Percutaneous Cannulated Screw Fixation vs. Plating With Minimally Invasive Longitudinal Approach After Closed Reduction for Intra-Articular Tongue-Type Calcaneal Fractures: A Retrospective Cohort Study

A simple modified technique for screw fixation of displaced intra-articular calcaneus fracture through a sinus tarsi approach: a comparison with plate fixation

BACKGROUND

Plates and screws are frequently used for the fixation of displaced intra-articular calcaneus fracture (DIACF). In this study, we compared the outcomes of a modified screw fixation technique with plate fixation via a sinus tarsi approach (STA).

METHODS

A series of 187 DIACF patients who were treated via an STA using a plate fixation (n = 81) or a screw fixation (n = 106) were included. Screw fixation was done with two 2.7 mm screws and two 6.5 mm cannulated screws. Outcomes were evaluated radiographically and clinically. Clinical evaluations included pain assessment by Visual Analogue Scale (VAS) and functional assessment by the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire and Foot Function Index (FFI).

RESULTS

The mean final VAS was smaller in the screw group (P = 0.01). The mean AOFAS and FFI scores were not significantly different between the two groups (P = 0.17 and P = 0. 19, respectively). The mean improvement of Bohler's angle, but not the Gissane's angle, was significantly greater in the screw group (P = 0.014 and P = 0.09, respectively). The mean improvement of calcaneal length and height were not significantly different between the two groups (P = 0.78 and P = 0.22, respectively). The hardware removal rate was 14.8% in the plate group and 3.8% in the screw group (P = 0.007).

CONCLUSION

The modified screw fixation method provides lower pain, better radiographic outcome, and lower rate of hardware removal compared to plate fixation in the treatment of DIACF.

Comparative Biomechanical Analysis of Anterior Process Locking Plate Alone versus Combined with Percutaneous Cannulated Screw Fixation for Sanders Type II Calcaneal Fractures: A Finite Element Study

BACKGROUND Calcaneal fractures are the most common tarsal bone fractures, and account for 75% of intra-articular fractures. The purpose of this study was to compare the biomechanical stability of the anterior process locking plate combined with the percutaneous cannulated screw fixation (screw group) versus the anterior process locking plate fixation alone (plate group) for the treatment of Sanders type II calcaneal fractures using finite element analysis to provide a theoretical basis for clinical work. MATERIAL AND METHODS We established a 3D model of Sanders type II calcaneal fracture; assigned material properties to the internal fixation systems; applied loads; set up analysis criteria; analyzed the displacement of the fracture, relative displacement, stress state of bone tissue, and internal fixation; and compared mechanical stability. RESULTS For Sanders type II A, II B, and II C calcaneal fractures, the degree of displacement and relative displacement of the fracture in the screw group was less than that of the plate group. For all subtypes of Sanders type II calcaneal fractures, the screw group had better mechanical stability than the plate group. CONCLUSIONS Both fixation methods (screw and plate group) were within a reasonable range for restoring the levelling effect of the joint surface and maintaining the strength of fixation, and both had good mechanical stability. Finite element analysis is a relatively reliable method, and biomechanics and clinical studies must further verify the experimental results.

Treatment of Fracture of the Calcaneus via Bone Axial X-Ray Image-Based Minimally Invasive Approach

To discuss the values of two bone axial X-ray image-based minimally invasive approach surgeries in the diagnosis and treatment of fracture of the calcaneus, 80 patients diagnosed with fracture of the calcaneus by bone axial X-ray examination were selected and divided equally into the minimally invasive longitudinal approach (MILA) group (40 cases) and the sinus tarsal approach (STA) group (40 cases). Besides, the duration of operation, the incidence of complications, the time-to-start weight training, and the American Orthopaedic Foot and Ankle Society (AOFAS) foot function scoring system between the patients in the two groups were compared. The results showed that the duration of operation and incidence of complications among the patients in the MILA group (42.87 ± 5.12 minutes, 20%) were both superior to those among the patients in the STA group (60.43 ± 7.31 minutes, 32.5%). The time-to-start weight training in the MILA group was 5.2 weeks, which was obviously shorter than that in the STA group (5.7 weeks). The difference in AOFAS scores between the two groups was not significant. The walking pavement score in the MILA group (4.2 ± 0.37 points) was slightly higher than that in the STA group (3.3 ± 0.45 points), and the differences demonstrated statistical meaning (P < 0.05). To sum up, the bone axial X-ray image is an essential examination method of diagnosing fracture of the calcaneus. The two minimally invasive methods both showed good clinical therapeutic effects. The operation of MILA was relatively shorter with fewer complications and is worthy of being promoted as an effective treatment method of fracture of the calcaneus.