ObjectiveTo investigate the short-term effectiveness of modified tarsal sinus approach and traditional tarsal sinus approach in the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures.MethodsBetween January 2015 and August 2017, 53 patients with Sanders Ⅱ-Ⅲ type calcaneal fractures were selected and divided into observation group (21 cases, using modified tarsal sinus approach for fracture reduction after exposure of the subtalar joint below the long and short fibular tendon) and control group (32 cases, using traditional tarsal sinus approach) by random number method. There was no significant difference between the two groups in terms of gender, age, side, cause of injury, fracture type, injury to operation time, and preoperative B?hler angle, Gissane angle, visual analogue scale (VAS) core (P>0.05), which were comparable. The operation time, postoperative drainage volume, postoperative B?hler angle, Gissane angle, and postoperative angle improvement values of the two groups were recorded and compared. VAS score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and short-form 36 health survey scale (SF-36) score were used to evaluate the effectiveness.ResultsAll the 53 patients successfully completed the operation without serious complications such as vascular and nerve injury and perioperative death. There was no significant difference in operation time and postoperative drainage volume between the two groups (P>0.05). Patients in both groups were followed up 12-36 months (mean, 17 months). No infection, fracture displacement, failure of internal fixation, and malunion of fracture occurred after operation. None of the patients underwent secondary joint fusion. There was no significant difference in fracture healing time between the two groups (t=0.30, P=0.77). The postoperative B?hler angle and Gissane angle at 2 days in the two groups were significantly improved when compared with those before operation (P<0.05); however, there was no significant difference in B?hler angle, Gissane angle, and improvement value between the observation group and the control group at 2 days after operation (P>0.05). VAS scores at 24 hours and 1 year after operation were significantly improved when compared with that before operation in both groups (P<0.05). There was no significant difference in VAS scores between the two groups at 24 hours and 1 year after operation (P>0.05). There was no significant difference in AOFAS scores between the two groups at 1 year after operation (t=1.46, P=0.15). However, the SF-36 scale score at 1 year after operation was significantly higher than that of the control group (t=2.08, P=0.04). At last follow-up, 2 patients in the observation group and 8 patients in the control group presented subtalar joint stiffness or pain, and there was no significant difference in the incidence between the two groups (χ2=1.98, P=0.16).ConclusionThe modified tarsal sinus approach for the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures has the advantages of minimal invasion, clear reduction under direct vision, reliable reduction and fixation, and low incision complications.
ObjectiveTo investigate the effect and safety of subgluteal approach continous sciatic nerve block with 0.2% ropivacaine for postoperative analgesia in calcaneal fracture patients. MethodsForty calcaneal fracture patients treated from May 2012 to January 2013 were randomly assigned to two groups:20 patients in continuous sciatic nerve block group (group CSB) and 20 patients in self-controlled intravenous analgesia group (group PCIA).Patients in group CSB were given subgluteal approach continuous sciatic nerve block,and PCA pump was connected to give 0.2% ropivacaine via continuous nerve block catheter continuously for analgesia.Patients in group PCIA were given PCA pump directly for self-controlled intravenous analgesia.The movement/rest VAS scores and Ramsay scores at 2,8,24,48 hours after surgery,the dose of other analgesia drugs after surgery,the satisfaction of patients and surgeons,and side effects were recorded. ResultsThe movement and rest visual analogue scale (VSA) scores and the dose of analgesia drugs in group CSB were significantly lower than group PCIA at all time points (P<0.05).The satisfaction of patients and surgeons in group CSB was higher than group PCIA (P<0.05). ConclusionCompared with self-controlled intravenous analgesia,subgluteal approach continuous sciatic nerve block with 0.2% ropivacaine can provide better and safer postoperative analgesia for calcaneal fracture patients.
