A prospective study on treatment of Sanders type <b>Ⅱ</b> and <b>Ⅲ</b> calcaneal fractures with interlocking intramedullary nail fixation system_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Bo , MA Long , LIU Chen , ZHANG Bing ,  WU Gangqiang

Department of Orthopedics, No.2 People’s Hospital of Fuyang City, Fuyang Anhui, 236000, P. R. China;

Corresponding?author：

WU Gangqiang, Email: 18010998811@163.com

Keywords：

Calcaneus fracture; interlocking intramedullary nail fixation system; internal fixation

DOI：

10.7507/1002-1892.202312076

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Objective To explore the effectiveness of interlocking intramedullary nail fixation system for Sanders type Ⅱ and Ⅲ calcaneal fractures by comparing with open surgery. Methods Forty patients (40 feet) with Sanders type Ⅱ and Ⅲ calcaneal fractures, who were admitted between May 2020 and December 2022 and met the selection criteria, were included in the study. They were randomly allocated into control group and minimally invasive group using a random number table method, with 20 cases in each group. The patients were treated with the interlocking intramedullary nail fixation system in the minimally invasive group and with steel plate internal fixation via a lateral L-shaped incision in the control group. There was no significant difference between the two groups (P>0.05) in terms of gender, age, fracture classification and side, cause of injury, time from injury to admission, and preoperative width, length, height, B?hler angle, and Gissane angle of the calcaneus. The operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time, incidence of complications, as well as pre- and post-operative imaging indicators (B?hler angle, Gissane angle, width, height, and length of the calcaneus) and American Orthopaedic Foot and Ankle Society (AOFAS) score of foot were recorded and compared between the two groups. Results The incision length, operation time, and hospital stay of the minimally invasive group were significantly shorter than those of the control group, and the intraoperative blood loss significantly reduced (P<0.05). All patients of the two groups were followed up, with the follow-up time of 8-12 months (mean, 10.2 months) in the minimally invasive group and 8-12 months (mean, 10.4 months) in the control group. No complication occurred in the minimally invasive group after operation. One case of incision epidermal necrosis and 1 case of traumatic arthritis occurred in the control group after operation. However, there was no significant difference in the incidence of complications between the two groups (P>0.05). At last follow-up, the AOFAS score was significantly higher in the minimally invasive group than in the control group (P<0.05). Imaging examination showed that the calcaneal fractures of the two groups healed, and there was no significant difference in healing time between the two groups (P>0.05). Compared with preoperative conditions, the B?hler angle and Gissane angle of the calcaneus in the two groups significantly increased, the width narrowed, and the height and length increased at 3 days after operation and the last follow-up, with significant differences (P<0.05). There was no significant difference between 3 days after operation and last follow-up (P>0.05). There was no significant difference between the two groups at each time point (P>0.05). Conclusion The interlocking intramedullary nail fixation system in treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures has the advantages of minimal trauma, shortened hospital stay, reliable fracture reduction and fixation, and satisfactory foot function recovery.

Citation： LIU Bo, MA Long, LIU Chen, ZHANG Bing, WU Gangqiang. A prospective study on treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures with interlocking intramedullary nail fixation system. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(3): 303-308. doi: 10.7507/1002-1892.202312076 Copy

