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Pang J, Hussain A, Yan M, Kapur K, Solomou G, Brassett C, Pasapula C, Norrish AR. The cadaveric research model for calcaneus fractures: A scoping review of biomechanical, anatomical, radiographic and fracture fixation studies. Foot (Edinb) 2024; 59:102085. [PMID: 38493665 DOI: 10.1016/j.foot.2024.102085] [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: 07/11/2022] [Accepted: 03/10/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Calcaneal fractures remain a big challenge in orthopaedic surgery and lead to long lasting disabilities. Cadaveric research plays an important role in determining optimal fracture treatment. This scoping review aims to provide insight into cadaveric research that has been conducted on calcaneal fractures, including biomechanics, fixation, approaches and radiographic studies. METHODOLOGY A search strategy was created and implemented as per PRISMA guidance. 3 databases, Medline, Embase and Scopus, were used when conducting this review. RESULTS 484 individual studies were retrieved across the 3 databases, of which 186 duplicates were excluded. Study abstracts were individually reviewed, of which 208 studies were excluded in accordance with study criteria. 90 papers were sought for retrieval, of which 83 full text papers were successfully retrieved. Of the full papers retrieved, 22 did not meet our inclusion criteria, and 19 papers related only to talus fractures. In the end, 43 cadaveric studies pertaining to this scoping review were included and reviewed. DISCUSSION Studies were grouped into biomechanical, anatomical, fixation and radiographic studies for review. CONCLUSION Evaluation of current cadaveric studies pertaining to calcaneal fractures has allowed greater insight into the myriad challenges in the management of these injuries. Effects of intra-articular fractures on calcaneal biomechanics assist in establishing surgical goals. Whilst fixation studies showing good stability of nail fixations could encourage further development in minimally invasive techniques. Avoiding pitfalls seen in the extensile lateral approach. Recommendations of areas for further research include use of external fixators, fixation in non-Sanders Type 2 fractures, and comparison of intraoperative CT/3D fluoroscopy with o conventional fluoroscopy.
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Affiliation(s)
- Joe Pang
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Department of Orthopaedic Surgery, Gayton Road, King's Lynn PE30 4ET, United Kingdom
| | - Ali Hussain
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
| | - Mathhew Yan
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
| | - Karan Kapur
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
| | - Georgios Solomou
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Department of Orthopaedic Surgery, Gayton Road, King's Lynn PE30 4ET, United Kingdom; School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, United Kingdom.
| | - Cecilia Brassett
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
| | - Chandra Pasapula
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Department of Orthopaedic Surgery, Gayton Road, King's Lynn PE30 4ET, United Kingdom
| | - Alan R Norrish
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Department of Orthopaedic Surgery, Gayton Road, King's Lynn PE30 4ET, United Kingdom; Academic Unit of Injury, Recovery and Inflammation Sciences, Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
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Li Z, Xiao F, Huang H, Xia J, Zhou H, Li B, Yang Y. Impact of sustentaculum tali screw positioning on radiographic and functional outcomes in calcaneal fractures. J Orthop Surg Res 2024; 19:136. [PMID: 38347573 PMCID: PMC10863261 DOI: 10.1186/s13018-023-04521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/29/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND To investigate whether accurate placement of sustentaculum tali screws have the impacts on the clinical efficacy of calcaneal fractures. METHODS A retrospective analysis of 72 cases (73 feet) of calcaneal fractures from September 2015 to September 2019 treated with open reduction and internal fixation with sustentaculum tali screws was conducted. Patients were divided into the sustentaculum tali fixation group (ST group) and the sustentaculum fragment fixation group (STF group) according to the location of the sustentaculum tali screw placement. The functional outcomes at preoperative, 7 days and 1 year postoperative were collected and analyzed. RESULTS In the ST group (40 feet), the Gissane's angle altered from (109.89 ± 12.13)° to (121.23 ± 9.34)° and (119.08 ± 8.31)° at 7 days and 1 year postoperative, respectively. For Böhler's angles altered from (11.44 ± 5.94)°, to (31.39 ± 7.54)°, and (30.61 ± 7.94)° at 7 days and 1 year postoperative, respectively. In the STF group (33 feet), Gissane's angle altered from (110.47 ± 14.45)°, to (122.08 ± 8.84)°, and (120.67 ± 9.07)° and Böhler's angle altered from (11.32 ± 6.77)°, to (28.82 ± 8.52)°, and (28.25 ± 9.13)° (P < 0.001). However, there was no statistically significant difference in functional outcomes at 1 week after surgery and 1 year after surgery (P > 0.05). The AOFAS scores at the final follow-up of the two groups: ST group (88.95 ± 6.16) and STF group (89.78 ± 8.76); VAS scores, ST group (0.83 ± 0.98) and STF group (1.03 ± 1.59), all differences were not statistically significant (P > 0.05). CONCLUSION The position of sustentaculum tali screws has no significant difference on the short-term clinical outcome in patients with calcaneal fractures, while reliable fixation of screws to sustentaculum tali fragment can achieve similar clinical outcome. LEVEL OF EVIDENCE V