ObjectiveTo analyze the clinical outcomes of 3D-printing assisting minimally invasive fixation of calcaneal fractures. MethodsThe study included 12 patients who were diagnosed with calcaneal fractures between October 2014 and May 2015. Using a real-size 3D-printed calcaneus model, the calcaneal locking plate could be preshaped before the operation and used with a minimally invasive approach to achieve rigid plate fixation just as with the lateral approach. Complications and surgery time were recorded and functional results were evaluated using the American Orthopaedic Foot Society ankle-metapedes score (AOFAS). The reduction of fracture was evaluated using the Bohler angle and Gissane angle. ResultsThere was no relevant postoperative complications. All fractures got bone union. The mean postoperative Bohler angle was (29.4±6.1) ° and the mean postoperative Gissane angle was (121.4±12.6) °. The difference in Bohler angle and calcaneal Gissane angle before and after the surgery was significant (P ＜ 0.01) . The mean postoperative AOFAS score was 75.2±5.4, and the fine/excellent rate was 83.3%. ConclusionWe believe this novel technique can be useful for the operative treatment of displaced intra-articular calcaneal fractures.
Objective To precisely treat compl icated calcaneal fracture by 3D simulation through computer aid designed operation. Methods From November 2007 to March 2008, 38 patients of calcaneal fracture were treated. There were 29 males and 9 females aged 14-69 years old (average 29.8 years old). According to Sanders classification, there were 4 patients oftype I, 14 of type II, 12 of type III, and 8 of type IV. The time between injury and surgery was 3 hours to 5 days. The CT images of calcaneal fracture of 38 patients were put into computer for 3D reconstruction, then the Bouml;hler angles were measured and bone grafting angles were designed. According to the angle surveyed by the computer, the individual-oriented operation program was made, and then the operation was done under C-arm X-ray machine. Results The preoperative Bouml;hler angel was (34.58 ± 4.38)° in the normal side and (8.33 ± 12.62)° in the injured side, indicating there was significant difference (P lt; 0.05). During the process of the poking reduction by 3D simulation, when the bone rotating angle was (28.84 ± 6.51)°, the Bouml;hler angel was restored to (32.86 ± 1.72)°, indicating there was no significant difference when compared with the normal side before operation (P gt; 0.05), and significant difference compared with the injured side before operation (P lt; 0.05). Twenty-eight patients were followed up for 12-22 months (average 18 months). The Bouml;hler angel was restored to (32.41 ± 1.42)° 1 year after operation. According to the foot function scoring system made by American Ankle Surgery Association, 16 cases were graded as excellent, 10 as good, 1 as fair, 1 as poor, and the excellent and good rate was 92.9%. Conclusion Computer aid designed operation of compl icated calcaneal fracture by 3D simulation technique can restore the Bouml;hler angel and subtalar joint precisely. It is aneffective supplementary treatment method for calcaneal fracture.
Objective To probe into the effectiveness of vertical compression of locking plate combined with hollow screws in the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures. MethodsThe clinical data of 128 patients with Sanders type Ⅱ and Ⅲ calcaneal fractures who were admitted between March 2019 and April 2022 and met the selection criteria were retrospectively analyzed. Among them, 65 patients were treated with locking plate combined with hollow screw vertical compression (study group), and 63 patients were treated with simple locking plate (control group). There was no significant difference in baseline data between the two groups (P>0.05), such as gender, age, fracture side and Sanders classification, cause of injury, time from injury to operation. The operation time, intraoperative blood loss, hospital stay, and fracture healing time were recorded and compared between the two groups. Before operation and at 12 months after operation, the American Orthopaedic Foot and Ankle Association (AOFAS) score (including total score, pain score, functional score, and alignment score) was used to evaluate the recovery of foot function, and imaging indicators such as calcaneal width, calcaneal height, calcaneal length, B?hler angle, and Gissane angle were measured on X-ray films. ResultsAll patients were followed up 12 months after operation. There was no significant difference in operation time, intraoperative blood loss, hospital stay, and fracture healing time between the two groups (P>0.05). Poor wound healing occurred in 1 case in the study group and 2 cases in the control group. At 12 months after operation, there was no significant difference between the two groups in the pre- and post-operative difference of calcaneal length, calcaneal height, Gissane angle, and B?hler angle (P>0.05). However, the pre- and post-operative difference in calcaneal width in the study group was significantly higher than that in the control group (P<0.05). The pre- and post-operative difference of AOFAS total score in the study group was significantly higher than that in the control group (P<0.05), and further analysis showed that the pre- and post-operative difference of pain and function scores in the study group were significantly higher than those in the control group (P<0.05), while there was no significant difference in the pre- and post-operative difference of force score between the two groups (P>0.05). ConclusionCompared with simple locking plate treatment, the treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures with vertical compression of locking plate combined with hollow screws can more effectively improve the width of the subtalar calcaneal articular surface, avoid peroneal longus and brevis impingement, reduce pain, and increase the range of motion of the subtalar joint, and the effectiveness is better.