1.	Monaco SJ, Calderone M, Fleming JJ. Paradigm shift for the surgical management of calcaneal fractures? Clin Podiatr Med Surg, 2018, 35(2): 175-182.
2.	Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg (Am), 2000, 82(2): 225-250.
3.	Wang J, Han W, Su Y, et al. Comparison of robot-assisted percutaneous cannulated screws versus open reduction and internal fixation in calcaneal fractures. Orthop Surg, 2023, 15(3): 724-730.
4.	Sanders R, Vaupel ZM, Erdogan M, et al. Operative treatment of displaced intraarticular calcaneal fractures: long-term (10-20 years) results in 108 fractures using a prognostic CT classification. J Orthop Trauma, 2014, 28(10): 551-563.
5.	Eelsing R, Aronius LB, Halm JA, et al. Implant choice and outcomes of the sinus tarsi approach for displaced intra-articular calcaneal fractures. Foot Ankle Int, 2023, 44(8): 738-744.
6.	Krissian S, Samargandi R, Druon J, et al. Poor prognosis for infectious complications of surgery for ankle and hindfoot fracture and dislocation. A 34-case series. Orthop Traumatol Surg Res, 2019, 105(6): 1119-1124.
7.	Shuler FD, Conti SF, Gruen GS, et al. Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures: does correction of Bohler’s angle alter outcomes? Orthop Clin North Am, 2001, 32(1): 187-192.
8.	Backes M, Spijkerman IJ, de Muinck-Keizer RO, et al. Determination of pathogens in postoperative wound infection after surgically reduced calcaneal fractures and implications for prophylaxis and treatment. J Foot Ankle Surg, 2018, 57(1): 100-103.
9.	黃杰, 劉瑾, 張建偉. 經皮復位微創跟骨釘中釘固定治療 SandersⅡ 型及 Ⅲ 型跟骨骨折. 中國骨傷, 2023, 36(4): 313-319.
10.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
11.	Kline AJ, Anderson RB, Davis WH, et al. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int, 2013, 34(6): 773-780.
12.	Hsu AR, Anderson RB, Cohen BE. Advances in surgical management of intra-articular calcaneus fractures. J Am Acad Orthop Surg, 2015, 23(7): 399-407.
13.	馬超, 王成偉, 唐國柱. 微創技術與開放手術治療SandersⅡ、Ⅲ型跟骨骨折的療效比較. 中華骨科雜志, 2020, 40(21): 1443-1452.
14.	暢寧, 徐靜磊, 徐晨陽, 等. 微創三窗切口新型解剖鎖定鋼板治療跟骨骨折的療效分析. 中華創傷骨科雜志, 2021, 23(10): 871-876.
15.	Le Roux G, David G, Cronier P, et al. C-Nail^? locking nail versus conventional plate for thalamic calcaneal fractures. Orthop Traumatol Surg Res, 2023, 109(1): 103467.
16.	Fascione F, Di Mauro M, Guelfi M, et al. Surgical treatment of displaced intraarticular calcaneal fractures by a minimally invasive technique using a locking nail: A preliminary study. Foot Ankle Surg, 2019, 25(5): 679-683.
17.	Steinhausen E, Martin W, Lefering R, et al. C-Nail versus plate osteosynthesis in displaced intra-articular calcaneal fractures-a comparative retrospective study. J Orthop Surg Res, 2021, 16(1): 203.
18.	Peng Y, Wang J, Feng B, et al. Calcaneous interlocking nail treatment for calcaneous fracture: a multiple center retrospective study. BMC Musculoskelet Disord, 2022, 23(1): 911.
19.	胡曉偉, 孫開強, 厲運收, 等. 跗骨竇撬撥復位經皮釘中釘內固定微創治療跟骨骨折. 實用手外科雜志, 2023, 37(1): 76-79.
20.	Agren PH, Wretenberg P, Sayed-Noor AS. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg (Am), 2013, 95(15): 1351-1357.
21.	Radnay CS, Clare MP, Sanders RW. Subtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter? Surgical technique. J Bone Joint Surg (Am), 2010, 92 Suppl 1 Pt 1: 32-43.
22.	Pompach M, Carda M, Amlang M, et al. Treatment of calcaneal fractures with a locking nail (C-Nail). Oper Orthop Traumatol, 2016, 28(3): 218-230.
23.	Zwipp H, Pa?a L, ?ilka L, et al. Introduction of a new locking nail for treatment of intraarticular calcaneal fractures. J Orthop Trauma, 2016, 30(3): e88-e92.

