A comparative study on internal fixation of calcaneal fractures assisted by robot and traditional open reduction internal fixation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUAN Xinwei ,  ZHANG Bin , HU Jiang , LU Bing , TANG Zhi

Department of Orthopedics, Sichuan Provincial People’s Hospital, Sichuan Academy of Medical Sciences, Chengdu Sichuan, 610072, P.R.China;

Corresponding?author：

ZHANG Bin, Email: 463237634@qq.com

Keywords：

Robot; calcaneal fracture; internal fixation; tarsal sinus incision

DOI：

10.7507/1002-1892.202101029

Video：

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Objective To compare the effectiveness of robot assisted internal fixation and traditional open reduction and internal fixation for calcaneal fractures.Methods The clinical data of 44 patients (44 feets) with calcaneal fracture admitted between October 2017 and December 2018 who met the selection criteria were retrospectively analyzed. According to different operation methods, they were divided into trial group (19 cases, treated with robot assisted percutaneous reduction and cannulated screw fixation through tarsal sinus incision) and control group (25 cases, treated with open reduction and internal fixation via traditional tarsal sinus incision). There was no significant difference in gender, age, injured side, cause of injury, fracture type, time from injury to operation, and preoperative B?hler angle, Gissane angle, calcaneus width, American Orthopedic Foot and Ankle Association (AOFAS) score, and other general data between the two groups (P>0.05). The operation time, intraoperative fluoroscopy frequency, and fracture healing time were recorded and compared between the two groups. Before operation and at 6 months after operation, the B?hler angle and Gissane angle were measured on the lateral X-ray film, and the calcaneal width was measured on the axial X-ray film of the calcaneus to evaluate the recovery of the deformity and collapse after surgical treatment; the AOFAS score was used to evaluate the function of the affected foot and ankle joint.Results The operation time of the trial group was significantly longer than that of the control group (P<0.05), but the intraoperative fluoroscopy frequency was significantly less than that of the control group (P<0.05). In the control group, 1 case had skin necrosis, and 1 case had a little leakage from the incision; the rest of the two groups had no skin- and incision-related complications. Patients in both groups were followed up 6-12 months, with an average of 9.5 months. At 6 months after operation, the B?hler angle, Gissane angle, and calcaneal width in the two groups were significantly improved when compared with preoperative ones (P<0.05), and there was no significant difference between the two groups (P>0.05); the fractures in the two groups were healed, there was no significant difference in healing time (t=–1.890, P=0.066); the AOFAS scores of the two groups were significantly higher than those before operation (P<0.05), and the AOFAS score of the trial group was significantly higher than that of the control group (t=–3.135, P=0.003).Conclusion Compared with traditional C-arm fluoroscopic internal fixation for calcaneal fractures, robot-assisted internal fixation via tarsal sinus incision for calcaneal fractures significantly improves the function of the affected foot and maintains the accuracy of nail implantation after fracture reduction, reducing intraoperative fluoroscopy times, and the fracture heals well.

Citation： YUAN Xinwei, ZHANG Bin, HU Jiang, LU Bing, TANG Zhi. A comparative study on internal fixation of calcaneal fractures assisted by robot and traditional open reduction internal fixation. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(6): 729-733. doi: 10.7507/1002-1892.202101029 Copy

1.	van der Vliet QMJ, Hietbrink F, Casari F, et al. Factors influencing functional outcomes of subtalar fusion for posttraumatic arthritis after calcaneal fracture. Foot Ankle Int, 2018, 39(9): 1062-1069.
2.	Zhan J, Hu C, Zhu N, et al. A modified tarsal sinus approach for intra-articular calcaneal fractures. J Orthop Surg (Hong Kong), 2019, 27(2): 2309499019836165. doi: 10.3389/fcell.2020.00694.
3.	Khazen G, Rassi CK. Rassi CK. Sinus tarsi approach for calcaneal fractures: The new gold standard? Foot Ankle Clin, 2020, 25(4): 667-681.
4.	Ceccarini P, Manfreda F, Petruccelli R, et al. Minimally invasive sinus tarsi approach in Sanders Ⅱ-Ⅲ calcaneal fractures in high-demand patients. Med Glas (Zenica), 2021, 18(1): 322-327.
5.	Meng H, Zhu Y, Zhang J, et al. Incidence and risk factor for preoperative deep vein thrombosis (DVT) in isolated calcaneal fracture, a prospective cohort study. Foot Ankle Surg, 2020. doi: 10.1016/j.fas.2020.06.007.
6.	Herlyn A, Brakelmann A, Herlyn PK, et al. Calcaneal fracture fixation using a new interlocking nail reduces complications compared to standard locking plates-Preliminary results after 1.6 years. Injury, 2019, 50 Suppl 3: 63-68.
7.	Fourgeaux A, Estens J, Fabre T, et al. Three-dimensional computed tomography analysis and functional results of calcaneal fractures treated by an intramedullary nail. Int Orthop, 2019, 43(12): 2839-2847.
8.	Buzzi R, Sermi N, Soviero F, et al. Displaced intra-articular fractures of the calcaneus: ORIF through an extended lateral approach. Injury, 2019, 50 Suppl 2: S2-S7.
9.	Tantavisut S, Phisitkul P, Westerlind BO, et al. Percutaneous reduction and screw fixation of displaced intra-articular fractures of the calcaneus. Foot Ankle Int, 2017, 38(4): 367-374.
10.	Day MA, Ho M, Dibbern K, et al. Correlation of 3D joint space width from weightbearing CT with outcomes after intra-articular calcaneal fracture. Foot Ankle Int, 2020, 41(9): 1106-1116.
11.	Dhillon MS, Bali K, Prabhakar S. Controversies in calcaneus fracture management: a systematic review of the literature. Musculoskelet Surg, 2011, 95(3): 171-181.
12.	Rachakonda KR, Nugur A, Shekar NA, et al. Minimally invasive fixation for displaced intra-articular fractures of calcaneum: a short-term prospective study on functional and radiological outcome. Musculoskelet Surg, 2019, 103(2): 181-189.
13.	Wang C, Xu C, Li M, et al. Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study. BMC Musculoskelet Disord, 2020, 21(1): 407. doi: 10.1186/s12891-020-03439-3.
14.	Chen W, Liu B, Lv H, et al. Radiological study of the secondary reduction effect of early functional exercise on displaced intra-articular calcaneal fractures after internal compression fixation. Int Orthop, 2017, 41(9): 1953-1961.