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Affiliation(s)
- Zihua Li
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Fajiao Xiao
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Hui Huang
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Jiang Xia
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Haichao Zhou
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Bing Li
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
| | - Yunfeng Yang
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
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ŞAHAN K, POLAT A, KILIÇ F, KAZDAL C, FİDAN F, ÖZKAYA U. Comparison of clinical and radiological outcomes between extended lateral and sinus tarsi approach in the surgical treatment of displaced intraarticular calcaneal fractures surgery. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1164835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: The aim of this stud was to compare the clinical and radiological results between Sinus-tarsi (ST) and Extended-Lateral (EL) approaches in open reduction internal fixation of intra-articular calcaneal fractures.
Materials and Methods: 51 calcaneal fractures of 48 patients surgically treated between 2012 and 2017 were retrospectively analyzed. The patients were divided into two groups. Preoperative CT, early postoperative and postoperative 1st-year radiographs, and The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score scores were evaluated.
Results: According to the Sanders classification, nine patients in the EL group were type 2(36%), 16 patients type 3 (64%), 8 patients in ST group type 234.8%), 13 patients (56.5%) type 3, 2 patients (8.7%) type 4. The mean AOFAS-Hindfoot score was 85(63-100) in the ST group and 83(52-93) in the LE group at one year. Mean preoperative waiting time was shorter, with an average of 2(1-4) days in ST and 6(3-12) days in LE.
Conclusion: ST approach shortens the preoperative waiting time in intra-articular calcaneal fracture surgery, provides a sufficient vision for anatomical restoration, and effectively avoids complications.
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Affiliation(s)
- Kemal ŞAHAN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL GAZİOSMANPAŞA SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Abdulkadir POLAT
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL GAZİOSMANPAŞA SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Feyzi KILIÇ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL GAZİOSMANPAŞA SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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Prather J, Wilson J, Abyar E, Young S, McGwin G, Crocker CC, Patch DA, Johnson MD. Exposure of the Calcaneus in the Sinus Tarsi Approach Versus the Lateral Extensile Approach: A Cadaveric Study. Foot Ankle Spec 2022:19386400221114488. [PMID: 35880349 DOI: 10.1177/19386400221114488] [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: 11/15/2022]
Abstract
BACKGROUND The lateral extensile approach (LEA) is an operative approach for calcaneal fractures. High rates of wound complications have led to alternative approaches such as the sinus tarsi approach to grow in popularity. The LEA affords substantial visualization of the calcaneus. This visualization has never been compared in a quantitative manner with the sinus tarsi approach (STA). We aim to quantify the calcaneal visualization afforded by STA and LEA. METHODS Seven pair-matched, fresh-frozen, below-knee cadaver extremities were included. For each pair, one side received an LEA and the other side received an STA. RESULTS There were no statistically significant differences in the articular surfaces accessible between the 2 approaches. The total calcaneal surface area accessible was 3107.08 mm2 for LEA and 1444.19 mm2 for STA (P = .02). The LEA allowed better exposure to the lateral wall (P = .01) and the dorsal tuberosity of the calcaneus (P = .04). CONCLUSION The STA allows for equivalent articular surface exposure when compared with the LEA. Although LEA allows for greater exposure of the lateral wall and dorsal tuberosity, direct visualization of these structures may not warrant the higher risk of wound complications. Surgeons should consider these differences when choosing an operative approach in the treatment of calcaneal fractures. Level III.
