Clinical Outcomes of Minimally Invasive Surgery in Sanders Type IV Intra-Articular Calcaneal Fractures

PURPOSE: This study evaluated the radiologic and clinical results in patients who underwent minimal invasive surgery using sinus tarsi approach in Sanders type IV calcaneal fracture. MATERIALS AND METHODS: This retrospective study evaluated 13 cases of Sanders type IV calcaneus fractures that were treated by minimal invasive surgery using the sinus tarsi approach from July 2012 to April 2017. Further, these cases could be followed up for more than 12 months. Bone union, radiologic parameters such as Böhler's angle, Gissane's angle, calcaneal height, length, and width, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the postoperative complications were evaluated. RESULTS: Bony union was achieved in all the cases at the final follow up, and the mean union time was 5.5 months. One patient underwent reoperation for a surgical site infection, six patients had post traumatic arthritis, and two of them underwent subtalar joint fusion. The mean AOFAS ankle-hindfoot score was 81.2. At the final follow-up, the mean values of Böhler's angle and Gissane's angle were 20° and 119.8°, respectively, and the mean values of the calcaneus height, length, and width were 46.8 mm, 81.8 mm, and 45.6 mm, respectively. CONCLUSION: Minimal invasive surgery using the sinus tarsi approach for Sanders type IV calcaneal fracture resulted in satisfactory anatomic reduction and stable fixation, and satisfactory clinical and radiologic results were obtained in most of the patients. Minimal invasive surgery is thought to reduce the soft tissue-related complications as compared to surgery using the extensile lateral approach.

Clinical curative effect of the exceed-calcaneocuboid-joint plate fixation in the treatment of Sanders III/IV calcaneal fracture / 中国基层医药

Objective To investigate the clinical curative effect of the exceed -calcaneocuboid -joint plate in the treatment of Sanders Ⅲ/Ⅳ calcaneal fracture .Methods 58 cases ( 67 feet ) with Sanders Ⅲ/Ⅳ calcaneal fractures were selected .The patients were followed up for 1 year postoperation .The patients′age,fracture classification , Maryland foot score,complications,and postoperative 1 day,postoperative 1 year B?hler corner,Gissane angle,height, and length of the calcaneus were recorded .Results The preoperative B?hler corner,Gissane angle,height and length of calcaneus were (7.9 ±4.2)°,(85.2 ±6.9)°,(30.6 ±2.6) mm,(65.5 ±2.1) mm,respectively,which of postoperative 1 day were (31.8 ±4.7)°,(128.6 ±8.1)°,(43.7 ±2.3)mm,(70.3 ±2.6)mm,respectively,which of postoperative 1 year were (31.9 ±4.8)°,(128.7 ±7.7)°,(43.5 ±2.1) mm,(70.2 ±2.8) mm,respectively. Compared with preoperation ,the postoperative data were significantly improved , and the differences were statistically significant(postoperative 1 day compared with preoperation:t=7.13,3.59,4.14,6.95,postoperative 1 year compared with preoperation:t=8.76,3.92,5.02,7.17,all P<0.05).The excellent rate in exceed -calcaneocuboid -joint plate group was 91.04％.Conclusion Using exceed-calcaneocuboid-joint plate internal fixation for Sanders Ⅲ/Ⅳ calcaneal fractures , can significantly improve the prognosis of patients and better restore height and length of the calcaneus ,it is worthy of clinical application .

Treatment of Sanders' type Ⅲ intra-articular fracture of the calcaneus using a small dorsolateral incision / 中华创伤骨科杂志

