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Park CH, Na HD, Woo IH, Park KH. Is the occurrence of extra-articular calcaneal fractures of the joint depression type related to osteoporosis and aging? INTERNATIONAL ORTHOPAEDICS 2024; 48:2727-2734. [PMID: 39060509 DOI: 10.1007/s00264-024-06253-x] [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: 02/21/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE The authors experienced several cases of extra-articular calcaneal fracture accompanied by joint depression involving the entire posterior facet without joint involvement. This type of fracture and its characteristics and treatment outcomes have not been previously reported. The study was performed to analyze the characteristics of extra-articular calcaneal fractures of the joint depression type and their postoperative clinical and radiographic results and complications. METHODS Between February 2013 and March 2021, 23 extra-articular calcaneal fractures of the joint depression type were consecutively treated by a single surgeon. Relationships between fracture characteristics and patient demographics were assessed. Clinical results were quantified using visual analog scale, American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, and Foot Function Index, radiographic results were evaluated using Böhler's angles, and calcaneal widths were determined using calcaneal axial and lateral radiographs obtained preoperatively and at last follow-up. RESULTS Twenty (87%) of the 23 cases occurred in women, and the mean age of all patients was 65.8 years (43-90). The three men were older than 65. Five (21.7%) patients had osteopenia, and 12 (52.2%) had osteoporosis. Bone mineral density testing could not be performed in the other six patients. Clinical and radiographic results were significantly improved after surgery. CONCLUSION Extra-articular calcaneal fractures of the joint depression type are much more common in women and occur at an older age than calcaneal fractures commonly occur. These fractures are also more common in patients with a low bone mineral density. LEVEL OF EVIDENCE Level IV. CASE SERIES
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopedic Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
| | - Ho Dong Na
- Department of Orthopaedic Surgery, MS Jaegeon Hospital, Daegu, Republic of Korea
| | - In Ha Woo
- ROKA 7th Artillery Brigade, Namyangju-si, Republic of Korea
| | - Kyeong-Hyeon Park
- Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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2
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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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3
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Dehoust J, Berninger MT, Behrendt P, Thürig G, Christensen JH, Hinz N, von Rehlingen-Prinz F, Frosch KH, Hartel M. Comparison of different intraoperative reduction monitoring methods in a cadaveric intraarticular calcaneal fracture model: 3D scan vs arthroscopy vs nanoscopy. Eur J Trauma Emerg Surg 2023; 49:2561-2567. [PMID: 37552339 DOI: 10.1007/s00068-023-02330-9] [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] [Received: 02/06/2023] [Accepted: 07/06/2023] [Indexed: 08/09/2023]
Abstract
AIMS Visualization of the subtalar joint surface in surgical management of calcaneal factures remains a big challenge and anatomic reduction of the articular surface is essential for a good clinical outcome. We hypothesize that video-assistance can provide superior fracture reduction compared to fluoroscopy and that nanoscopy (NSC) achieves more extensive visualization compared to fracturoscopy (FSC). METHODS Ten human cadaveric feet with artificially pre-fractured intraarticular calcaneal fractures with involvement of the posterior facet were treated via a minimal invasive subtalar approach. After initial control of reduction by 2D fluoroscopy, the reduction was further analyzed intraoperatively by FSC and NSC. 3D Scan served as gold standard control of reduction. Need of revision of reduction after the different visualization techniques was recorded and the extent of visualization of the subtalar joint surface in the medio-lateral dimension was compared for FSC and NSC. To quantify access and visualization of the medial and posterior facet, a depth gauge was used to measure from laterally at the clinically widest portion of the calcaneus targeted to the sustentaculum tali. The distance in millimetres was referred to the complete medio-lateral distance seen on paracoronal CT at the widest portion of the calcaneus. RESULTS Fracture analysis in preoperative CT-scans according to Sanders classification revealed four type IC, two IIA, three IIC and one IIIAC fractures. Mean visualization of the medial and posterior facet was significantly improved with NSC (30.4 ± 3.78 mm) compared to FSC (23.6 ± 6.17 mm) (p = 0.008). An imperfect reduction requiring revision was more often required with NSC compared to FSC. Insufficient reduction using video-assistance was found in two cases. CONCLUSION In order to optimize subtalar joint reduction and congruency, video-assisted techniques, especially NSC, provide superior visualization and thus can improve reduction in the surgical treatment of intraarticular calcaneal fractures.