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Affiliation(s)
- John Prather
- University of Alabama at Birmingham, Birmingham, Alabama
| | - John Wilson
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Eildar Abyar
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Sean Young
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Gerald McGwin
- University of Alabama at Birmingham, Birmingham, Alabama
- Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
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Surgical Treatment Using Sinus Tarsi Approach with Anterolateral Fragment Open-Door Technique in Sanders Type 3 and 4 Displaced Intraarticular Calcaneal Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910400. [PMID: 34639700 PMCID: PMC8508352 DOI: 10.3390/ijerph181910400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022]
Abstract
Although various outcomes of the sinus tarsi approach have been reported, these are limited to the Sanders type 2 displaced intraarticular calcaneal fractures (DIACF) because of the limited visibility of the posterior facet joint. In this study we aimed to (1) introduce a sinus tarsi approach combined with an anterolateral fragment open-door technique that enables adequate visibility of the innermost and middle portion of the posterior facet joint, and (2) evaluate the radiographic and clinical outcomes of the patients treated with that technique. This is a retrospective case-series study performed on medical records of 25 patients who presented with the Sanders type 3 or 4 DIACF and were treated with the sinus tarsi approach. The radiologic measurements showed significant corrections of the Bohler’s angle, calcaneal width, length, height, and articular step-off in both X-rays and CTs in the last follow-up period. The mean AOFAS score was 90.08 ± 6.44 at the last follow-up. Among all the follow-up patients, two cases (8%) had acute superficial infections, and no other wound complications occurred. Therefore, we suggest that the Sanders type 3 or 4 DIACF could be successfully treated with the proposed technique with low complications and bring out effective clinical and radiologic outcomes.
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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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McKnight RR, Pean CA, Buck JS, Hwang JS, Hsu JR, Pierrie SN. Virtual Reality and Augmented Reality-Translating Surgical Training into Surgical Technique. Curr Rev Musculoskelet Med 2020; 13:663-674. [PMID: 32779019 PMCID: PMC7661680 DOI: 10.1007/s12178-020-09667-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW As immersive learning outside of the operating room is increasingly recognized as a valuable method of surgical training, virtual reality (VR) and augmented reality (AR) are increasingly utilized in orthopedic surgical training. This article reviews the evolving nature of these training tools and provides examples of their use and efficacy. The practical and ethical implications of incorporating this technology and its impact on both orthopedic surgeons and their patients are also discussed. RECENT FINDINGS Head-mounted displays (HMDs) represent a possible adjunct to surgical accuracy and education. While the hardware is advanced, there is still much work to be done in developing software that allows for seamless, reliable, useful integration into clinical practice and training. Surgical training is changing: AR and VR will become mainstays of future training efforts. More evidence is needed to determine which training technology translates to improved clinical performance. Volatility within the HMD industry will likely delay advances in surgical training.
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Affiliation(s)
- R Randall McKnight
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA.
| | - Christian A Pean
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - J Stewart Buck
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA
| | - John S Hwang
- Department of Orthopedic Surgery, Mount Carmel, Columbus, OH, USA
- Department of Orthopedic Surgery, Orthopedic ONE, Columbus, OH, USA
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Sarah N Pierrie
- Department of Orthopaedics and Center for the Intrepid, San Antonio Military Medical Center, Fort Sam Houston, TX, USA
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Zhan J, Hu C, Zhu N, Fang W, Jing J, Wang G. A modified tarsal sinus approach for intra-articular calcaneal fractures. J Orthop Surg (Hong Kong) 2020; 27:2309499019836165. [PMID: 30885093 DOI: 10.1177/2309499019836165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Plate fixation using traditional lateral L-shape approach for intra-articular calcaneal fractures is complicated by 30% of wound complications, and the lateral small incision techniques with a tarsal sinus approach cannot sufficiently address all the fragments. A modified tarsal sinus approach with combined advantages of traditional lateral L-shape and tarsal sinus approaches for the treatment of intra-articular calcaneal fractures was developed. METHOD This prospective study included 29 patients (13 Sanders type II and 16 type III) with calcaneal fractures were managed with this technique. Calcaneal height, width, length, Bohler's angle, and Gissane angle were measured preoperatively, postoperatively, and at 1-year follow-up. Functional outcomes were assessed based on American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score. RESULTS Twenty-nine patients with average follow-up time of 18 (range 13-29) months were included. The radiographs demonstrated significant corrections of the Bohler's angle and Gissane angle, calcaneal width, length, and height from preoperation to postoperation and 1-year follow-up. Among all follow-up patients, one case had skin necrosis but healed after dressing. Another case had symptoms of numbness in the sural innervation area, which disappeared after 5 months of physical therapy and drug therapy. One case showed degenerative changes of subtalar joint at 1-year follow-up. No other wound complications like incision infection (superficial or deep) and wound dehiscence occurred. At 1-year follow-up, the mean AOFAS score was 90.2 ± 17.7 (range 70-98) and the good and excellent rate was 89.7%. CONCLUSION The modified tarsal sinus approach in the treatment of Sander's type II and III calcaneal fractures allowed adequate reduction and rigid fixation with low incidence of wound complications. Compared to sinus tarsi approach, this technique required shorter learning curve and was more easily mastered by young orthopedic surgeons. Thus, it was worthy of application clinically.