Objective To investigate the operative treatment of Sanders' type Ⅲ displaced intra-articular fractures of the calcaneus using a small dorsolateral incision.Methods From October 2006 to April 2012,90 patients with displaced intra-articular calcaneal fracture of sanders' type Ⅲ were treated by open reduction and internal fixation through a small dorsolateral incision at our department.The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal.They were 69 men and 21 women,aged from 17 to 61 years (average,39 years).On the right side were 49 cases and on the left side 41 cases.According to Sander's classification,26 fractures were of type Ⅲ AB,36 of type Ⅲ AC and 28 type Ⅲ BC.The displacements of articular facet were all larger than 1 mm.The foot functions were evaluated before and after operation by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system.Results For each patient,4 to 6 calcaneal cannulated screws of 4.0 mm and 2 full threaded screws of 6.5 mm were used.No incision infection,skin necrosis or injury to the posterior tibial nerve or vessels occurred after surgery.Seventy-six patients were followed up for 10 to 56 months (average,20.5 months).Clinical union was achieved after 8 to 12 weeks (average,9.5 weeks).The lateral and axial X-ray films of the calcaneus at the last follow-up showed fine reduction and fixation of the fracture fragments and significant improvements in the length,width,height,and B(o)hler and Gissane angles of the calcaneus compared with the preoperation (P ＜ O.05).The ankle and hindfoot scored 70 to 100 AOFAS points at the last follow-up.Forty-five cases were excellent,24 good,5 fair and 2 poor (excellent to good rate of 90.8％).Follow-up observed no infection,nonunion or osteomyelitis.Conclusion Open reduction and internal fixation through a small dorsolateral incision is a good option for Sanders' type Ⅲ calcaneus fractures with a displacement of more than 1 mm,because it leads to minimal soft tissue damage,excellent exposure and convenience for later removal of internal fixators and subtalar arthrodesis.

The Result Treated by Open Reduction and Internal Fixation with Minimally Invasive Technique in Joint Depressive Calcaneal Fracture

PURPOSE: To evaluate the short term follow-up results of minimally invasive technique in the management of Sanders type II, III, and IV joint depressive calcaneal fracture. MATERIALS AND METHODS: Between May 2008 and May 2011, we studied 17 cases undergoing treatment with minimally invasive technique with modified sinus tarsi approach for Sanders II, III, and IV joint depressive intra-articular calcaneal fracture and were followed up for more than 1 year. We evaluated the treatment result by assessing the radiologic parameters (Bohler angle, Gissane angle, and calcaneal height/width/length) and clinical outcomes (American Orthopaedic Foot and Ankle Society [AOFAS] score and visual analog scale [VAS]) and investigating the complication. RESULTS: Radiological results improved from 7.9degrees to 19.8degrees in the Bohler angle after the operation. Satisfactory results were obtained in clinical assessment with average AOFAS score of 82.45 and the average VAS score of 3.94. We experienced 3 cases of complications, 1 case of superficial wound infection and radiologic findings of subtalar arthritis in 2 cases. CONCLUSION: Minimally invasive technique may be a useful alternative surgical method in the management of Sanders type II, III, and IV joint depressive calcaneal fracture that cannot adopt extensile approach, which enable to obtain good radiological and clinical results.

Observation on the effect of limited open reduction and Kirschner wire fixation in the treatment of calcaneal fractures / 中国基层医药

Objective To observe the effect of limited open reduction and Kirschner wire fixation in the treatment of calcaneal fractures.Methods Clinical data of 23 patients with calcaneal fracture treated with limited open reduction and Kirschner wire fixation were collected,and the efficacy was evaluated according to Maryland foot score.Results The B(o)hler corner and Gissane angle of 23 patients recovered well without any complications.Conclusion For the patients with Sanders Ⅱ and Ⅲ calcaneus fracture,the limited open reduction and Kirschner wire fixation has good effect.

Avulsion Fracture of Calcaneal Tubercle Treated with Cannulated Cancellous Screws and Wire: Surgical Technique

The incidence rate of calcaneal fracture consists about 2% of all fractures, and, of the fracture, calcaneal tubercle avulsion fracture is known to be rare. To treat non-displaced calcaneal tubercle avulsion fracture, conservative treatment such as cast fixation is applied. However, most cases accompany displacement of the avulsion fragment, and, usually, surgery is necessary to treat the displaced fracture. Although surgical fixation simply by cancellous screw or tension wire is widely used, fixation failure is potential complication in this method. Thus, this study wants to introduce a prospective and useful method that further strengthens the calcaneal fixation by using both cannulated screw and tension band wiring.