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Affiliation(s)
- Julius Dehoust
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany.
| | - Markus Thomas Berninger
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Behrendt
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery, Orthopedics and Sports Orthopedics, St. Georg, Hamburg, Germany
- Institute of Anatomy, Christian-Albrechts-University, Kiel, Germany
| | - Grégoire Thürig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Orthopedics and Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Jan-Hendrik Christensen
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Nico Hinz
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany
| | | | - Karl-Heinz Frosch
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Hartel
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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4
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Yan H, Na HD, Park JJ, Park CH. Study on Sustentaculum Tali Fragment Constancy in Intraarticular Calcaneus Fracture. J Orthop Trauma 2023; 37:e422-e427. [PMID: 37448162 DOI: 10.1097/bot.0000000000002657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES To establish reproducible measurements of the sustentaculum tali (ST) fragment regarding fracture classification and patient-related factors. DESIGN Retrospective. SETTING Trauma center, University Hospital. PATIENTS A retrospective analysis of the 142 fractured calcanei of 122 patients (101 men and 21 women) treated at our institution between 2012 and 2020 was performed. As control, 62 unaffected calcanei were used. INTERVENTION Radiographic images were evaluated twice within 2 weeks by 2 orthopaedic surgeons and 1 postgraduate student. Angulation and diastasis were used to distinguish ST fragment constancy based on computed tomography. Using these parameters, the prevalence of inconstant ST fragments was assessed. We also analyzed factors related to ST fragment inconstancy. Patient factors included age, body mass index, smoking, and diabetes. Radiographic factors included the Sanders classification, location of the outermost fracture line of the posterior facet, presence of an intraarticular fracture of the ST, and ST fragment width. MAIN OUTCOME MEASUREMENTS Angulation and diastasis were used to confirm the ST fragment constancy. Potential risks for inconstant ST fragment subsequently defined. RESULTS According to the criteria, ST fragment inconstancy was observed in 34.5%. ST fragment width was significantly smaller in the inconstant group ( P < 0.001). Severe comminution of the posterior facet ( P < 0.05), intraarticular fracture of the ST ( P < 0.001), and diabetes ( P < 0.05) were significantly higher in the inconstant group. The cut-off value of the ST fragment width was 20.5 mm. CONCLUSIONS In intraarticular calcaneus fractures, small ST fragment width, comminuted fracture, intraarticular fracture of the ST, and diabetes were associated with the inconstant group. The ST fragment was expected to be inconstant when the width was less than 20.5 mm.
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Affiliation(s)
- Hongfei Yan
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Srour J, Rubin L. Subtalar Joint Arthroscopy. Clin Podiatr Med Surg 2023; 40:439-444. [PMID: 37236681 DOI: 10.1016/j.cpm.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Subtalar arthroscopy is being more commonly utilized by surgeons who perform foot and ankle arthroscopy. The joint can be entered from an anterior lateral or posterior approach. There is unique pathology in the joint that can be repaired through an arthroscopic approach.
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Affiliation(s)
- Jonathon Srour
- Tier 1 Orthopedic and Neurosurgical Institute, 105 S. Willow Avenue, Cookeville, TN 38501, USA
| | - Laurence Rubin
- Foot and Ankle Specialists of Virginia, 7016 Lee Park Road, Ste 105, Mechanicsville, VA 23111, USA.