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Affiliation(s)
- Junfeng Zhan
- 1 Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.,2 Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Chuanzhen Hu
- 3 Department of Orthopaedics Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Nan Zhu
- 2 Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Wang Fang
- 2 Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Juehua Jing
- 2 Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Gang Wang
- 1 Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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Early Complications Following Articular Calcaneus Fracture Repair: Evaluation of Open Versus Percutaneous Techniques. OTA Int 2019; 2:e049. [PMID: 33937677 PMCID: PMC7997092 DOI: 10.1097/oi9.0000000000000049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 10/16/2019] [Indexed: 11/26/2022]
Abstract
Objectives: To assess complications and secondary operations in patients treated with either open reduction and internal fixation (ORIF) versus percutaneous fixation of displaced intra-articular calcaneus fractures. Design: Retrospective comparative study. Setting: Level 1 trauma center. Patients/Participants: Ninety-three adult patients with 111 fractures treated by a single orthopaedic traumatologist between 2001 and 2014. Intervention: ORIF through an extensile lateral approach or percutaneous reduction and internal fixation. Main Outcome Measurements: Wound-healing complications, infections, posttraumatic arthrosis (PTOA), and secondary procedures. Results: Fifty patients with 58 fractures underwent ORIF, and 43 patients with 53 fractures had percutaneous fixation. Mean age was 43 years, and 80% were male. Open fractures and two-part fractures were more often treated percutaneously (26% vs 8%, P = 0.03) and (49% vs 31%, P = 0.02), respectively. Patients undergoing percutaneous fixation were more often tobacco users (58% vs 36%, P = 0.04) and with history of alcohol and other substance abuse. Twenty-seven patients (29%) had 28 complications, including 21% with PTOA, with no differences based on type of treatment. Six patients had secondary procedures, with no difference based on type of treatment. Patients with open fractures (P = 0.001) or tobacco abuse (P = 0.005) were more likely to experience complications. Conclusions: No differences in complication rates were found for ORIF versus percutaneous fixation. Regardless of fixation technique, patients with open fractures or history of tobacco abuse were more likely to develop complications. Percutaneous reduction and fixation represents an alternative to extensile ORIF in terms of similar early and late complications, particularly in high risk patients. Level of Evidence: Therapeutic Level III
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Zhuang L, Wang L, Xu D, Wang Z, Zheng J. Same wound complications between extensile lateral approach and sinus tarsi approach for displaced intra-articular calcaneal fractures with the same locking compression plates fixation: a 9-year follow-up of 384 patients. Eur J Trauma Emerg Surg 2019; 47:1211-1219. [DOI: 10.1007/s00068-019-01221-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022]
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Looijen RC, Misselyn D, Backes M, Dingemans SA, Halm JA, Schepers T. Identification of Postoperative Step-Offs and Gaps With Brodén's View Following Open Reduction and Internal Fixation of Calcaneal Fractures. Foot Ankle Int 2019; 40:797-802. [PMID: 30957544 PMCID: PMC6610549 DOI: 10.1177/1071100719840812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To date, there is no consensus regarding which postoperative imaging technique should be used after open reduction and internal fixation of an intra-articular calcaneal fracture. The aim of this study was to clarify whether Brodén's view is sufficient as postoperative radiologic examination to assess step-offs and gaps of the posterior facet. METHODS Six observers estimated the size of step-offs and gaps on Brodén's view in 42 surgically treated intra-articular calcaneal fractures. These findings were compared to postoperative CT scans (gold standard). Inter- and intraobserver reliability were calculated and compared using intraclass correlation coefficients (ICCs). RESULTS An accuracy of approximately 75% for both step-offs and gaps was found in foot and ankle experts. Less experienced observers