The Usefulness of Arthroscopy in the Operative Treatment of Intra-Articular Calcaneal Fracture / 대한족부족관절학회지

PURPOSE: We tried to evaluate the usefulness of the arthroscopy in the operative treatment of intra-articular calcaneal fracture. MATERIALS AND METHODS:Between March 2005 and May 2008, 9 patients with intra-articular calcaneal fractures (Tongue type or Sanders type IIC) were treated with arthroscopically assisted percutaneous reduction and screw fixation. American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), preoperative and postoperative Bohler's angle and the rate of complication were evaluated. RESULTS:AOFAS score at postoperative 1 year was 88.2 (range, 71-92), and mean VAS score was 2.8 (range, 1-4). Bohler angle was improved from preoperative mean 16.2 degrees to postoperative mean 29.7 degrees . There were no complications such as wound problem, infection or nerve injury. CONCLUSION: Subtalar arthroscopy provides precise view of posterior facet during the operation. Therefore, it can be a useful tool in treating intra-articular calcaneus fractures, especially tongue type and Sanders type IIC fractures.

The Result of Closed Reduction and Percutaneous Screw Fixation for Intra-articular Calcaneal Fracture of Joint Depression Type / 대한족부족관절학회지

PURPOSE: To evaluate the results of treatments by percutaneous Acutrak screw fixation for intra-articular joint depression type fracture of calcaneus. MATERIALS AND METHODS: Thirteen cases with intra-articular joint depression type fracture of calcaneus, from September 2004 to March 2006, were reviewed. There were 9 males and 4 females with 52.5 years old mean age (range: 31~74 years old). The average follow-up period was 18 months (range: 8~32 months). Steinmann pins and Freers were used for closed reduction. After closed reduction, Acutrak screws and K-wires were inserted. The patients were evaluated with Creighton-Nebraska health foundation assessment sheet for calcaneal fracture, the extent of recovery of Bohler angle, fragment size, and state of subtalar joint. RESULTS: Clinical results according to Creighton-Nebraska health foundation assessment sheet for calcaneal fracture were excellent in 6 cases (46%), good in 4 cases (30%), fair in 2 cases (15%), and poor in 1 case (7%). Average preoperative Bohler angle was 7.6degrees (range: 2degrees~13degrees). Average postoperative Bohler angle was 24.4degrees (range: 4degrees~33degrees). There were no soft tissue complications. There were one mild subtalar arthritis and one moderate subtalar arthritis. CONCLUSION: We think that closed reduction and percutaneous Acutrak screw fixation with or without K-wire is a good option for joint depression type fracture of calcaneus.

The efficacy of post-operation rehabilitation treatment of calcaneus fracture as evaluated by Footscan system / 中华物理医学与康复杂志

Objective To evaluate the effects of post-operation rehabilitation treatment of patients with calcaneus fracture by dynamic plantar pressure analysis,and assess the value of the Footscan system.Methods Sixty-two patients with unilateral calcaneus fracture were randomly divided into a rehabilitation group and a control group.The patients in the rehabilitation group were given early,systemic standard rehabilitation treatment,while those in the control group took functional exercise following the doctors'advice.At 3 months and 6 months after operation,the plantar pressure distribution of the patients in both groups was analyzed with the Footscan system,respectively.Results After 3 months of treatment.there was statistically significant difference between the injured and the uninjured sides in both groups,with regard to the contact time,average plantar pressure and pressure-time integrals at different phases of gait.However,there was no significant difference between the injured and the uninjured sides after 6 months in rehabilitation group.But in control group,there was still statistically significant difference between the two sides with regard to the above parameters.Conclusion Early rehabilitation treatment could significantly improve the function outcome of patients with calcaneus fracture.Footscan System can objectively evaluate the recovery of the calcaneous fracture.

Percutaneous Acutrak Screw Fixation of Intra-articular Tongue Type Fracture of Calcaneus / 대한족부족관절학회지

PURPOSE: To evaluate the results of treatments by percutaneous Acutrak screw fixation for intra-articular tongue type fracture of calcaneus, especially in elderly patient or patients with underlying disease including diabetes mellitus. MATERIALS AND METHODS: Seven cases with intra-articular tongue type fracture of calcaneus, from November 2003 to February 2005, were reviewed. There were 6 males and 1 female with 65 years old mean age (range: 61~71 years old). The average follow-up period was 16 months (range: 10~25 months). Two Steinmann pins were used for closed reduction. After closed reduction was done like Essex-Lopresti's method, two Acutrak screws were inserted. The third Acutrak screw was inserted at the sustentaculum tali away from sinus tarsi to fix the primary fracture line. The patients were evaluated with Salama scale, the extent of recovery of Bohler angle, state of subtalar joint. RESULTS: Clinical results according Salama scale were excellent in 5 cases, and good in 2 cases. Average preoperative Bohler angle was 13 degrees (range: 12~15 degrees). Average postoperative Bohler angle was 31o (range: 23 degrees - 40 degrees). There were no soft tissue complications. There were two mild subtalar arthritis. CONCLUSIONS: We think that percutaneous Acutrak screw fixation is a good option for tongue type fracture of calcaneus in elderly patient or patients with underlying disease including diabetes mellitus.