1. van der Vliet QMJ, Hietbrink F, Casari F, et al. Factors influencing functional outcomes of subtalar fusion for posttraumatic arthritis after calcaneal fracture. Foot Ankle Int, 2018, 39(9): 1062-1069.
2. Zhan J, Hu C, Zhu N, et al. A modified tarsal sinus approach for intra-articular calcaneal fractures. J Orthop Surg (Hong Kong), 2019, 27(2): 2309499019836165. doi: 10.3389/fcell.2020.00694.
3. Khazen G, Rassi CK. Rassi CK. Sinus tarsi approach for calcaneal fractures: The new gold standard? Foot Ankle Clin, 2020, 25(4): 667-681.
4. Ceccarini P, Manfreda F, Petruccelli R, et al. Minimally invasive sinus tarsi approach in Sanders Ⅱ-Ⅲ calcaneal fractures in high-demand patients. Med Glas (Zenica), 2021, 18(1): 322-327.
5. Meng H, Zhu Y, Zhang J, et al. Incidence and risk factor for preoperative deep vein thrombosis (DVT) in isolated calcaneal fracture, a prospective cohort study. Foot Ankle Surg, 2020. doi: 10.1016/j.fas.2020.06.007.
6. Herlyn A, Brakelmann A, Herlyn PK, et al. Calcaneal fracture fixation using a new interlocking nail reduces complications compared to standard locking plates-Preliminary results after 1.6 years. Injury, 2019, 50 Suppl 3: 63-68.
7. Fourgeaux A, Estens J, Fabre T, et al. Three-dimensional computed tomography analysis and functional results of calcaneal fractures treated by an intramedullary nail. Int Orthop, 2019, 43(12): 2839-2847.
8. Buzzi R, Sermi N, Soviero F, et al. Displaced intra-articular fractures of the calcaneus: ORIF through an extended lateral approach. Injury, 2019, 50 Suppl 2: S2-S7.
9. Tantavisut S, Phisitkul P, Westerlind BO, et al. Percutaneous reduction and screw fixation of displaced intra-articular fractures of the calcaneus. Foot Ankle Int, 2017, 38(4): 367-374.
10. Day MA, Ho M, Dibbern K, et al. Correlation of 3D joint space width from weightbearing CT with outcomes after intra-articular calcaneal fracture. Foot Ankle Int, 2020, 41(9): 1106-1116.
11. Dhillon MS, Bali K, Prabhakar S. Controversies in calcaneus fracture management: a systematic review of the literature. Musculoskelet Surg, 2011, 95(3): 171-181.
12. Rachakonda KR, Nugur A, Shekar NA, et al. Minimally invasive fixation for displaced intra-articular fractures of calcaneum: a short-term prospective study on functional and radiological outcome. Musculoskelet Surg, 2019, 103(2): 181-189.
13. Wang C, Xu C, Li M, et al. Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study. BMC Musculoskelet Disord, 2020, 21(1): 407. doi: 10.1186/s12891-020-03439-3.
14. Chen W, Liu B, Lv H, et al. Radiological study of the secondary reduction effect of early functional exercise on displaced intra-articular calcaneal fractures after internal compression fixation. Int Orthop, 2017, 41(9): 1953-1961.

Chinese Journal of Reparative and Reconstructive Surgery

A comparative study on internal fixation of calcaneal fractures assisted by robot and traditional open reduction internal fixation

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