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6
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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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7
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Pînzaru RM, Pavăl SD, Perțea M, Alexa O, Sîrbu PD, Filip A, Carp AC, Savin L, Forna N, Veliceasa B. Biomechanical Comparison of Conventional Plate and the C-Nail® System for the Treatment of Displaced Intra-Articular Calcaneal Fractures: A Finite Element Analysis. J Pers Med 2023; 13:jpm13040587. [PMID: 37108973 PMCID: PMC10141664 DOI: 10.3390/jpm13040587] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
The C-Nail® system is a novel intramedullary fixation method for displaced intra-articular calcaneal fractures. The aim of this study was to evaluate the biomechanical performance of the C-Nail® system and compare it with conventional plate fixation for the treatment of displaced intra-articular calcaneal fractures using finite element analysis. The geometry of a Sanders type-IIB fracture was constructed using the computer-aided design software Ansys SpaceClaim. The C-Nail® system (Medin, Nové Mesto n. Morave, Czech Republic) and the calcaneal locking plate (Auxein Inc., 35 Doral, Florida) and screws were designed according to the manufacturer specifications. Vertical loading of 350 N and 700 N were applied to the subtalar joint surfaces to simulate partial weight bearing and full weight bearing. Construct stiffness, total deformation, and von Mises stress were assessed. The maximum stress on the C-Nail® system was lower compared with the plate (110 MPa vs. 360 MPa). At the bone level the stress was found to have higher values in the case of the plate compared to the C-Nail® system. The study suggests that the C-Nail® system can provide sufficient stability, making it a viable option for the treatment of displaced intra-articular calcaneal fractures.
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Affiliation(s)
- Roxana Maria Pînzaru
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Silviu Dumitru Pavăl
- Department of Computer Science and Engineering, “Gheorghe Asachi” Technical University, 27, Dimitrie Mangeron, 700050 Iasi, Romania
- Correspondence: (S.D.P.); (M.P.)
| | - Mihaela Perțea
- Department of Plastic Surgery and Reconstructive Microsurgery, Surgical Science (I), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
- Correspondence: (S.D.P.); (M.P.)
| | - Ovidiu Alexa
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Paul Dan Sîrbu
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Alexandru Filip
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Adrian Claudiu Carp
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Liliana Savin
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Norin Forna
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
| | - Bogdan Veliceasa
- Department of Orthopaedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16, University Street, 700115 Iasi, Romania
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8
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Dislozierte intraartikuläre Kalkaneusfrakturen. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-023-00592-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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9
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Pujol O, Sallent A, Salom J, Duarri G, Maled I, Busquets R. ORIF Assisted by Open Subtalar Small Joint Arthroscopy for Intra-articular Displaced Calcaneus Fractures. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231163822. [PMID: 36968811 PMCID: PMC10034289 DOI: 10.1177/24730114231163822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Affiliation(s)
- Oriol Pujol
- Foot and Ankle Unit, Orthopaedic
Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de
Barcelona, Barcelona, Spain
- Oriol Pujol, MD, Foot and Ankle Unit,
Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Universitat
Autònoma de Barcelona, Pg. Vall d’Hebron 119-129, Barcelona, 08035, Spain.
| | - Andrea Sallent
- Foot and Ankle Unit, Orthopaedic
Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Juan Salom
- Foot and Ankle Unit, Orthopaedic
Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Gemma Duarri
- Foot and Ankle Unit, Orthopaedic
Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Ignacio Maled
- Foot and Ankle Unit, Orthopaedic
Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Rosa Busquets
- Foot and Ankle Unit, Orthopaedic
Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de
Barcelona, Barcelona, Spain
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10
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Xie W, Cui X, Zhang C, Chen X, Rui Y, Chen H. Modified sinus tarsi approach with a variable-angle locking anterolateral plate for Sanders type II and III calcaneal fractures. Foot Ankle Surg 2022; 28:872-878. [PMID: 34916143 DOI: 10.1016/j.fas.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/25/2021] [Accepted: 11/30/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND We compared the effectiveness of the extensile lateral approach (ELA) and modified sinus tarsi approach (MSTA) with a variable-angle locking anterolateral plate in treating Sanders type II and III calcaneal fractures. METHODS We reviewed 45 DIACFs treated by a single surgeon from 2017 to 2020. Open reduction using ELA and MSTA was performed in 25 and 20 patients, respectively. Follow-up evaluations included radiological assessments and clinical evaluations. RESULTS Pre- and postoperative radiologic parameters for the calcaneus were significantly different. The average American Orthopaedic Foot and Ankle Society scores were 81.24 and 85.00, the mean visual analogue scale scores were 2.28 and 1.65, and the wound-related complication rates were 64.0% and 15.0% in the ELA and MSTA groups, respectively. Bony union was achieved in all cases. CONCLUSIONS For Sanders type II and III fractures, MSTA seems to be a safer and more satisfactory method, with fewer postoperative complications.
