Arthroscopic surgery plus one or more posterior small incisions for calcaneal fractures / 中华创伤骨科杂志

Objective To compare the effects of arthroscopic surgery plus one or more posterior small incisions and the sinus tarsi approach in the treatment of calcaneal fracture.Methods A retrospective analysis was conducted of the 85 patients with calcaneal fracture who had been treated from January 2017 to June 2017 at Department of Foot & Ankle Surgery,Guangzhou Orthopaedic Hospital.They were 43 men and 42 women,32 to 58 years of age (average,46.0 years).Arthroscopic surgery plus one or more posterior small incisions was performed in 40 of them while the sinus tarsi approach was used in the other 45 cases.The 2 groups were compared in terms of operation time,fracture healing time,incision complications and functions of the affected foot by the American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot scores.Results There were no significant differences in the preoperative general data between the 2 groups,showing they were comparable (P ＞ 0.05).The average follow-up period for all the patients was 8 months (from 6 to 12 months).For the arthroscopic surgery group and sinus tarsi approach group,the fracture healing time was 8.6 ± 2.4 weeks and 8.9 ± 1.8 weeks,and the AOFAS ankle-hindfoot scores were 82.5 ± 5.6 and 85.1 ± 4.0,respectively,showing no significant differences between them (P ＞ O.05).The operation time in the arthroscopic surgery group (43.6 ±5.4 min) was significantly less than in the sinus tarsi approach group (56.5 ±6.4 minutes),and the rate of complications in the former[2.5％ (1/40)] significantly lower than in the latter[15.6％ (7/45)] (P ＜0.05).Conclusion Arthroscopic surgery plus one or more posterior small incisions may be a fine treatment for calcaneal fractures because postoperative incision complications can be reduced.

A prospective randomized trial comparing high negative pressure and conventional drainage for postoperative blood loss and wound healing in calcaneal fractures / 中华创伤骨科杂志

Objective To compare the effects of high negative pressure drainage and conventional drainage on postoperative blood loss and wound healing in patients with calcaneal fracture. Methods A prospective randomized controlled single-blinded trial was conducted on the 66 patients with closed calcaneal facture who had been treated from June 2012 to March 2016 in our hospital. They were randomized by coin into 2 groups: 36 patients (aged from 21 to 65 years with a mean age of 38.1 years) were treated with a high vacuum drainage system while the other 30 (aged from 19 to 66 years with a mean age of 37.5 years) with a conventional silicone tube and a drainage vessel. The 2 groups were treated by the same team of surgeons and the same surgical procedures. The 2 groups were compared in terms of postoperative drainage volume, hemoglobin (HGB), bleeding volume, wound healing time, incision complications and wound infection. Results The high negative pressure group incurred significantly greater drainage volume (516.7 ± 138.8 mL) and bleeding volume (612.9 ± 179.5 mL) than the conventional drainage group (305.8 ± 95.4 mL and 437.8 ± 102.0 mL) (P <0.05). The former incurred significantly less HGB (116.8 ± 6.9 g/L) and wound healing time (15.2 ± 3.1 d) than the latter (124.1 ± 7.8 g/L and 18.5 ± 4.2 d) (P <0.05). The rate of incision complications for the high negative pressure group (5.6%, 2/36) was significantly lower than that for the conventional drainage group (26.7%, 8/30) (χ2=4.150, P=0.042). There was no significant difference between the 2 groups in the rate of wound infection (0 versus 3.3%) (P=0.927). Conclusion After surgery for calcaneal fractures, high negative pressure drainage may lead to faster wound healing and fewer postoperative wound complications but greater blood loss and lower HGB than conventional drainage.

Symptomatic tarsometatarsal osteoarthritis after open reduction and screwing of Lisfranc injuries / 中华创伤骨科杂志

Objective To explore the outcomes of open reduction and internal fixation ( ORIF ) with transarticular screws for Lisfranc injuries and the postoperative incidence of symptomatic tarsometatarsal os-teoarthritis ( OA ) . Methods This retrospective study involved 28 patients who had been treated surgically at our institution between January 2009 and January 2015 for Lisfranc injuries. They were 18 males and 10 females, with an average age of 36. 1 years ( from 19 to 54 years ) . According to the Quenu-Kuss classifica-tion, 5 patients had type-A injury, 10 type-B injury ( 4 cases of type-B1 and 6 ones of type-B2 ) , and 13 type-C injury ( 8 cases of type-C1 and 5 ones of type-C2 ) . The patients underwent ORIF with screws for the 1st to the 3rd tarsometatarsal joints and ORIF with Kirschner wires for the 4th to the 5th tarsometatarsal joints within 2 weeks. After the Kirschner wires were removed 8 to 10 weeks postoperatively, progressive weight-bearing began. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society ( AOFAS ) midfoot scores and visual analog scale ( VAS ) at final follow-ups. Results The mean duration of follow-up was 29. 9 months ( from 26 to 72 months ) . AOFAS scores revealed one excellent case, 22 good ones and 5 poor ones with an excellent to good rate of 82. 1％. The mean VAS score was 2. 8. Radiographic evidence of OA was noted in 20 patients ( 71. 4％, 20/28 ) , in 18 of whom ( 90. 0％) symp-tomatic OA was observed. There was no significant difference ( P=0. 399 ) in the incidence of symptomatic OA either between the patients with anatomic reduction ( 60. 9％, 14/23 ) and those without anatomical re-duction ( 80. 0％, 4/5 ) . Conclusions ORIF with transarticular screws can lead to good therapeutic outcomes for Lisfranc injuries. The incidence of symptomatic OA may not be related to the injury type or re-duction quality.