The Results of Treatment for Tarsal Tunnel Syndrome Associated with Calcaneus Fracture / 대한족부족관절학회지

PURPOSE: To review the results of surgical decompression for tarsal tunnel syndrome associated with calcaneus fractures. MATERIALS AND METHODS: Six tarsal tunnel syndromes in five patients were surgically decompressed at our hospital with followed up of average 26.0 months (range, 12~36 months). All patients were male and average age at surgery was 50.0 years (range, 33~69 years). All five cases developed after calcaneus fractures including one bilateral case. Clinical results were assessed according to the criteria of Pfeiffer and Cracchiolo. RESULTS: The result was good in three cases, fair in one case and poor in two cases. Four cases in four patients were satisfied with the result of treatment. CONCLUSION: Clinical results of surgical treatment for tarsal tunnel syndrome associated with calcaneus fracture of the foot or ankle was improved and maintained in four of six cases.

Medial Plantar Nerve Injury after Screw Fixation of the Calcaneus Fracture

We present a case of medial plantar nerve injury by screw tip after open reduction and internal fixation of intraarticular calcaneus fracture. We reviewed the risk and prevention technique of medial plantar nerve injury in fixing the calcaneus fracture.

Clinical study on calcaneus fracture with poking reduction and artificial bone grafting technique / 中国矫形外科杂志

[Objective]To observe the clinical treatment of calcaneus fracture with poking reduction and artificial bone grafting technique.[Method]From 1999.6 to 2005.5,60 cases with recent calcaneus fracture,including 46 feet in 38 males and 24 feet in 22 females with falling injure;aged from 20 to 65,were equally divided into two groups,including the observed group treated with poking reduction and artificial bone grafting and the control group with steel needle pry-poking reposition.[Result]During followed up for 6-60 months,average 20.7months,it was notable different in Maryland foot score,and the same in Bhler′,Gissane′ and Perie′ angle in X-ray in post-operation and pre-operative between observed group and the control.[Conclusion]It showed us that the technique of poking reduction and artificial bone grafting was liable to operate and could provide exactly efficiency.

Clinical study of Osteoset~ synthetic bone transplants and internel fixations on calcaneus fracture / 中国矫形外科杂志

[Objective]To evaluate curative effects of Osteoset~ synthetic bone transplants and internel fixations on calcaneus fracture.[Method]Twenty-three patients with calcaneus fracture,who were treated by Osteoset~ synthetic bone transplants and internel fixation,were followed up by plain X-Rays and JOA functional questionnaires.Fracture patterns were based on Sanders methods.[Result]A series of 23 patients,7 of which were sanders Ⅱ,15 were sanders Ⅲ,3 were sanders Ⅳ,were treated with ORIF and Osteoset~ implants.The preoperative Blher's angle was 4.8 degrees(standard deviation 6.6 degrees).Blher's angle increased to a mean of 26.8 degrees(SD 8.6 degrees) postoperatively.In the first 3 months after surgery,a mean decrease in the Blher's angle of 0.4 degrees(SD 2.27 degrees) occurred.One month after surgery osteoset synthetic bone transplants,which was replaced by new bone,were gradually absorbed and degraded.JOA questionnaires suggested that the whole effective rate was 92 percent.[Conclusion]Osteoset synthetic bone transplants and internel fixations has good therapeutic effects on patients with comminuted calcaneus fracture.Osteoset~ synthetic bone has the same effects as autogenous bone.

