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Ahluwalia R, Lewis TL, Musbahi O, Reichert I. Minimally Invasive Surgery vs Nonoperative Treatment for Displaced Intraarticular Calcaneal Fracture: A Prospective Propensity Score Matched Cohort Study With 2-Year Follow-up. Foot Ankle Int 2024; 45:456-466. [PMID: 38415605 DOI: 10.1177/10711007241230550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Optimal management of displaced intraarticular calcaneal fractures remains controversial. The aim of this prospective cohort study was to compare the clinical and radiologic outcomes of minimally invasive surgery vs nonoperative treatment in displaced intraarticular calcaneal fracture up to 2 years. METHODS All displaced intraarticular calcaneal fractures between August 2014 and January 2019 that presented to a level 1 trauma center were considered for inclusion. The decision to treat was made by a multidisciplinary team consisting of fellowship-trained orthopaedic surgeons. Operative treatment protocol involved sinus tarsi approach or percutaneous reduction and internal fixation. Nonoperative protocol involved symptomatic management with no attempt at closed reduction. The Manchester-Oxford Foot Questionnaire (MOXFQ) and EuroQol-5 Dimensions-5 Level (EQ-5D-5L) patient-reported outcome measures were used to assess foot and ankle and general health related quality of life outcomes, respectively, at 2-year follow-up. Radiographic assessment was performed based on preinjury and 12-week postinjury radiographs. RESULTS A total of 101 patients were included for analysis between August 2014 and January 2019. We propensity score matched 46 patients in the surgical cohort to 46 patients in the nonsurgical cohort. At 24 months, there was no significant difference in the MOXFQ Index score (P > .05); however, the surgical cohort had a significantly higher EQ-5D-5L Index score (P < .05) and return to work (91% vs 72%, P < .05) and physical activity rate (46 vs 35%, P < .05) despite a higher proportion of more complex fractures in the surgical cohort. The wound complication rate following surgery was 16%. In addition, 14% of patients in the nonoperative cohort subsequently underwent arthrodesis compared with none of the patients in the surgical cohort. CONCLUSION In this study, we found that operative treatments were associated with low rates of surgical complication at 2 years and long-term pain improvement, facilitating earlier and better functional outcomes for complex injury patterns compared with nonoperative treatment for less severe fractures. LEVEL OF EVIDENCE Level III, retrospective cohort.
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Affiliation(s)
- Raju Ahluwalia
- King's College Hospital (Denmark Hill), Kings College Hospital NHS Foundation Trust, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- Surgical and Trauma Academic Research (STAR) Alliance, King's College Hospital, London, United Kingdom
| | - Thomas Lorchan Lewis
- King's College Hospital (Denmark Hill), Kings College Hospital NHS Foundation Trust, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Omar Musbahi
- King's College Hospital (Denmark Hill), Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ines Reichert
- King's College Hospital (Denmark Hill), Kings College Hospital NHS Foundation Trust, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- Surgical and Trauma Academic Research (STAR) Alliance, King's College Hospital, London, United Kingdom
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Eltabbaa AY, El-Rosasy MA, El-Tabbakh MR, Elfakhrany MN. Minimally invasive K-wire fixation of displaced intraarticular calcaneal fractures through a minimal sinus tarsi approach. J Orthop Traumatol 2023; 24:4. [PMID: 36680654 PMCID: PMC9867788 DOI: 10.1186/s10195-022-00680-5] [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: 08/08/2022] [Accepted: 12/28/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Displaced intra-articular calcaneal fractures are challenging injuries, and there is debate regarding the best method of treatment. PATIENTS AND METHODS Between January 2018 and January 2021, a prospective study was conducted on 46 patients with 56 displaced intraarticular calcaneal fractures that were treated with minimally invasive fixation using Kirschner wires (KWs) through the sinus tarsi approach. RESULTS The mean follow-up period was 22.36 months. The American Orthopaedic Foot and Ankle Society (AOFAS) score was adopted as a method of clinical evaluation; the mean AOFAS score was 78.4. All cases showed radiographic evidence of adequate healing, with no collapse till the final follow-up. Complications included persistent pain, subtalar arthritis, deep infection and superficial pin site infection. CONCLUSION The use of the sinus tarsi approach and percutaneous KWs represents a minimally invasive approach which expands the indications of surgery for displaced intra-articular calcaneal fractures with fewer treatment-related complications. Level of evidence (4) case series. Trial registration This study has been approved by the ethical research committee of the Faculty of Medicine, Tanta University, under the code: 35901/10/22.