ObjectiveTo evaluate the clinical results of the self-manufactured screw director of the calcaneous sustentaculum tali in the surgical treatment of intra-articular calcaneal fractures. MethodsBetween 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. ResultsThe 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%. ConclusionThe 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.
To investigate the therapeutic effect of open reduction, bone grafting, and internal fixation with plastic ti-alloy plate on intra-articular calcaneal fracture. Methods From January 2005 to December 2007, 32 patients (37 feet) with intra-articular calcaneal fracture underwent open reduction, bone grafting of autogeneic il ium (30-80 g) and internal fixation of plastic ti-alloy plate. There were 21 males and 11 females aged 18-56 years old (average 42.1 years old). There were 5 cases of bilateral calcaneal fracture and 27 cases of unilateral calcaneal fracture, including 2 cases of open fracture and 30 cases of close fracture. According to Sanders classification system, there were 11 cases of type II, 18 cases of type III and 8 cases of type IV. Preoperatively, Bouml;hler angle was (— 9.6 ± 4.2)° and Gissane angle was (101.4 ± 10.6)°. Nine feet underwent emergency operation and 28 feet received operation 5-7 days after injury. Results The wounds of 34 feet healed by first intention. The wound margin of 3 feet was gray with a small amount of colorless exudates, and healed after dressing change. All patients were followed for 12-24 months (average 16 months). X-ray films displayed that the fracture all healed within 3-4 months after operation. At 6 months after operation, the Bouml;hler angle and the Gissane angle was (28.5 ± 6.1)° and (128.9 ± 4.8)°, respectively, indicating there were significant differences when compared with before operation (P lt; 0.05). According to Maryland foot score system, 15 cases were graded as excellent, 18 cases were good, 4 cases were poor, and the excellent and good rate was 89.19%. Conclusion Open reduction, bone grafting, and internal fixation with plastic ti-alloy plate is an effective method to treat intra-articular calcaneal fracture. Choosing right operational timing, performing subarticular surface grafting when necessary and using appropriate plastic ti-alloy plate internal fixation can minimize the incidence of postoperative compl ications
Objective To evaluate the cl inical results of arthroscopical subtalar arthrodesis for malunion of calcaneal fractures. Methods Between July 2006 and December 2008, 12 cases of malunion of calcaneal fractures were treated witharthroscopical subtalar arthrodesis, inculding 10 males and 2 females with an age range of 38-54 years (44.8 years on average). The location was left side in 5 cases and right side in 7 cases. The injury was caused by fall ing from height in 8 cases, by traffic accident in 3 cases, and other in 1 case. It was 3-7 months from injury to operation. All cases were classified as Stephens type II. The total score was 35.68 ± 10.35 and the pain score was 8.14 ± 1.83 before operation according to Hindfoot scores system of American Orthopaedic Foot amp; Ankle Society (AOFAS). Results All incisions achieved parimary heal ing and the patients were all followed up 14-32 months (18 months on average). The X-ray films showed bony fusion after 10-14 weeks (11.5 weeks on average). The total score was 76.45 ± 9.83 and the pain score was 1.52 ± 1.48 after operation according to Hindfoot scores system of AOFAS, showing significant difference when compared with those before operation (P lt; 0.01). Conclusion Arthroscopical subtalar arthrodesis can get satisfactory fusion rate with few compl ications for malunion of calcaneal fractures.
