Fractures of the sustentaculum tali of the calcaneus: a case report

Evaluation of Sanders Type 2 Joint Depression Calcaneal Fractures in 197 Patients from a Single Center Using Three-Dimensional Mapping

BACKGROUND This study aimed to evaluate Sanders type 2 calcaneal fractures in 197 patients from a single center using the 3D (three-dimensional) CT (computed tomography) mapping method. MATERIAL AND METHODS A consecutive series of 197 Sanders type 2 joint depression calcaneal fractures was used. The segment and split functions were used to create each calcaneal fragment using Mimics Research 20.0 software. The fracture fragments were reduced in 3-matic Research 12.0 software. In the E-3D Medical 18.01 software, after superimposing the fractured calcaneus entity with the calcaneus template, we drew the fracture line on the template. Finally, the heatmap was obtained by fracture statistical analysis function. Simultaneously, the distribution of the fracture lines in the anterior part of the calcaneus (APC) and middle talar joint was recorded. RESULTS There were 109 cases of Sanders type 2A, 46 cases of Sanders type 2B, and 42 cases of Sanders type 2C. Based on the data, we drew the characteristic fracture map of type 2A 2B and 2C. This study found that the most common types of Sanders type 2A in APC and middle talar articular surface are type AC and type AD. In Sanders type 2B, the most common type is type AC, and in Sanders type 2C it is type ACD. CONCLUSIONS The findings from this study showed that 3D CT imaging and reconstruction of the calcaneus was a useful diagnostic method to evaluate and classify joint depression calcaneal fractures. The calcaneal fracture map can be used to guide surgical planning and optimize the design of internal fixation.

Comprehensive Review of Rock Climbing Injuries

Increasing numbers of people are participating in the sport of rock climbing, and its growth is expected to continue with the sport's Olympic debut in 2020. Extreme loading of the upper extremities, contorted positioning of the lower extremities, rockfall, and falling from height create an elevated and diverse injury potential that is affected by experience level and quantity of participation. Injuries vary from acute traumatic injuries to chronic overuse injuries. Unique sport-specific injuries to the flexor tendon pulley system exist, but the remaining musculoskeletal system is not exempt from injury. Orthopaedic evaluation and surgery is frequently required. Understanding the sport of rock climbing and its injury patterns, treatments, and prevention is necessary to diagnose, manage, and counsel the rock-climbing athlete.

Bilateral Isolated Fractures of the Sustentaculum Tali: A Case Report

CASE

This article presents a case of bilateral isolated fractures of the sustentaculum tali. Subtle radiographic findings of sustentaculum fractures on routine foot and ankle series are often difficult to detect, which can result in a delayed diagnosis. Early diagnosis and timely operative management allowed for a good short-term outcome.

CONCLUSIONS

We emphasize the importance of a thorough physical examination in all high-energy trauma patients and an awareness of less common injury patterns that are subtle on radiographs and may require further workup. When clinical suspicion exists, we recommend the use of computed tomography scans for evaluation.

Treatment for displaced sustentaculum tali fractures

BACKGROUND

Sustentaculum tali fractures are rare foot fractures accounting for 1% of all calcaneal fractures, which accounts for about 1-2% of all bone fractures. Since the importance of sustentaculum tali in maintaining the medial foot arch, its fractures should be dealt with anatomical fixation to avoid post-traumatic arthrosis.

OBJECTIVE

Is to delineate the importance of sustentacular tali fractures fixation mentioning operative technique and the post-operative outcome.

METHODOLOGY

Ten cases with 10 consequent closed sustentaculum tali fractures were treated by ORIF. Nine of them were male gender. Patient's age was 27.6 (ranged 22-40). Of those 10 cases, 7 were isolated sustentaculum tali fractures, while 3 cases were associated by other fractures. All patients were followed-up with a follow-up period 52.8 months (ranged 24-84m).

RESULTS

All fractures were united with a union rate 100%. Union appeared radiologically between 6-8 weeks post-operatively with an average 6.8 weeks. Isolated sustentacular fractures achieved post-operative 100 score while in the case with fractured talar neck, patient had a score 80, associated distal fibular fracture achieved 90 score, overall average score was 97 ranged 80-100. There was no recorded complication regarding to the operative maneuver.

CONCLUSION

Fractures of the sustentaculum tali are rare injuries associated with high energy mechanisms. These fractures have a high incidence of misdiagnosis. A high index of suspicion is, therefore, required when there is pain and hematoma directly over the sustentaculum tali. Open reduction and internal fixation of these fractures is reliable and possible through a medial approach.

The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture: A finite element analysis

Objective: In the surgery of calcaneal fracture, whether the sustentaculum tali screw should always be placed is widely controversial. The aim of this study was to explore the necessity and function of the sustentaculum tali screw placement for the treatment of Sanders type II calcaneal fracture.