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Affiliation(s)
- Wenjun Xie
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Xueliang Cui
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Cheng Zhang
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Xiangxu Chen
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Yunfeng Rui
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
| | - Hui Chen
- Department of Orthopaedics, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu 210009, PR China; Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing, Jiangsu 210009, PR China.
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11
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Kim GB, Park JJ, Park CH. Intra-articular Calcaneal Fracture Treatment With Staged Medial External Fixation. Foot Ankle Int 2022; 43:1084-1091. [PMID: 35590469 DOI: 10.1177/10711007221092761] [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 To compare the clinical and radiographic outcomes between the conventional delayed and staged approaches for intra-articular calcaneus fractures in which early definite fixation could not be performed because of severe soft tissue injury. METHODS From January 2015 to May 2019, a total of 32 cases with acute intra-articular calcaneal fractures met criteria and were enrolled in the study. We compared the outcomes of intra-articular calcaneal fractures that underwent delayed internal fixation between groups treated with a conventional delayed approach (non-EF group) vs a temporary medial external fixation (EF group). Clinical outcome measures included a 10-point visual analog scale score, the AOFAS score, and the Foot Function Index. Radiographic outcome measures included Böhler angle, talar declination angle, and calcaneal width. Reduction of the posterior facet was assessed on CT scans. RESULTS The first 15 (46.9%) were treated with a conventional delayed approach, and the latter 17 (53.1%) were treated with a staged approach with temporary medial external fixation. Clinical outcomes were not different between the groups at the last follow-up. The time from injury to definite internal fixation was shorter by an average of 3.8 days in the EF group (P = .001). The Böhler angle, talar declination angle, and calcaneal width were not different between the groups before surgery and at the last follow-up. Reduction of the posterior facet on CT scans was significantly better in the EF group than in the non-EF group (good/excellent = 94% vs 60%, respectively, P = .033). CONCLUSION The staged approach using medial external fixation for displaced intra-articular calcaneus fractures could be an effective method to decrease the time to definitive internal fixation and obtain optimal reduction of the posterior facet. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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Affiliation(s)
- Gi Beom Kim
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Nam-gu, Daegu, Republic of Korea.,Department of Orthopedic Surgery, Yeungnam University College of Medicine, Nam-gu, Daegu, Republic of Korea
| | - Jeong Jin Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Nam-gu, Daegu, Republic of Korea
| | - Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Nam-gu, Daegu, Republic of Korea.,Department of Orthopedic Surgery, Yeungnam University College of Medicine, Nam-gu, Daegu, Republic of Korea
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12
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Abstract
Treatment of calcaneal fractures has to be tailored to the individual pathoanatomy. If operative treatment is chosen, anatomic reconstruction of the calcaneal shape and joint surfaces is mandatory. For most of the displaced, intraarticular fractures, this can be achieved by less invasive reduction and fixation via a sinus tarsi approach, which may be extended along the "lateral utility" line for calcaneocuboid joint involvement or calcaneal fracture-dislocations. Purely percutaneous fixation is the treatment of choice for displaced extraarticular fractures and simple intraarticular fractures with adequate control of joint reduction. Specific approaches are used for rare calcaneal fracture variants.
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Affiliation(s)
- Stefan Rammelt
- University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, Dresden 01307, Germany.
