RESUMO
Objective:To investigate the efficacy of treatment of Sanders Ⅱ & Ⅲ calcaneal fractures with an absorbable stick plus Kirschner wire through the tarsal sinus incision.Methods:From July 2017 to May 2020, 37 patients with 42 Sanders Ⅱ & Ⅲ calcaneal fractures were treated with an absorbable stick plus Kirschner wire through the tarsal sinus incision at The Third Ward of Department of Traumatic Orthopeadics, The Sixth Hospital of Ningbo. There were 25 males and 12 females, with an age of (48.2±5.6) years (from 20 to 69 years). The fractures were at the left side in 12 cases, at the right side in 20 and at bilateral sides in 5. By Sanders classification, 20 fractures were type Ⅱ and 22 ones type Ⅲ. Fracture union time and complications were recorded. Their B?hler and Gissane angles were compared between preoperation, postoperation and the last follow-up. The range of motion of the subtalar joint was evaluated by the Morrey method at 6 months postoperation. The functional recovery was evaluated by the American Society of Foot and Ankle Surgery (AOFAS) ankle-hindfoot score at 12 months postoperation.Results:The 37 patients were followed up for (15.2±2.7) months (from 13 to 18 months). There were no such complications as incision skin necrosis, Kirschner wire deformation, loss of fracture reduction or Kirschner wire infection. The anatomical morphology of the calcaneus was restored satisfactorily in the 37 patients. At preoperation, postoperation and the last follow-up, the B?hler angles were 13.3°±1.6°, 32.5°±5.5° and 32.7°±5.4° and the Gissane angles 78.3°±6.7°, 127.2°±6.7° and 128.0°±6.4°, respectively, showing significant differences between the preoperative and postoperative values ( P<0.05) but no significant differences between postoperation and the last follow-up ( P>0.05). The range of motion of the subtalar joint at 6 months postoperation was slightly limited in 25 cases and moderately limited in 12 cases, giving a rate of moderate and above limitation of 32.4% (12/37). By the AOFAS ankle-hindfoot score at 12 months postoperation, 12 cases were excellent, 21 ones good and 4 ones fair, giving a good to excellent rate of 89.2% (33/37). Conclusion:Treatment with an absorbable stick plus Kirschner wire through the tarsal sinus incision may lead to fine clinical efficacy for Sanders Ⅱ & Ⅲ calcaneal fractures.
RESUMO
Objective To clarify the relationship between the basivertebral foramen (BF) and the retropulsed bone fragment (RBF) in thoracolumbar burst fracture (TLBF) and further explain the mechanism of RBF formation.Methods From June 2013 to June 2016,Sixty-two patients suffering from TLBF with RBF were collected.The characteristics of RBF as well as the parameters of vertebral body were studied using CT reconstruction imaging.In the transverse images,the lengths of RBF (RL) and vertebral body (VL) were measured.In median sagittal images,the heights and widths of RBF (RH,RW) and vertebral body (VH,VW) were also obtained.The ratios of different parameters of RBF and vertebral body (RL/VL,RW/VW,RH/VH) were calculated,and then defined the location relationship of RBF and BF.Eight frozen cadaveric spine were selected and evaluated by Micro-CT scans.Each vertebral body was divided into three layers (Superior,Middle,Inferior).Each layer was further divided into 9 regions (R1-R9),named as SR1-SR9,MR1-MR9,IR1-IR9.Microarchitecture parameters of each region in each layer,including bone volume fraction (BV/TV),bone mineral density (BMD),trabecular connectivity (Corn.D),and trabecular number (Tb.N) and thickness (Tb.Th) were calculated,and their differences were also analyzed to see if the trabecular bone distribution would be affected by BF.In vitro study,burst fractures were simulated on cadaveric spines by using bursting fracture simulator,aiming to observe the RBF morphology and imaging findings to future investigate the relationship between RBF and BF.Results The length and height of RBF were close to half of vertebral body length and height (RL/VL:0.497±0.059,RH/VH:0.485±0.036).The width of RBF was usually one-third of vertebral body width (RW/VW:0.319±0.025),which indicated that the fracture block was often located in the posterior of vertebral body above the BF.BV/TV,Tb.N in the MR2 and MR5 regions were lowest than other regions and the SMI of MR2 and MR5 was largest than others.SR5 was the lowest region in superior lawyer that was corresponded to regions most affected by burst fracture.In simulated burst fractures,the fracture line of RBF went across the vertex or upper surface of the BF and the lower boundaries of RBF were also the upper bound of the BF.Moreover,the damage sites of posterior longitudinal ligament were mainly located at the edge of the BF.Conclusion At the bone defect region,the BF is the weakest area in the vertebral body which may affect the distribution of trabecular bone surrounding it.When subjected to vertical violence,these regions undergo fracture first which impact the anterior and lower boundaries of RBF.Ultimately,RBF was produced upon the BF,involving all or part of the upper bound of the BF.
RESUMO
Objective To clarify the relationship between the basivertebral foramen (BF) and the retropulsed bone fragment (RBF) in thoracolumbar burst fracture (TLBF) and further explain the mechanism of RBF formation.Methods From June 2013 to June 2016,Sixty-two patients suffering from TLBF with RBF were collected.The characteristics of RBF as well as the parameters of vertebral body were studied using CT reconstruction imaging.In the transverse images,the lengths of RBF (RL) and vertebral body (VL) were measured.In median sagittal images,the heights and widths of RBF (RH,RW) and vertebral body (VH,VW) were also obtained.The ratios of different parameters of RBF and vertebral body (RL/VL,RW/VW,RH/VH) were calculated,and then defined the location relationship of RBF and BF.Eight frozen cadaveric spine were selected and evaluated by Micro-CT scans.Each vertebral body was divided into three layers (Superior,Middle,Inferior).Each layer was further divided into 9 regions (R1-R9),named as SR1-SR9,MR1-MR9,IR1-IR9.Microarchitecture parameters of each region in each layer,including bone volume fraction (BV/TV),bone mineral density (BMD),trabecular connectivity (Corn.D),and trabecular number (Tb.N) and thickness (Tb.Th) were calculated,and their differences were also analyzed to see if the trabecular bone distribution would be affected by BF.In vitro study,burst fractures were simulated on cadaveric spines by using bursting fracture simulator,aiming to observe the RBF morphology and imaging findings to future investigate the relationship between RBF and BF.Results The length and height of RBF were close to half of vertebral body length and height (RL/VL:0.497±0.059,RH/VH:0.485±0.036).The width of RBF was usually one-third of vertebral body width (RW/VW:0.319±0.025),which indicated that the fracture block was often located in the posterior of vertebral body above the BF.BV/TV,Tb.N in the MR2 and MR5 regions were lowest than other regions and the SMI of MR2 and MR5 was largest than others.SR5 was the lowest region in superior lawyer that was corresponded to regions most affected by burst fracture.In simulated burst fractures,the fracture line of RBF went across the vertex or upper surface of the BF and the lower boundaries of RBF were also the upper bound of the BF.Moreover,the damage sites of posterior longitudinal ligament were mainly located at the edge of the BF.Conclusion At the bone defect region,the BF is the weakest area in the vertebral body which may affect the distribution of trabecular bone surrounding it.When subjected to vertical violence,these regions undergo fracture first which impact the anterior and lower boundaries of RBF.Ultimately,RBF was produced upon the BF,involving all or part of the upper bound of the BF.