Methods: The finite element analysis was used in this study. After the establishment of the finite element model of Sanders type II calcaneal fracture, the two internal fixation simulations were designed. In one model, the AO calcaneal plate was simulated on the lateral side of the calcanues with 7 screws being fixated at different position of the plate. In the other model, the calcaneus was fixated with the same AO calcaneal plate together with an additional screw being infiltrated into the sustentaculum tali. The two models were simulated under the same loading and the displacement of the fracture line and the stress distribution in the two models were calculated respectively.

Results: The maximum principal stress focused on the cortical bone of sustentaculum tali in both the models under the same loading. The displacement of the fracture line, the maximum principal stress of calcaneus and internal fixation system in the model with sustentaculum screw fixation were smaller than that in the model without sustentaculum screw fixation. The stress in the model with sustentaculum screw fixation was more dispersed.

Conclusions: The placement of sustentaculum tali screw is essential for fixation of type II calcaneal fracture to achieve the biomechanical stability.

Isolated Fractures of the Sustentaculum Tali: Injury Characteristics and Surgical Technique for Reduction Management

Isolated fractures of sustentaculum tali are rare and often missed at an initial visit. They can be difficult to manage and may have implications for future hindfoot function. This article describes sustentacular fracture patterns and characteristics, and a method of surgical treatment via a medial approach to the calcaneus. During the last 6 years, 11 recent isolated sustentacular fractures without calcaneal posterior facet involvement were surgically-treated at our hospital. Of these all underwent open reduction and internal fixation via medial approach to the calcaneus. Patient charts, X-ray radiographs and CT scans were reviewed for injury characteristics and associated musculoskeletal injures. Five patients had intra-articular middle facet involvement, and two had subtalar joint subluxation. By cannulated screws reduction was maintained through fractures rigidly fixation. Isolated fracture of the sustentaculum tali is tend to be ignored and easily misdiagnosed as acute ankle sprain. Open reduction and internal fixation of this fractures was reliable and should be procedure via medial approach.

How to cite this article

mu h, xiangyang x, gang b. Isolated Fractures of the Sustentaculum Tali: Injury Characteristics and Surgical Technique for Reduction Management. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):48-51.

Commonly missed peritalar injuries

Because of the effect on hindfoot kinematics, missed or delayed diagnosis of peritalar injuries often results in impairment. The seemingly innocuous nature of these injuries, subtle radiographic findings, and low incidence limit familiarity, thereby increasing the likelihood of misdiagnosis. Because of delay in diagnosis, salvage arthrodesis may be necessary to restore function to the extremity. Talar head fracture, talar process fracture, subtalar fracture-dislocation, transverse tarsal joint fracture, and transverse tarsal ligamentous disruption with instability are recurrently misdiagnosed. The keys to proper diagnosis of these potentially devastating injuries are the recognition of their existence, their injury patterns, and their radiographic appearance. The threshold for additional imaging studies should be lowered when a patient has pain and physical examination findings are out of proportion to a provisional diagnosis, or when symptoms fail to improve.

Fractures of the sustentaculum tali: injury characteristics and surgical technique for reduction

BACKGROUND

The sustentaculum tali of the calcaneus is a vital load-bearing structure. Isolated sustentacular fractures are rare and may have implications for future hindfoot function. This retrospective cohort study describes sustentacular fracture patterns and characteristics, associated foot injuries, and a method of surgical treatment via a medial approach to the calcaneus.

MATERIALS AND METHODS

During a 7-year period, 19 surgically-treated sustentacular fractures without calcaneal posterior facet involvement were identified from a prospectively-collected database at a single Level 1 regional trauma center. Of these, 15 underwent open reduction and internal fixation utilizing a medial approach to the calcaneus. Patient charts, plain radiographs, and CT scans were reviewed for injury characteristics/morphology and associated musculoskeletal injuries.

RESULTS

Fourteen patients had associated ipsilateral foot/ankle injuries, and nine had other musculoskeletal injuries. Seven patients had intra-articular middle facet involvement, and seven had subtalar joint subluxation or dislocation. The medial approach to the calcaneus involves distal retraction of the neurovascular bundle and toe flexors. This allowed for an accurate indirect articular reduction using the extraarticular medial calcaneal cortex, as well as reduction of any associated subluxations. No complications were related to the surgical approach. Reduction was maintained through fracture healing.

CONCLUSION

Fractures of the sustentaculum tali are rare injuries associated with high energy mechanisms, and associated ipsilateral foot injuries are common. Open reduction and internal fixation of these fractures was reliable and possible through a medial approach involving distal retraction of the digital flexors and neurovascular bundle, allowing for an anatomical extraarticular cortical reduction.