MANUFACTURE AND CLINICAL APPLICATION OF SCREW DIRECTOR OF CALCANEOUS SUSTENTACULUM TALI FOR TREATMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUBinggen ¹ ,  PANGQingjiang ² , YUXiao ² , CHENXianjun ² , GUOZonghui ²

1. Department of Ningbo University School of Medicine, Ningbo Zhejiang, 315211, P. R. China;
2. Department of Orthopedics, Ningbo No.2 Hospital, Ningbo Zhejiang, 315211, P. R. China;

Corresponding?author：

PANGQingjiang, Email: pqjey@sina.com

Keywords：

Calcaneal fracture; Sustentaculum tali; Screw director of the calcaneous sustentaculum tali; Clinical application

DOI：

10.7507/1002-1892.20150064

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Objective To evaluate the clinical results of the self-manufactured screw director of the calcaneous sustentaculum tali in the surgical treatment of intra-articular calcaneal fractures. Methods Between May 2012 and October 2013, 40 patients (47 feet) underwent surgical treatment of intra-articular calcaneal fractures, and the clinical data were analyzed. There were 29 males and 11 females with an average age of 46 years (range, 25-68 years). According to Sanders classification, 17 feet were rated as type Ⅱ, 20 feet as type Ⅲ, and 10 feet as type IV. The average time from injury to admission was 6.02 hours (range, 1-12 hours). All the patients were treated with the screw director of the calcaneous sustentaculum tali to fix the sustentaculum tali. The intraoperative times of fluoroscopy were recorded. The B?hler angle and Gissane angle were measured at pre- and post-operation. The clinical functional outcomes were evaluated according to the Maryland foot score system. Results The intraoperative times of fluoroscopy were 2-4 times (mean, 2.85 times). Radiographic examination showed 45 screws were accurately implanted into the middle of the sustentaculum tali in implanted 47 screws except 1 screw which penetrated into the anteroinferior of the sustentaculum tali and 1 screw which penetrated into the anterior of the sustentaculum tali. The accurate rate of screw implant was 95.7%. All patients were followed up for an average of 12 months (range, 8-18 months). During the follow-up, incision skin necrosis and infection occurred in 2 cases, and sural nerve injury developed in 3 cases. Bone union was achieved at an average of 12.72 weeks (range, 9-18 weeks) postoperatively. The B?hler angle was improved significantly from (6.48±3.67)° pre-operatively to (29.40±4.65)° post-operatively (t=-31.38, P=0.00). The Gissane angle was improved significantly from (99.30±5.85)° pre-operatively to (130.84±5.08)° post-operatively (t=-28.32, P=0.00). The Maryland foot score was 90.66 on average (range, 65-98) at last follow-up; the results were excellent in 41 feet, good in 3 feet, and fair in 3 feet with an excellent and good rate of 93.6%. Conclusion The self-manufactured screw director of the calcaneous sustentaculum tali can significantly improve the accuracy of the screw implanted into the sustentaculum tali and reduce the harm of intraoperative fluoroscopy to the body.

Citation： LIUBinggen, PANGQingjiang, YUXiao, CHENXianjun, GUOZonghui. MANUFACTURE AND CLINICAL APPLICATION OF SCREW DIRECTOR OF CALCANEOUS SUSTENTACULUM TALI FOR TREATMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 296-300. doi: 10.7507/1002-1892.20150064 Copy

1.	Rammelt S, Zwipp H. Fractures of the calcaneus:current Treatment strategies. Acta Chir Orthop Traumatol Cech, 2014, 81(3):177-196.
2.	Kinner B, Schieder S, Müiller F, et al. Calcaneocuboid joint involvementin calcaneal fractures. J Trauma, 2010, 68(5):1192-1199.
3.	Yu GR, Pang QJ, Yu X, et al. Surgical management for avulsion fracture of the calcaneal tuberosity. Orthop Surg, 2013, 5(3):196-202.
4.	Jiang N, Lin QR, Diao XC, et al. Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture:a meta-analysis of current evidence base. Int Orthop, 2012, 36(8):1615-1622.
5.	Gitajn IL, Toussaint RJ, Kwon JY. Assessing accuracy of sustentaculum screw placement during calcaneal fixation. Foot Ankle Int, 2013, 34(2):282-286.
6.	Phisitkul P, Sullivan JP, Goetz JE, et al. Mximizing safety in screw placement for posterior facet fixation in calcaneus fractures:a cadaveric radio-anatomical study. Foot Ankle Int, 2013, 34(9):1279-1285.
7.	LevyA, Berkowitz R, Franklin P, et al. Magnetic resonance imaging evaluation of calcaneal fat pads in patients with OS calcis fractures. Foot Ankle Int, 1992, 13(2):57-62.
8.	Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular ealcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290):87-95.
9.	陳雁西, 俞光榮. 動靜脈泵在骨科臨床應用中的現狀與展望. 中華創傷雜志, 2005, 21(4):309-311.
10.	校伯平, 李明, 王邦榮, 等. 跟骨骨折的臨床解剖學觀察及應用. 中國骨傷, 2010, 23(11):814-816.
11.	Mahato NK. Morphology of sustentaculum tali:Biomechanical importance and correlation with angular dimensions of the talus. Foot (Edinb), 2011, 21(4):179-183.
12.	Della Rocca GJ, Nork SE, Barei DP, et al. Fractures of the sustentaculum tali:injury characteristics and surgical technique for reduction. Foot Ankle Int, 2009, 30(11):1037-1041.
13.	胡牧, 施忠民, 徐向陽, 等. 內側入路切開復位內固定治療跟骨單純載距突骨折. 中華骨科雜志, 2013, 33(4):326-332.
14.	施忠民, 鄒劍, 顧文奇, 等. 經跗骨竇間隙與外側"L"形切口治療SandersⅡ型跟骨骨折的療效比較. 中華骨科雜志, 2013, 33(4):298-303.
15.	Pang QJ, Yu X, Guo ZH. The sustentaculum tali screw fixation for the treatment of Sanders type Ⅱ calcaneal fracture:A finite element analysis. Pak J Med Sci, 2014, 30(5):1099-1103.
16.	張鵬, 黃勇, 張增方, 等. 跟骨載距突與其外側壁關系的測量. 青島大學醫學院學報, 2007, 43(6):507-509.
17.	Swanson SA, Clare MP, Sanders RW. Management of intra-articular fractures of the ealcaneus. Foot Ankle Clin, 2008, 13(4):659-678.
18.	Brunner A, Müller J, Regazzoni P, et al. Open reduction and internal fixation of OTA type C2-C4 fractures of the caleaneus with a triple-plate technique. J Foot Ankle Surg, 2012, 51(3):299-307.