| | - Michael P Swords
- Michigan Orthopedic Center, Sparrow Hospital, 2815 S. Pennsylvania Avenue, Suite 204 Lansing, MI 48910, USA
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13
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Park CH, Yan H, Park J. Randomized comparative study between extensile lateral and sinus tarsi approaches for the treatment of Sanders type 2 calcaneal fracture. Bone Joint J 2021; 103-B:286-293. [PMID: 33390020 DOI: 10.1302/0301-620x.103b.bjj-2020-1313.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA. METHODS Between August 2013 and August 2018, 64 patients with Sanders type 2 calcaneus fractures were randomly assigned to receive surgical treatment by the ELA (32 patients) and STA (32 patients). The primary outcome was development of wound complications. The secondary outcomes were postoperative complications, pain scored of a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-item Short Form health survey, operative duration, subtalar joint range of motion (ROM), Böhler's angle and calcaneal width, and posterior facet reduction. RESULTS Although four patients (12.5%) in the ELA groups and none in the STA group experienced complications, the difference was not statistically significant (p = 0.113). VAS and AOFAS score were significantly better in the STA group than in the ELA group at six months (p = 0.017 and p = 0.021), but not at 12 months (p = 0.096 and p = 0.200) after surgery. The operation time was significantly shorter in the STA group than in the ELA group (p < 0.001). The subtalar joint ROM was significantly better in the STA group (p = 0.015). Assessment of the amount of postoperative reduction compared with the uninjured limb showed significant restoration of calcaneal width in the ELA group compared with that in the STA group (p < 0.001). CONCLUSION The ELA group showed higher frequency of wound complications than the STA group for Sanders type 2 calcaneal fractures even though this was not statistically significant. Cite this article: Bone Joint J 2021;103-B(2):286-293.
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Affiliation(s)
- Chul Hyun Park
- College of Medicine, Yeungnam University, Daegu, Republic of Korea, Daegu, Korea
| | - Hongfei Yan
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Jeongjin Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
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Williams CE, Joo P, Oh I, Miller C, Kwon JY. Arthroscopically Assisted Internal Fixation of Foot and Ankle Fractures: A Systematic Review. FOOT & ANKLE ORTHOPAEDICS 2021; 6:2473011420950214. [PMID: 35097419 PMCID: PMC8727837 DOI: 10.1177/2473011420950214] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients undergoing fixation for foot and ankle fractures may experience poor outcomes despite achieving apparent anatomic reduction. Adjunct arthroscopy to identify missed concomitant injuries and subtle displacements has been proposed as a vehicle to enhance functional results for these patients. The purpose of this review is to provide an overview of the literature regarding arthroscopically assisted open reduction and internal fixation (AAORIF) methods for commonly encountered foot and ankle injuries including pilon, ankle, and calcaneus fractures published to date. METHODS A systematic review of the literature was performed using the PubMed database to access all studies reporting on arthroscopically assisted internal fixation methods for pilon, ankle, and calcaneus fractures. Relevant publications were analyzed for details on their respective study designs, the operative technique used, clinical outcomes, outcome instruments used, and reported complications. RESULTS A total of 32 studies were included in this review. Two studies on pilon fractures, a randomized controlled trial (RCT) and case series with a total of 243 patients, met inclusion criteria. Postoperative articular reductions, bone union, and Mazur scores were found to be significantly better for those using adjunct arthroscopy when compared to those with no arthroscopy use. Patient-reported outcomes were overall reported as excellent for most patients, with no difference in patient-reported outcomes reported in the RCT. For ankle fractures, a total of 17 studies comprising of 2 systematic reviews, 1 meta-analysis, 2 RCTs, 5 retrospective comparative studies, 6 case series, and 1 case-control study met inclusion criteria for this review. Results were mixed, though the overall consensus was that arthroscopy use may help to better visualize concomitant intra-articular injuries and is generally considered safe with at least comparable outcomes to conventional methods. For the calcaneus, 13 studies met the criteria. Two studies were review papers, 8 were case series, and 3 were retrospective comparative studies. A total of 308 patients with 316 fractures formed the basis of analysis. In general, the studies found comparable functional outcomes between with or without arthroscopy use, but found that anatomical reductions were significantly improved with the use of arthroscopy. CONCLUSIONS Arthroscopy shows promise as a valuable adjunct tool for internal fixation of foot and ankle fractures, though definitive conclusions as to its clinical significance have yet to be drawn because of limited evidence. Potential advantages related to the direct visualization of the fracture site and minimally invasive nature of arthroscopy were suggested throughout studies examined in this review. The presence of intra-articular pathology may lead to unexpectedly poor outcomes seen in some patients who undergo surgical fixation of ankle fractures with an otherwise anatomic reduction on postoperative radiographs; the ability to diagnose and address these lesions with arthroscopy, therefore, has the potential to improve patient outcomes. To date, however, available literature has not shown that significant improvements in anatomical reductions and treatment of these intra-articular injuries provide any improvement in outcomes over standard fixation methods. Few prospective randomized controlled studies have been performed comparing these 2 operative techniques, rendering any suggestion that AAORIF improves clinical outcomes over traditional open fixation difficult to justify. Further research is indicated for what may be a potentially promising surgical adjunct prior to advocating for its routine use in patients.