1. Monaco SJ, Calderone M, Fleming JJ. Paradigm shift for the surgical management of calcaneal fractures? Clin Podiatr Med Surg, 2018, 35(2): 175-182.
2. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg (Am), 2000, 82(2): 225-250.
3. Wang J, Han W, Su Y, et al. Comparison of robot-assisted percutaneous cannulated screws versus open reduction and internal fixation in calcaneal fractures. Orthop Surg, 2023, 15(3): 724-730.
4. Sanders R, Vaupel ZM, Erdogan M, et al. Operative treatment of displaced intraarticular calcaneal fractures: long-term (10-20 years) results in 108 fractures using a prognostic CT classification. J Orthop Trauma, 2014, 28(10): 551-563.
5. Eelsing R, Aronius LB, Halm JA, et al. Implant choice and outcomes of the sinus tarsi approach for displaced intra-articular calcaneal fractures. Foot Ankle Int, 2023, 44(8): 738-744.
6. Krissian S, Samargandi R, Druon J, et al. Poor prognosis for infectious complications of surgery for ankle and hindfoot fracture and dislocation. A 34-case series. Orthop Traumatol Surg Res, 2019, 105(6): 1119-1124.
7. Shuler FD, Conti SF, Gruen GS, et al. Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures: does correction of Bohler’s angle alter outcomes? Orthop Clin North Am, 2001, 32(1): 187-192.
8. Backes M, Spijkerman IJ, de Muinck-Keizer RO, et al. Determination of pathogens in postoperative wound infection after surgically reduced calcaneal fractures and implications for prophylaxis and treatment. J Foot Ankle Surg, 2018, 57(1): 100-103.
9. 黃杰, 劉瑾, 張建偉. 經皮復位微創跟骨釘中釘固定治療 SandersⅡ 型及 Ⅲ 型跟骨骨折. 中國骨傷, 2023, 36(4): 313-319.
10. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
11. Kline AJ, Anderson RB, Davis WH, et al. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int, 2013, 34(6): 773-780.
12. Hsu AR, Anderson RB, Cohen BE. Advances in surgical management of intra-articular calcaneus fractures. J Am Acad Orthop Surg, 2015, 23(7): 399-407.
13. 馬超, 王成偉, 唐國柱. 微創技術與開放手術治療SandersⅡ、Ⅲ型跟骨骨折的療效比較. 中華骨科雜志, 2020, 40(21): 1443-1452.
14. 暢寧, 徐靜磊, 徐晨陽, 等. 微創三窗切口新型解剖鎖定鋼板治療跟骨骨折的療效分析. 中華創傷骨科雜志, 2021, 23(10): 871-876.
15. Le Roux G, David G, Cronier P, et al. C-Nail^? locking nail versus conventional plate for thalamic calcaneal fractures. Orthop Traumatol Surg Res, 2023, 109(1): 103467.
16. Fascione F, Di Mauro M, Guelfi M, et al. Surgical treatment of displaced intraarticular calcaneal fractures by a minimally invasive technique using a locking nail: A preliminary study. Foot Ankle Surg, 2019, 25(5): 679-683.
17. Steinhausen E, Martin W, Lefering R, et al. C-Nail versus plate osteosynthesis in displaced intra-articular calcaneal fractures-a comparative retrospective study. J Orthop Surg Res, 2021, 16(1): 203.
18. Peng Y, Wang J, Feng B, et al. Calcaneous interlocking nail treatment for calcaneous fracture: a multiple center retrospective study. BMC Musculoskelet Disord, 2022, 23(1): 911.
19. 胡曉偉, 孫開強, 厲運收, 等. 跗骨竇撬撥復位經皮釘中釘內固定微創治療跟骨骨折. 實用手外科雜志, 2023, 37(1): 76-79.
20. Agren PH, Wretenberg P, Sayed-Noor AS. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg (Am), 2013, 95(15): 1351-1357.
21. Radnay CS, Clare MP, Sanders RW. Subtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter? Surgical technique. J Bone Joint Surg (Am), 2010, 92 Suppl 1 Pt 1: 32-43.
22. Pompach M, Carda M, Amlang M, et al. Treatment of calcaneal fractures with a locking nail (C-Nail). Oper Orthop Traumatol, 2016, 28(3): 218-230.
23. Zwipp H, Pa?a L, ?ilka L, et al. Introduction of a new locking nail for treatment of intraarticular calcaneal fractures. J Orthop Trauma, 2016, 30(3): e88-e92.

Chinese Journal of Reparative and Reconstructive Surgery

A prospective study on treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures with interlocking intramedullary nail fixation system

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