Changes of contact characteristics of the subtalar joint after calcaneus fracture / 中国矫形外科杂志

[Objective]To observe the changes of contact characteristics of the subtalar joint after calcaneus fracture in load condition, so as to provid a theoretical basis for its clinical treatment.[Method]Six fresh speciments consisting of foots and lower legs were harvested.A specimen,including an intact foot and 15~20cm of the distal tibia and fibula prepared by removing the skin,muscle and tendons down to the level of the hindfoot and the ligaments and joint capsules were kept intact with the exception of the posterior aspect of the posterior facet and the lateralaspect of middle and anterior facets of the talocalcaneal joint.The pressure sensitive film was inserted into the posterior and anterior-middle facets of the talocalcaneal articulation,and 500-N load was applied in the neutral position.After testing of the intact foot,the calcaneus was splited into anterointernal and posterolateral compoments using microoscillating saw to simulate primary fracture of calcaneus.The test was repeated after tile posterolateral fragment was anatomically reduced and displaced 2mm,5mm and 10mm respectively in a planter direction.The changes of contact characteristics of the subtalar joint ware recorded.[Result]The average pressure area of the intact posterior facet was(275.67?46.02) mm~2,the average stress to bear the weight was(1.83?0.56) MPa.The bearing average pressure area decreased to(167.67?25.09) mm~2 when the posterolateral compoment was displaced to plantar in 2 mm,it was significantly lower(P0.05).The bearing stress the anterior and middle facets significant increased only in a 1 10mm plantar displacement of the posterolateral component(P

Analysis of Complications after Treatment of Calcaneal Fracture / 대한족부족관절학회지

PURPOSE: Problematic late sequelae are common following a calcaneal fracture regardless of the initial treatment. We retrospectively evaluated the painful conditions and reviewed the results of the operative treatment in patients with previously treated calcaneal fractures. MATERIALS AND METHODS: Between October 1996 and September 2001, forty-three patients who underwent subsequent surgical treatment for late sequelae of calcaneal fracture were reviewed. The initial treatment consisted of only immobilization in a cast in 7 patients, closed reduction with pin fixation (Essex-Lopresti technique) in 22 and open reduction and internal fixation in 14. Painful conditions in the hind foot included subtalar arthritis in 31 patients, calcaneofibular impingement in 13, peroneal tendinitis in 6, displaced posterior bony fragment in 3, sural neuritis in 2, subtalar and midtarsal arthritis in 1 and displaced plantar bony fragment in 1. The surgical procedures for the late complications were performed at a mean of 19 months (range, 6 to 35 months) after the injury and consisted of lateral wall ostectomy and in situ subtalar fusion in 28 patients, only lateral wall ostectomy in 5 patients, lateral wall ostectomy and subtalar distraction arthrodesis in 3, removal of displaced posterior bony fragment in 3, sural nerve transposition in the peroneus brevis in 2, triple arthrodesis in 1 and removal of displaced plantar bony fragment in 1. Mean postoperative follow up period was 57 months (range, 33 to 82 months). The results of treatment were evaluated on the basis of pain, improvement in the ability to perform activities of daily living, to return to work or to a pre-injury level of activity. RESULTS: Pain was partially relieved in 38 patients (88%), but not relieved in 5. Function improved in 34 patients (79%), and 32 (74%) returned to work or to a pre-injury level of activity. There was a trend that the longer the interval between the injury and the operation, the longer the subsequent interval until the patient returned to full activities or work. CONCLUSION: Meticulous physical examination and intensive prompt treatment for remaining pain after initial treatment of calcaneal fractures are recommended for patient's satisfaction and returning to work.

Non operative and simple operative managements of calcaneal fractures / 中华创伤骨科杂志

Objective To evaluate non operative and simple operative managements of the calcaneal fractures. Methods 97 patients with calcaneal fractures were treated by non operative management or percutaneous reduction with wires or screw fixation from April 1997 to December 2001 in our department. They were followed up for more than 2 years. 64 patients were treated with non operation, 27 were fixed with wires and 6 with screws. Results 23 patients had excellent results, 67 good, 5 fair and 2 poor. The total good and excellent rate was 92.7%. 2 patients experienced secondary arthrodesis 1 year after injury. Conclusion Although the calcaneal fractures can be treated satisfactorily with non operative management or percutaneous reduction with wires or screws fixation, further prospective and comparative studies should be done in clinic to determine whether the calcaneal fractures should be treated with open reduction and fixation or with simple operative management.