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Affiliation(s)
- Ayman Youssef Eltabbaa
- grid.479691.4Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
| | - Mahmoud Abdelmonem El-Rosasy
- grid.479691.4Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
| | - Mohammed Roshdy El-Tabbakh
- grid.479691.4Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
| | - Mostafa Naguib Elfakhrany
- grid.479691.4Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
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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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Hu Y, Chen L, Qian Y, Wu J, Xu H. Emergency surgery of intra-articular calcaneal fractures using sinus tarsi approach with modified reduction technique. BMC Musculoskelet Disord 2023; 24:523. [PMID: 37365534 DOI: 10.1186/s12891-023-06636-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate emergency surgery of calcaneal fractures using the sinus tarsi approach (STA) with modified reduction technique in terms of complication rates, iconography results and functional outcome. METHODS We evaluated the outcomes of 26 patients treated in an emergency using STA with modified reduction technique. For that, we assessed Böhler´s angle, Gissane angle, reduction of the calcaneal body, and posterior facet, the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, complications, preoperative time, operative time, and in-hospital time. RESULTS Recovery of calcaneal anatomy and articular surface were found at final follow-up. The mean Böhler´s angle at final follow-up were 30.68° ± 3.69°, of which was 15.02° ± 3.88° preoperatively (p < 0.001). The mean Gissane angle at final follow-up were 114.54° ± 11.16° of which was 88.86° ±10.96° preoperatively (p < 0.001). All cases had the varus/valgus angle of the tuber within 5 degrees. At the final follow-up, the mean AOFAS score was 89.23 ± 4.63, and the VAS score was 22.73 ± 6.5. CONCLUSIONS Emergency surgery using STA with modified reduction technique is reliable, effective, and safe for treatment of calcaneal fractures. This technique can bring good clinical outcomes and a low rate of wound complications, reducing the in-hospital time, costs, and accelerating rehabilitation.
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Affiliation(s)
- Yanwen Hu
- Department of Nuclear Medicine, Suzhou Ninth Hospital, 215000, Suzhou, Wujiang, Jiangsu Province, People's Republic of China
| | - Lucheng Chen
- Department of Orthopaedics, RuiHua Orthopaedic Hospital of Suzhou, Jiangsu Province, 5, Tayun Road, 215000, WuZhong, People's Republic of China
| | - Yaxing Qian
- Yongding Hospital of Suzhou, 1000, Gaoxin Road, 215000, Wujiang, Jiangsu Province, People's Republic of China
| | - Junjie Wu
- Yongding Hospital of Suzhou, 1000, Gaoxin Road, 215000, Wujiang, Jiangsu Province, People's Republic of China
| | - Hao Xu
- Yongding Hospital of Suzhou, 1000, Gaoxin Road, 215000, Wujiang, Jiangsu Province, People's Republic of China.
- Department of Orthopaedics, Suzhou Yongding Hospital, 1388, Gaoxing Road, 215000, Suzhou, Wujiang, Jiangsu Province, People's Republic of China.
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Xu H, Hou R, Ju J, Liu Y, Chen L. Articular calcaneal fractures: open or minimally invasive surgery, when the medial wall reduction is obtained percutaneously from the lateral side. INTERNATIONAL ORTHOPAEDICS 2021; 45:2365-2373. [PMID: 34333675 DOI: 10.1007/s00264-021-05164-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to compare the clinical outcomes of intra-articular calcaneal fractures with medial column displacement treated with different surgical techniques, namely extensile lateral approach (ELA) or sinus tarsi approach (STA), combined with percutaneous medial reduction. METHODS Ninety-six patients with intra-articular calcaneal fractures who were subjected to ELA or STA (45 in STA group and 51 in ELA group) were retrospectively assessed. Reduction of the posterior facet, calcaneal body, Böhler's angle, and Gissane's angle were evaluated. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale (VAS). The complications, time to surgery, operative time, and blood loss were also assessed. RESULTS Incidence of wound complications, post-operative blood drainage, and time to the operation were significantly different between the two groups. There was no significant difference in the recovery of calcaneal anatomy and articular surface between the two groups. Similarly, no difference was detected in Böhler's and Gissane's angles between ELA and STA groups (P > 0.05). Finally, there was no difference in AOFAS and VAS scores between the two groups at the final follow-up (P > 0.05). CONCLUSION STA resulted in favourable radiological and clinical results with fewer wound complications and a shorter waiting time when compared to ELA. The percutaneous medial reduction technique is effective in reducing medial column displacement.
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Affiliation(s)
- Hao Xu
- Department of Orthopaedics, RuiHua Orthopaedic Hospital of Suzhou, 5, Tayun Road, Wuzhong, 215000, Jiangsu Province, People's Republic of China
| | - Ruixing Hou
- Department of Orthopaedics, RuiHua Orthopaedic Hospital of Suzhou, 5, Tayun Road, Wuzhong, 215000, Jiangsu Province, People's Republic of China.
| | - Jihui Ju
- Department of Orthopaedics, RuiHua Orthopaedic Hospital of Suzhou, 5, Tayun Road, Wuzhong, 215000, Jiangsu Province, People's Republic of China.