correctly identified step-offs and gaps in approximately 62% of cases on fluoroscopy and in 48% on radiographs. Interobserver reliability for intraoperative fluoroscopy as well as postoperative radiographs was fair for step-offs, whereas interobserver reliability for gaps was excellent. Intraobserver reliability showed a low level of agreement for intraoperative fluoroscopy, in contrast to postoperative radiographs with excellent agreement for step-offs and good agreement for gaps. CONCLUSION Our results show that especially for more experienced foot and ankle surgeons, in the majority of fractures, Brodén's view accurately showed step-offs and gaps following open reduction and internal fixation. Interobserver reliability showed a fair level of agreement for step-offs and excellent agreement for gaps. Intraobserver reliability was only enough for radiographs, not for fluoroscopy. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Rosalie C. Looijen
- Trauma Unit, Amsterdam University
Medical Center, Amsterdam, the Netherlands
| | - Dominique Misselyn
- Department of Trauma Surgery, University
Hospitals Leuven (UZ), Louvain, Belgium
| | - Manouk Backes
- Trauma Unit, Amsterdam University
Medical Center, Amsterdam, the Netherlands
| | - Siem A. Dingemans
- Trauma Unit, Amsterdam University
Medical Center, Amsterdam, the Netherlands
| | - Jens A. Halm
- Trauma Unit, Amsterdam University
Medical Center, Amsterdam, the Netherlands
| | - Tim Schepers
- Trauma Unit, Amsterdam University
Medical Center, Amsterdam, the Netherlands,Tim Schepers, MD, PhD, Trauma Unit,
Amsterdam UMC, Meibergdreef 9, PO Box 22660, Amsterdam, 1100DD, the Netherlands.
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Xia S, Fu B, Wang B, Wu J, Cui Y, Wang X. Computed Tomography Imaging-Based Preoperative Virtual Simulation for Calcaneal Fractures Reduction. J Foot Ankle Surg 2019; 58:248-252. [PMID: 30850096 DOI: 10.1053/j.jfas.2018.08.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Indexed: 02/03/2023]
Abstract
Reduction of calcaneal fractures via a small incision approach at the sinus tarsi is technically difficult. This study was undertaken to determine if preoperative virtual simulation based on computed tomographic data improves reduction and reduces complications. Fifty-five patients with calcaneal fractures were treated via the sinus tarsi approach with minimally invasive plates between February 2013 and December 2015. DICOM files obtained from computed tomographic imaging preoperatively were imported into Superimage software, and virtual surgery was performed. Preoperative planning time, operative time, and complications were recorded. Clinical function was analyzed with radiology and with the American Orthopaedic Foot and Ankle Society and visual analogue scale scores. As a result, preoperative planning time was 30.7 ± 4.1 minutes, which increased with the severity of the fracture (Sanders III vs Sanders II: 34.2 ± 2.5 minutes vs 27.8 ± 2.7 minutes), which was in line with the real surgery, with a mean operative time of 86.7 ± 4.5 minutes (Sanders III vs Sanders II: 89.5 ± 2.7 minutes vs 84.3 ± 4.4 minutes). Radiologic results indicated that the calcaneal width, length, height, Böhler angle, and Gissane angle were significantly corrected from preoperatively to postoperatively. After a mean follow-up of 21.5 ± 6.1 months, no complications were observed. The mean American Orthopaedic Foot and Ankle Society score was 88.7 ± 4.0, with an excellent/good rate of 94.5% (52 of 55). The mean visual analogue scale score was 0.8 ± 0.9. In conclusion, preoperative virtual simulation may be efficient to promote accomplishment of sinus tarsi surgery, and this step may help improve outcomes for calcaneal fractures.
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Affiliation(s)
- Shengli Xia
- Chief Physician, Department of Orthopedics, Shanghai Pudong New Area Zhoupu Hospital, Shanghai, China.
| | - Beigang Fu
- Associate Chief Physician, Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Bin Wang
- Resident Physician, Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jiajun Wu
- Resident Physician, Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yin Cui
- Associate Chief Physician, Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xiuhui Wang
- Chief Physician, Department of Orthopedics, Shanghai Pudong New Area Zhoupu Hospital, Shanghai, China
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