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Affiliation(s)
- Caroline E. Williams
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- University of Miami/Miller School of Medicine, Miami, FL, USA
| | - Peter Joo
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
| | - Irvin Oh
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA
| | | | - John Y. Kwon
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Abstract
OBJECTIVES To assess the outcome of the sinus tarsi approach and C-Nail fixation of displaced intra-articular calcaneal fractures (DIACFs). DESIGN Prospective study. SETTING University Trauma Department. PATIENTS Sixty-four patients (mean age 44.3 years, 48 men and 16 women) with 75 DIACFs were treated between October 1, 2016 and December 31, 2018. INTERVENTION In all cases, the posterior facet was reduced through the sinus tarsi approach and fixed with one or 2 screws. After reducing all fragments to the articular block, the final fixation was performed percutaneously with C-Nail, locked with 6 screws. MAIN OUTCOME MEASUREMENTS Patients were assessed for restoration of the Böhler angle, complications, and overall fracture reduction. To assess the functional outcome, we used the Mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score and Maryland Foot Score after 12 months. RESULTS The Böhler angle improved from -0.5 degrees preoperatively to 28.6 degrees postoperatively. The articular step-off was reduced from 5.4 mm preoperatively to 0.6 mm postoperatively. The postoperative radiologic calcaneal score was 2.9, on average. Superficial wound edge necrosis was seen in 3 patients (4%) and superficial infection was observed in one (1.3%). After a 1-year follow-up, we recorded a mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score of 90.2 and a mean Maryland Foot Score of 91.2. CONCLUSIONS After obtaining an anatomic reduction of the articular surface of the posterior facet with lag screws, the C-Nail represented a viable alternative to plate stabilization in the treatment of DIACFs, combining primary stability with low soft tissue complications. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Percutaneous arthroscopic calcaneal osteosynthesis for displaced intra-articular calcaneal fractures: Systematic review and surgical technique. Foot Ankle Surg 2020; 26:503-508. [PMID: 31320206 DOI: 10.1016/j.fas.2019.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/18/2019] [Accepted: 07/02/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to systematically evaluate the available literature on technique and outcomes of percutaneous arthroscopic calcaneal osteosynthesis for displaced intra-articular calcaneal fractures. METHODS A systematic review of the literature available in MEDLINE, EMBASE, and the Cochrane Library database was performed, including studies from January 1985 to august 2018. The literature search, data extraction, and quality assessment were conducted by 2 independent reviewers. The surgical technique and perioperative management, clinical outcomes scores, radiographic outcomes and complication rate were evaluated. RESULTS Of 66 reviewed articles, 8 studies met the inclusion criteria. The included studies reported on the results of 152 patients. At last follow up the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot was ranging from 72.1 to 94.1. The complication rate was low, including only one superficial infection. CONCLUSIONS The studies included were of too little level of evidence to allow for data pooling or meta-analysis. However, the percutaneous arthroscopic calcaneal osteosynthesis seems to be a good option for displaced intra-articular calcaneal fractures with a low complication rate. Appropriately powered randomized controlled trials with long-term follow up are needed to confirm the efficacy of this technique. LEVEL OF EVIDENCE Level III, systematic review of Level III studies.
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Abstract
Subtalar arthroscopy has an important role in enhancing the reduction of the posterior facet in percutaneous and open approaches of displaced intra-articular calcaneal fractures. In the percutaneous approach, arthroscopically assistant percutaneous approach must be selected carefully for mild-to-moderately displaced fractures. In the open approach, there is still little evidence of the utility of subtalar arthroscopy. Therefore, intraoperative arthroscopy should always be used in conjunction with fluoroscopy to achieve reduction and assess the internal fixation placement.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Hyeonchungno 170, Nam-gu, Daegu, 42415, Republic of Korea.
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Affiliation(s)
- Ryan J Donegan
- 1 GRAD Institute, St Francis Hospital, Hartford, CT, USA
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