Comparison of sinus tarsi and lateral L-shaped approaches in medial wall reduction and calcaneal alignment in treatment of calcaneal fractures / 中华创伤骨科杂志

Objective To compare the minimally invasive sinus tarsi approach and lateral intensive L-shaped approach in the therapeutic effects concerning medial wall reduction and calcaneal alignment for cal-caneal fractures. Methods A retrospective analysis was conducted of the 52 patients with calcaneal fracture who had been treated at Department of Foot & Ankle Surgery, Guangzhou Orthopaedic Hospital from January 2010 to December 2014. They were 39 men and 13 women, 28 to 46 years of age ( average, 40.4 years ). Of them, 26 were treated via the sinus tarsi approach ( minimally invasive group ) and the other 26 via the con-ventional lateral extensile L-shaped approach ( conventional group ) . X-ray axial films of the calcaneus were taken pre-operatively and post-operatively to evaluate the medial wall reduction and calcaneal alignment. The American Orthopedic Foot Ankle Society ( AOFAS ) ankle-hindfoot scale was adopted to assess the therapeutic effects. Results The average follow-up period for this cohort was 18 months ( from 12 to 24 months). The post-operative varus angle was 7.41°± 5.17°for the minimally invasive group and 8.01°± 5.33°for the con-ventional group; the correction of varus angle was 6.60°± 6.23°for the minimally invasive group and 8.57°± 6.64°for the conventional group; the good to excellent rate of medial wall reduction was 42.3% ( 11/26 ) for the minimally invasive group and 53.8% ( 14/26 ) for the conventional group; the AOFAS score was 89.5 ± 7.0 for the minimally invasive group and 86.2 ± 8.2 for the conventional group. There were no statistically signifi-cant differences between the 2 groups in all the above comparisons ( P ＞ 0.05 ). Conclusion The mini-mally invasive sinus tarsi approach can be a fine choice for treatment of calcaneal fractures, because it leads to no differences in medial wall reduction, postoperative varus angle and postoperative correction of varus angle, compared with the conventional lateral extensile L-shaped approach.

Treatment of Displaced Intra-articular Calcaneal Fractures by Minimally Invasive Retractor Reduction and Fixation Through Sinus Tarsi Approach Together with External Application of Chinese Medicine / 广州中医药大学学报

Objective To evaluate the therapeutic effect of minimally invasive retractor reduction and fixation through sinus tarsi approach together with external application of Chinese medicine for displaced intra-articular calcaneal fractures. Methods From October of 2009 to June of 2013, 52 patients with displaced intra-articular calcaneal fractures (Sanders type Ⅱ, Ⅲ) were enrolled into the study. The patients received minimally invasive retractor reduction through sinus tarsi approach and fixation with small plate and cannulated screws, and after the operation were given external washing with Chinese herbal formula Shenxing Fang ( mainly composed of Herba Lycopodii, Herba Speranskiae Tuberculatae, Rhizoma Sparganii, Rhizoma Curcumae, Herba Asari, Radix Aconiti Preparata, Radix Aconiti Kusnezoffii Preparat). Follow-up was carried out for the evaluation of the therapeutic effect of displaced intra-articular calcaneal fractures ( Sanders type Ⅱ, Ⅲ). Results Forty cases (involving 44 feet) received the postoperative follow-up for 12-18 months (average being 14.2 months). The Maryland foot scores were 95 points for type Ⅱ displaced intra-articular calcaneal fractures, and 86 points for type Ⅲ fractures. Satisfactory results were achieved in the height, width and length of the calcaneus as well as the B?hler's and Gissane angle ( P<0.01). Conclusion Minimally invasive retracter reduction and fixation through sinus tarsi approach together with external application of Chinese medicine exert satisfying effect for the treatment of displaced intra-articular calcaneal fractures.