| | - Yuefei Liu
- Department of Orthopaedics, RuiHua Orthopaedic Hospital of Suzhou, 5, Tayun Road, Wuzhong, 215000, Jiangsu Province, People's Republic of China
| | - Lucheng Chen
- Department of Orthopaedics, RuiHua Orthopaedic Hospital of Suzhou, 5, Tayun Road, Wuzhong, 215000, Jiangsu Province, People's Republic of China
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Wang CS, Tzeng YH, Yang TC, Lin CC, Chang MC, Chiang CC. Radiographic and clinical results of modified 2-incision sinus tarsi approach for treatment of calcaneus fracture. Injury 2021; 52:1971-1977. [PMID: 34039469 DOI: 10.1016/j.injury.2021.05.010] [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: 02/22/2021] [Revised: 04/12/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sinus tarsi approach (STA) is the most commonly used minimally invasive surgery (MIS) in the treatment of displaced intra-articular calcaneal fracture (DIACF). However, there are some limitations related to its limited access. The goal of the present study is to describe a modified 2-incision STA and to evaluate the radiographic and clinical outcomes in the treatment of DIACF. MATERIALS AND METHODS Patients had a Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification 82-C, Sanders type II, III calcaneal fracture, and underwent modified 2-incision STA and internal fixation were included in this retrospective study. Serial radiographic measurements and clinical assessment were taken to evaluate the effectiveness of this technique. RESULTS Thirty-four feet of 33 patients treated between 2014 and 2019 were included with an average follow-up of 28.5 (range, 12-65) months. Mean preoperative Böhler's angle was 1.5 ± 10.0 (range, -26.0-16.9) degrees and mean final Böhler's angle was 29.8 ± 4.9 (range, 19.3-39.3) degrees with significant difference (P < .001). The average American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) pain score at last follow-up were 86.2 ± 5.0 (range, 76-97) and 1.6 ± 1.1 (range, 0-4), respectively. Major complications included 2 (5.9%) wound infections and 1 (2.9%) incomplete separation of the lateral wall prior to plate insertion. DISCUSSION AND CONCLUSIONS This modified 2-incision STA is a safe and effective procedure. It allows access to the posterior facet and posterior calcaneal tuberosity, appropriate restoration of blowout lateral wall, and easy placement of a standard calcaneal plate.
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Affiliation(s)
- Chien-Shun Wang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology; Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics; School of Medicine; National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yun-Hsuan Tzeng
- Division of Medical Imaging for Health Management; Cheng-Hsin General Hospital, Taipei, Taiwan; Department of Radiology, School of Medicine; National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Tzu-Cheng Yang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology; Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics; School of Medicine; National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chun-Cheng Lin
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology; Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics; School of Medicine; National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Ming-Chau Chang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology; Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics; School of Medicine; National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chao-Ching Chiang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology; Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics; School of Medicine; National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Ma C, Zhao J, Zhang Y, Yi N, Zhou J, Zuo Z, Jiang B. Comparison of the modified sinus tarsi approach versus the extensile lateral approach for displaced intra-articular calcaneal fractures. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:695. [PMID: 33987393 PMCID: PMC8106015 DOI: 10.21037/atm-21-1226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study sought to assess and compare the clinical efficacy and complications of a modified sinus tarsi approach (MSTA) and the extensile lateral approach (ELA) in the treatment of displaced intra-articular calcaneal fractures. Methods This retrospective study enrolled 108 patients (117 feet) with Sanders II-IV calcaneal fractures, including 52 patients (56 feet) in the MSTA group and 56 patients (61 feet) in the ELA group. The functional and radiological results of the affected feet were analysed retrospectively. Functional evaluation included American Orthopaedic Foot and Ankle Society (AOFAS), visual analog scale (VAS), and Short Form-36 Health Survey (SF-36). Radiological evaluation included preoperative and postoperative changes in the Bohler Angle, Gissane Angle, length, width, and height of the calcaneus. The postoperative complications were also collected and analysed. The independent-samples t-test and analysis of variance (ANOVA) were employed to compare differences between the two groups. Differences within the same group were compared by paired Student's t-test, and categorical variables were compared using the chi-square test. Results The postoperative functional and radiological results showed that the mean AOFAS, VAS and physical component summary of SF-36 scores in the MSTA group were higher than those in the ELA group (P<0.05). After surgery, the Bohler and Gissane angles were significantly improved in both groups, as were the length, width, and height of the calcaneus; no statistically significant differences existed between the two groups. The incidences of wound healing complications and postoperative sural nerve injury were lower in the MSTA group than in the ELA group (P<0.000). Conclusions The MSTA can achieve similar effects to the ELA in terms of anatomical reconstruction and functional recovery. It also can also effectively reduce the incidences of wound healing complications and postoperative sural nerve injury, and shorten the length of hospital stay.
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Affiliation(s)
- Chao Ma
- Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiaju Zhao
- Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yong Zhang
- Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Nan Yi
- Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jupu Zhou
- Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhicheng Zuo
- Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Bo Jiang
- Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
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