Objective To evaluate the effectiveness of three-dimensional (3-D) printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation. Methods A retrospective analysis was performed of the 19 patients (19 feet) with intraarticular calcaneal fracture who had been treated between March 2015 and May 2016. There were 13 males and 6 females with an average age of 38.2 years (range, 24-73 years). There were 3 open fractures and 16 closed fractures. By Sanders classification, 12 cases were type Ⅱ, 7 cases were type Ⅲ. By Essex-Lopresti classification, 13 cases were tongue type, 6 cases were joint-depression type. The time from injury to surgery was 1-10 days (mean, 4.7 days). A thin slice CT scan was taken of bilateral calcaneus in patients. By using the mirror imaging technique, the contralateral mirror image and the affected side calcaneus model were printed according to 1∶1 ratio. The displacement of fracture block was observed and contrasted, and the poking reduction was simulated. Calcaneal fracture was treated by percutaneous minimally invasive poking reduction and cannulate screw fixation. The Böhler angle and Gissane angle at immediate after operation and last follow-up was measured on X-ray films, and compared with preoperative measurement. The functional recovery was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) scores. Results The operation time was 25-70 minutes (mean, 45 minutes). The intraoperative blood loss was 10-40 mL (mean, 14.5 mL). All the incisions healed by first intention and had no relevant postoperative complications such as skin necrosis, nail tract infection, and osteomyelitis. All the patients were followed up 12-25 months (mean, 14.6 months). All patients obtained fracture healing, and the fracture healing time was 8-14 weeks (mean, 10.3 weeks). No screw withdrawal or breakage occurred during follow-up; only 1 patient with Sanders type Ⅱ fracture, whose calcaneus height was partially lost at 6 weeks after operation, the other patients had no reduction loss and fracture displacement, and no traumatic arthritis occurred. The Böhler angle and Gissane angle at immediate after operation and last follow-up were significantly improved when compared with preoperative ones (P<0.05), but there was no significant difference between at immediate after operation and last follow-up (P>0.05). The AOFAS score was 76-100 (mean, 88.2), and the results were excellent in 10 feet, good in 7, and fair in 2, the excellent and good rate was 89.5%. Conclusion 3-D printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation can reduce the surgical trauma, improve the quality of reduction and fixation, and make the operation more safe, accurate, and individualized.
ObjectiveTo investigate the effectiveness of minimally invasive plate and medial supporting cannulated screw fixation via tarsal sinus approach in treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures. Methods A clinical data of 46 patients with Sanders type Ⅱand Ⅲ calcaneal fractures met the selective criteria between March 2016 and March 2021 was retrospectively analyzed. The factures were fixed with minimally invasive plate and medial supporting cannulated screws via tarsal sinus approach in 20 cases (group A) and with minimally invasive plate in 26 cases (group B). There was no significant difference between groups in term of the gender, age, injury causes, fracture type and side, the time from injury to operation, and preoperative calcaneal length and width, Böhler angle, Gissane angle, and visual analogue scale (VAS) score (P>0.05). The operation time, intraoperative blood loss, hospital stay, and the interval between operation and full weight-bearing were recorded. The pain improvement of patients was evaluated by VAS scores before operation and at 48 hours after operation. The ankle joint function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score at 3 and 12 months after operation. Besides, the calcaneal length and width, Böhler angle, and Gissane angle were measured by X-ray films before and after operation. Furthermore, the difference (loss value) between 3, 12 months and 1 day after operation was calculated. Moreover, the fracture healing and healing time was observed. ResultsAll operations of two groups were successfully completed. The incisions healed by first intention, and no vascular/nerve injury or incision infection occurred. The operation time of group A was significantly longer than that of group B (P<0.05). There was no significant difference in the intraoperative blood loss, hospital stay, and the interval between operation and full weight-bearing (P>0.05). All patients were followed up 12-36 months (mean, 14.8 months). The VAS scores at 48 hours after operation were significantly lower than those before operation in the two groups (P<0.05); there was no significant difference in the difference of pre- and post-operative VAS score between groups (P>0.05). The AOFAS scores at 12 months after operation were significantly higher than those at 3 months after operation in the two groups (P<0.05); and there was no significant difference between groups at 3 and 12 months (P>0.05). X-ray films showed that the fractures of the two groups healed and there was no significant difference in healing time (P>0.05). There was no significant difference in calcaneal length and width and Gissane angle between groups at each time point (P>0.05), but there was significant difference in Böhler angle between groups at 12 months (P<0.05). The imaging indexes of the two groups significantly improved at each time point after operation when compared with those before operation (P<0.05). There was no significant difference between different time points after operation (P>0.05) in the imaging indexes of group A. There were significant differences in the calcaneal length, calcaneal width, and Gissane angle of group B between 12 months and 1 day, 3 months after operation (P<0.05), and there was no significant difference between 1 day and 3 months after operation (P>0.05). The differences in Böhler angle of group B between different time points after operation were significant (P<0.05). There was no significant difference between groups in the loss of all imaging indexes at 3 months after operation (P>0.05). The losses of calcaneal width, Böhler angle, and Gissane angle in group A at 12 months after operation were significantly smaller than those in group B (P<0.05), and there was no significant difference in the loss of calcaneus length between groups (P>0.05). ConclusionCompared with only minimally invasive plate fixation, the combination of minimally invasive plate and medial supporting cannulated screw fixation via tarsal sinus approach for Sanders type Ⅱ and Ⅲ calcaneal fractures has the advantages of less trauma, less incision complications, reliable fracture reduction and fixation, and good long-term stability.
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 evaluate the effect of triple arthrodesison treating complications of calcaneus fractures. Methods From 1990to 2001, 12 patients with the complications of calcaneus fractures underwent the triple arthrodesis(subtalar,talaronavicular and calcaneocuboid joints). Ollier incision was applied to all patients. Peroneal tenolysis was required in 2 patients and a decompression and transposition of tibialnerve in 1 patient.Of the 12 patients, 7 were males and 5 were females. Their ages ranged from 29 to 64 years. Complications, like pain and deformity, occurred 5 to 22 months after the operation(18 months on average).Preoperative score, fibulocalcaneal distance, Bohler angle, differenceof talardeclination angle and height of hind foot were 40.00±5.22, 0.41±0.03 cm, 12.00±3.40°, 17.00±3.32° and 4.12±0.35 cm respectively. Results All patients were followed up from 3 to 13 years with an average of 7 years. Postoperative score, tibulocalcaneal distance, B[AKo¨]hler angle, difference of talar declination angle and height of hind foot were 75.00±6.46，0.73±0.02 cm， 31.00±5.61°，9.00±3.15° and 6.75±0.62 cm respectively. There were significant differences in these indexes(P＜0.05). Conclusion To evaluate the complications of calcaneus fractures and to adopt proper operative procedures are necessary. To restore theheight of hind foot and the anatomical relationship between hind foot and calcaneus is the key factor to success.
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, Böhler 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 Böhler 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.
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.