.2017.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Indexed: 02/03/2023]
Abstract
The purpose of the present study was to examine the clinical results of surgery for intra-articular calcaneal fractures using a calcaneal locking plate and a bone spreader as a reduction tool. Ten patients with intra-articular calcaneal fractures were treated. An extended lateral approach was used. The reduction of the intra-articular fragments of the posterior facet was temporarily held using a bone spreader and Kirschner wires. Internal fixation was achieved with a locking calcaneal plate. Böhler's angle and Preiss' angle were assessed on the day of injury and the day of the final follow-up examination. The step off and gap of the posterior facet were assessed on the day of injury and the first week after surgery. The functional outcome was evaluated using the American Orthopaedic Foot and Ankle Society ankle hindfoot scale score. The mean Böhler's angle ranged from 2.1° ± 11.0° to 30.4° ± 5.0° (p < .0001), the mean Preiss' angle ranged from 23.5° ± 4.5° to 15.5° ± 2.9° (p < .0001), the mean step off ranged from 4.0 ± 1.9 mm to 0.1 ± 0.2 mm (p = .0002), and the mean gap ranged from 2.6 ± 1.0 mm to 1.2 ± 0.6 mm (p = .0035). The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score was 89.2 (range 85 to 100) at a mean of 14.3 months after surgery. Our results suggest that a locking calcaneal plate can be used to restore and reduce an intra-articular calcaneal fracture and achieve good clinical results.
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Affiliation(s)
- Naohide Takeuchi
- Orthopedist, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan.
| | - Takao Mae
- Orthopedist, Department of Trauma and Orthopaedic Surgery, Saga-ken Medical Centre Koseikan, Saga City, Japan
| | - Jun-Ichi Fukushi
- Orthopedist, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
| | - Nobuaki Tsukamoto
- Orthopedist, Department of Trauma and Orthopaedic Surgery, Saga-ken Medical Centre Koseikan, Saga City, Japan
| | - Hideki Mizu-Uchi
- Orthopedist, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
| | - Kenta Momii
- Orthopedist, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
| | - Yasuharu Nakashima
- Professor, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
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Abstract
The indications for arthroscopy have expanded over the years. Arthroscopic-assisted open reduction internal fixation in the setting of acute trauma is gaining popularity with foot and ankle surgeons. It serves to facilitate direct visualization of fracture fragments and allows for precise articular reduction with minimal soft tissue insult. Current evidence reports a high incidence of chondral injury with ankle fractures. Arthroscopy performed at the time of open reduction internal fixation allows for joint inspection and potential treatment of these posttraumatic defects.
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Beals TR, Harris R, Auston DA. Articular Incongruity in the Lower Extremity: How Much Is Too Much? Orthop Clin North Am 2018; 49:167-180. [PMID: 29499818 DOI: 10.1016/j.ocl.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Intraarticular fractures carry a significant risk for posttraumatic osteoarthritis, and this risk varies across different joint surfaces of the lower extremity. These differences are likely due to the anatomic and biomechanical specifics of each joint surface. High-quality human studies are lacking to delineate the threshold articular incongruity that significantly increases risk for posttraumatic osteoarthritis and diminished clinical outcomes for many joint surfaces. Even with anatomic reduction of the articular surface, close attention must be paid to mechanical axis and joint stability to optimize outcomes.
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Affiliation(s)
- Tim R Beals
- Jack Hughston Memorial Hospital, Department of Orthopedic Surgery, 4401 Riverchase Drive, Phenix City, AL 36867, USA
| | - Robert Harris
- Hughston Orthopedic Trauma at Midtown Medical Center, Jack Hughston Memorial Hospital, Department of Orthopedic Surgery, 4401 Riverchase Drive, Phenix City, AL 36867, USA
| | - Darryl A Auston
- Hughston Trauma at Orange Park Medical Center, 1895 Kingsley Avenue, Suite 300, Orange Park, FL 32073, USA.
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Githens M, Shatsky J, Agel J, Bransford RJ, Benirschke SK. Medial external fixation for staged treatment of closed calcaneus fractures: Surgical technique and case series. J Orthop Surg (Hong Kong) 2018; 25:2309499017727915. [PMID: 28844198 DOI: 10.1177/2309499017727915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The derangement in calcaneal morphology after a fracture can be significant and is often associated with severe soft tissue envelop problems. Medial calcaneal external fixation is useful for early restoration of calcaneal morphology and the corresponding soft tissue envelop. When performed in a stepwise fashion, external fixation can successfully restore normal calcaneal height, length, width, and coronal plane alignment. For severely displaced joint depression and broken tongue-type calcaneus fractures where open treatment is the preferred strategy, early external fixation restores the normal soft tissue tension, allows a stable environment for soft tissue recovery, and facilitates the definitive operation by restoring and maintaining overall calcaneal architecture. We describe the stepwise approach to calcaneal reduction and external fixation and report a case series demonstrating this method is safe and effective for staged management of severely displaced calcaneus fractures.