1. Rammelt S, Zwipp H. Fractures of the calcaneus:current Treatment strategies. Acta Chir Orthop Traumatol Cech, 2014, 81(3):177-196.
2. Kinner B, Schieder S, Müiller F, et al. Calcaneocuboid joint involvementin calcaneal fractures. J Trauma, 2010, 68(5):1192-1199.
3. Yu GR, Pang QJ, Yu X, et al. Surgical management for avulsion fracture of the calcaneal tuberosity. Orthop Surg, 2013, 5(3):196-202.
4. Jiang N, Lin QR, Diao XC, et al. Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture:a meta-analysis of current evidence base. Int Orthop, 2012, 36(8):1615-1622.
5. Gitajn IL, Toussaint RJ, Kwon JY. Assessing accuracy of sustentaculum screw placement during calcaneal fixation. Foot Ankle Int, 2013, 34(2):282-286.
6. Phisitkul P, Sullivan JP, Goetz JE, et al. Mximizing safety in screw placement for posterior facet fixation in calcaneus fractures:a cadaveric radio-anatomical study. Foot Ankle Int, 2013, 34(9):1279-1285.
7. LevyA, Berkowitz R, Franklin P, et al. Magnetic resonance imaging evaluation of calcaneal fat pads in patients with OS calcis fractures. Foot Ankle Int, 1992, 13(2):57-62.
8. Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular ealcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290):87-95.
9. 陳雁西, 俞光榮. 動靜脈泵在骨科臨床應用中的現狀與展望. 中華創傷雜志, 2005, 21(4):309-311.
10. 校伯平, 李明, 王邦榮, 等. 跟骨骨折的臨床解剖學觀察及應用. 中國骨傷, 2010, 23(11):814-816.
11. Mahato NK. Morphology of sustentaculum tali:Biomechanical importance and correlation with angular dimensions of the talus. Foot (Edinb), 2011, 21(4):179-183.
12. Della Rocca GJ, Nork SE, Barei DP, et al. Fractures of the sustentaculum tali:injury characteristics and surgical technique for reduction. Foot Ankle Int, 2009, 30(11):1037-1041.
13. 胡牧, 施忠民, 徐向陽, 等. 內側入路切開復位內固定治療跟骨單純載距突骨折. 中華骨科雜志, 2013, 33(4):326-332.
14. 施忠民, 鄒劍, 顧文奇, 等. 經跗骨竇間隙與外側"L"形切口治療SandersⅡ型跟骨骨折的療效比較. 中華骨科雜志, 2013, 33(4):298-303.
15. Pang QJ, Yu X, Guo ZH. The sustentaculum tali screw fixation for the treatment of Sanders type Ⅱ calcaneal fracture:A finite element analysis. Pak J Med Sci, 2014, 30(5):1099-1103.
16. 張鵬, 黃勇, 張增方, 等. 跟骨載距突與其外側壁關系的測量. 青島大學醫學院學報, 2007, 43(6):507-509.
17. Swanson SA, Clare MP, Sanders RW. Management of intra-articular fractures of the ealcaneus. Foot Ankle Clin, 2008, 13(4):659-678.
18. Brunner A, Müller J, Regazzoni P, et al. Open reduction and internal fixation of OTA type C2-C4 fractures of the caleaneus with a triple-plate technique. J Foot Ankle Surg, 2012, 51(3):299-307.

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Chinese Journal of Reparative and Reconstructive Surgery

MANUFACTURE AND CLINICAL APPLICATION OF SCREW DIRECTOR OF CALCANEOUS SUSTENTACULUM TALI FOR TREATMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES

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