Objective To analyze the non-operation related risk factors of the wound complications by using lateral extensive L-shaped incision for open reduction and internal fixation of calcaneal fractures. Methods A retrospective analysis was made on the clinical data of 58 patients with closed calcaneal fractures (63 calcaneus) treated by using lateral intensive L-shaped incision for open reduction and internal fixation between September 2006 and August 2011. There were 52 males (56 calcaneus) and 6 females (7 calcaneus), aged 18 to 64 years (mean, 35 years). The causes of injury included fall injury in 53 cases (58 calcaneus), traffic injury in 5 cases (5 calcaneus). The mean time between injury and operation was 8 days (range, 3-22 days). According to Sanders classification, 4 calcaneus were rated as type II, 31 calcaneus as type III, and 28 calcaneus as type IV. Postoperative complications were observed and graded; 58 patients were divided into complication group (≥grade 2) and control group (lt; grade 2). The univariate analysis was used to analyze 18 factors which may lead to wound complications; multi-factor unconditioned logistic regression analysis was done for the factors showing significant difference. Results According to postoperative wound complications grading, 41 patients (46 calcaneus) were included in the control group, whose incision healed primarily, and 17 patients (17 calcaneus) in the complication group. In 17 patients of the complication group, 14 had skin necrosis or dehiscence, and 3 had superficial infection; they obtained healing after symptomatic treatment. The univariate analysis showed significant differences in combined spinal fracture, diabetes mellitus, and long-term smoking between 2 groups (P lt; 0.05). The logistic regression analysis revealed that combined spinal fracture was an independent risk factor for wound complications (95% confidence interval: 0.004-0.360, P=0.004). Conclusion Combined spinal fracture is an independent risk factor for wound complications after open reduction and internal fixation of calcaneal fracture using lateral extensive L-shaped incision.
ObjectiveTo investigate the anatomical characters of the sustentaculum tali (ST), accurate entry point and direction for the placement of ST screw from posterior subtalar joint facet to the constant fragment (CF) in calcaneal fractures.MethodsA total of 100 patients with calcaneal fractures performed ankle CT scans were enrolled between January 2016 and April 2016. According to the inclusion criteria, the clinical data of 33 patients were analyzed, including 18 males and 15 females, with a median age of 41.0 years (range, 18-60 years). There were 16 cases on left side and 17 cases on the right side. Three-dimensional (3D) calcaneal model was reconstructed by Mimics 17.0 software, and the ST anatomical references were measured, including the length of upper and lower edge, the length and height of the midline, the horizontal angle between the midline and foot plantar surface. The parameters of the optimal entry point position (P’ point) and placement angle of the ST screw were determined. The length of ST screw was also measured. The differences between males and females or left and right sides were compared.ResultsThe length of upper edge of the ST was (16.60±2.23) mm, lower edge (20.65±2.90) mm, midline (20.56±2.62) mm, and the height of midline was (9.61±1.36) mm. The horizontal angle between the midline and foot plantar surface was (23.43±3.36)°. The vertical distance from P’ point to the lowest point of the tarsal sinus was (3.09±1.65) mm, while the horizontal distance was (14.29±2.75) mm. The distance from P’ point to the apex of the lateral talus, subchondral bone of subtalar joint, calcaneocuboid joint was (11.41±3.22), (6.59±2.22), (34.58±3.75) mm, respectively. The horizontal angle between the ST screw and foot plantar surface was (–1.17±2.07)°. The anteversion angle of ST screw was (16.18±2.05)° and the length was (41.64 ± 3.09) mm. There were significant differences in the length of upper and lower edge, the length and height of the midline, the distance from P’ point to the apex of the lateral talus, subchondral bone of subtalar joint, and calcaneocuboid joint, and the anteversion angle and length of the ST screw between males and females (P<0.05). There was no significant difference in above all parameters between left and right sides (P>0.05).ConclusionAfter appropriate reduction of the calcaneal fractures, the entry point of ST screw was recommended at about 14 mm posterior and about 3 mm upper related to the foot horizontal line through the lowest tarsal sinus point; and the direction of ST screw placement was about 17° anteversion for males and 15° anteversion for females.