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Affiliation(s)
- Michael Githens
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Joshua Shatsky
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Julie Agel
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Richard J Bransford
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Stephen K Benirschke
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
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Diranzo-García J, Bertó-Martí X, Castillo-Ruiperez L, Estrems-Díaz V, Hernández-Ferrando L, Villodre-Jiménez J, Bru-Pomer A. Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [PMID: 29523412 DOI: 10.1016/j.recot.2018.01.010] [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: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the results of surgical treatment of intraarticular calcaneal fractures, and also to analyze the variables that influence the final clinical and radiological outcomes as well as the complications. MATERIAL AND METHODS We retrospectively analyzed 86 intraarticular calcaneal fractures in 78 patients, who underwent surgery with an extended lateral approach and reconstruction plate. The mean age was 48 years (16-74 years) and the mean follow-up was 4.6 years (9-99 months); 54 patients (69.2%) suffered falls from less than 3m in height or banal injuries and 24 patients (30.8%) falls from more than 3m in height or high energy-accidents. According to the Sanders classification we operated 12 (15%) typeII, 54 (62.8%) typeIII and 20 (23.2%) typeIV fractures. RESULTS The postoperative mean AOFAS score was 73.9 points, with good or excellent results in 57% of the patients. Twelve cases (14%) suffered surgical wound complications and 11 (12.8%) required subtalar arthrodesis. Significantly better results were obtained in the patients younger than 30 years old, patients that fell from less than 3m in height and patients with Sanders fractures types II and III compared to typeIV, which were associated with higher rate of subtalar arthrodesis. CONCLUSIONS We consider that open reduction and internal fixation of intraarticular fractures of the calcaneus with reconstruction plate is a valid treatment alternative. Given the complications described and the secondary subtalar arthrodesis rate, we recommend a meticulous technique carried out by experienced surgeons.
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Affiliation(s)
- J Diranzo-García
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - X Bertó-Martí
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Castillo-Ruiperez
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - V Estrems-Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Hernández-Ferrando
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J Villodre-Jiménez
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - A Bru-Pomer
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Razik A, Harris M, Trompeter A. Calcaneal fractures: Where are we now? Strategies Trauma Limb Reconstr 2017; 13:1-11. [PMID: 29052080 PMCID: PMC5862705 DOI: 10.1007/s11751-017-0297-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/04/2017] [Indexed: 11/30/2022] Open
Abstract
This review article on the current management for calcaneal fractures discusses the advantages and disadvantages of different treatment options including the problems encountered. Controversies are described and the evidence reviewed. The management of some types of displaced intra-articular calcaneal fractures remains contentious; is there a preferred stabilisation method for each type of calcaneal fracture? How constant is the “constant fragment” in an intra-articular calcaneal fracture and what is the evidence for primary arthrodesis and what is its place in these fractures?
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Affiliation(s)
- Aisha Razik
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - Mark Harris
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Alex Trompeter
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
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Bennett PM, Stevenson T, Sargeant ID, Mountain A, Penn-Barwell JG. Salvage of Combat Hindfoot Fractures in 2003-2014 UK Military. Foot Ankle Int 2017; 38:745-751. [PMID: 28362519 DOI: 10.1177/1071100717697913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hindfoot fractures pose a considerable challenge to military orthopaedic surgeons, as combat injuries are typically the result of energy transfers not seen in civilian practice. This study aimed to characterize the pattern of hindfoot injuries sustained by UK military casualties in recent conflicts, define the early amputation and infection rate, and identify factors associated with poor early outcomes. METHODS The UK Joint Theatre Trauma Registry was searched for British military casualties sustaining a hindfoot fracture from Iraq and Afghanistan between 2003 and 2014. Data on the injury pattern and management were obtained along with 18-month follow-up data. Statistical analysis was performed with the chi-square test and binomial logistic regression analysis. The threshold for significance was set at P < .05. One hundred fourteen patients sustained 134 hindfoot injuries. Eighteen-month follow-up was available for 92 patients (81%) and 114 hindfeet (85%). RESULTS The calcaneus was fractured in 116 cases (87%): 54 (47%) were managed conservatively, 32 (28%) underwent K-wire fixation, and 30 (26%) underwent internal fixation. Nineteen patients (17%) required transtibial amputation during this time. A deep infection requiring operative treatment occurred in 13 cases (11%) with Staphylococcus aureus, the most common infectious organism (46%). A deep infection was strongly associated with operative fracture management ( P = .0016). When controlling for multiple variables, the presence of a deep infection was significantly associated with a requirement for amputation at 18 months ( P = .023). There was no association between open fractures and a requirement for amputation at 18 months ( P = .640), nor was conservative management associated with a requirement for amputation ( P = .999). Thirty-six fractures (32%) required unplanned revision surgery within the first 18 months following salvage, of which 19 (53%) involved amputation. CONCLUSION A deep infection was the sole variable significantly associated with a requirement for amputation by 18 months. These results suggest that attempts at salvaging these injuries are at the limits of orthopaedic technical feasibility. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
| | | | - Ian D Sargeant
- 2 Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Edgbaston, UK
| | - Alistair Mountain
- 2 Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Edgbaston, UK
| | - Jowan G Penn-Barwell
- 1 Institute of Naval Medicine, Alverstoke, UK.,3 Surgical Reconstruction and Microbiology Research Centre, National Institute for Health Research, Birmingham, UK
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Sanders II/III Calcaneus Fractures in Laborers: A Cost-Effectiveness Analysis and Call for Effectiveness Research. J Orthop Trauma 2017; 31:299-304. [PMID: 28166172 DOI: 10.1097/bot.0000000000000813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study compares the cost and cost-effectiveness of treatments options for Sanders II/III displaced intra-articular calcaneus fractures (DIACFs) in laborers. METHODS Literature on Sanders type II and III fractures was reviewed to determine complication rates and utility values for each treatment option. Costs were calculated using Medicare reimbursement and implant prices from our institution. Monte Carlo simulations were used to analyze a decision tree to determine the cost and cost-effectiveness of each treatment from a societal perspective. Sensitivity analysis was performed on all variables. RESULTS Minimally invasive open reduction internal fixation (ORIF) (sinus tarsi approach with 4 screws alone) was least expensive ($23,329), followed by nonoperative care ($24,530) and traditional ORIF using extensile lateral approach ($27,963) (P < 0.001); this result was most sensitive to time out of work. Available cost-effectiveness data were limited, but our analysis suggests that minimally invasive ORIF is a dominant strategy, and traditional ORIF is superior to nonoperative care (incremental cost-effectiveness ratio $57,217/quality-adjusted life year). CONCLUSIONS Our findings suggest that minimally invasive ORIF (sinus tarsi approach) is the least expensive option for managing Sanders II/III displaced intra-articular calcaneus fractures, followed by nonoperative care. Our cost-effectiveness results favor operative management but are highly sensitive to utility values and are weakened by scarce utility data. We therefore cannot currently recommend a treatment course based on value, and our primary conclusion must be that more extensive effectiveness research (ie, health-related quality of life data, not just functional outcomes) is desperately needed to elucidate the value of treatment options in this field. LEVEL OF EVIDENCE Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
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50
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Wang C, Huang D, Ma X, Wang X, Huang J, Zhang C, Chen L, Geng X. Sustentacular screw placement with guidance during ORIF of calcaneal fracture: an anatomical specimen study. J Orthop Surg Res 2017; 12:78. [PMID: 28558765 PMCID: PMC5450139 DOI: 10.1186/s13018-017-0580-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/12/2017] [Indexed: 12/03/2022] Open
Abstract
Background The sustentacular screw is essential to maintain the stability of the subtalar joint during ORIF (open reduction with internal fixation) of calcaneal fractures. Currently, the screw is still inserted based on surgeons’ anatomical experiences and nearly 40% of screws are misplaced from the sustentaculum. Previous studies demonstrated some methods of sustentacular screw placement through anatomical measurements or navigation system. The purposes of this study are to design an assistant guidance device that can effectively improve the accuracy of sustentacular screw placement and to compare the accuracy of this technique with traditional screw placement based on experience. Methods A customized guidance device is designed, aiming to improve the accuracy of sustentacular screw placement. Twenty cadaveric specimens are used in the present study. Ten specimens are allocated into the guidance-assisted group, and others are included in the traditional screw insertion group. A total of 40 sustentacular screw placements are performed in each group. Fluoroscopic images are obtained after each screw placement. Only the screw that captures the sustentaculum both on the lateral and axial X-ray views was regarded as an accurate placement. Results The accuracy rate in the guidance-assisted group is 87.5% (35 out of 40 times of insertions) while in the traditional screw insertion group, the accuracy rate is 65% (26 out of 40 times of insertions). A significant difference is found between the two groups (p = 0.018). Conclusions The guidance-assisted technique is a convenient approach that can effectively improve the accuracy of sustentacular screw placement during the ORIF of calcaneal fractures. This study provides a novel technique that significantly facilitates sustentacular screw insertion and improves its accuracy.
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Affiliation(s)
- Chen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Dichao Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China.
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Li Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Xiang Geng
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
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