Postoperative 3D computed tomographic evaluation of 92 calcaneal fracture reduction using the sinus tarsi technique and fixation with 3.5 mm cortical screws.

BACKGROUND: Fixation of calcaneus through the sinus tarsi approach is increasingly popular due to the lower rate of wound complications. The use of postoperative CT provided a better evaluation tool than using plain radiography. Our objective of the present study is to evaluate the quality of fracture reductions by postoperative 3D CT scans after surgical intervention using the sinus tarsi approach and fixation with 3.5 cortical screws. METHODS: Between January 2018 and April 2020, 86 consecutive patients with 92 closed displaced intra-articular calcaneal fractures underwent ORIF with 3.5 mm screws constructed via a minimally invasive sinus tarsi approach by a single foot and ankle surgeon. RESULTS: The preoperative radiographic assessment found 36 joint depression type and 56 tongue type fractures according to the Essex-Lopresti classification. Preoperative CT assessment found 82 type II and 10 type III according to the Sander classification. Analysis of pre- and postoperative CT parameters showed that the height of the posterior facet, the length of the posterior facet, Gissane, and Bohler's angle were significantly improved. In addition, the means of posterior facet step-off in postoperative CT was 1.07, and 72% of posterior facet reductions were < 2 mm step-offs. CONCLUSION: With postoperative CT scan assessment, the treatment of displaced intra-articular calcaneal fracture with 3.5 mm screws via sinus tarsi approach has achieved good quality of reduction. Therefore, the screws-only technique is an option for treating calcaneal fracture with less soft tissue damage and implant cost.

Outcomes of Early Weight Bearing in Displaced Intra-articular Calcaneus Fractures Treated with Screws-Only Fixation Technique.

Background: Displaced intraarticular calcaneus fracture indicates surgical treatment. The current trend is open reduction and internal fixation with a plate or multiple screws through the sinus tarsi approach. Most postoperative protocols are prolonged non-weight bearing that causes a high socioeconomic burden. This study aims to determine the safety of the early weight-bearing protocol of screws-only fixation in calcaneal fracture. Materials and Methods: Evaluate displaced intraarticular calcaneus fractures treated with screws-only technique via the sinus tarsi approach in our institution. The first group, from July 2017 to December 2018, allowed patients to start partial weight bearing as tolerated at 4 weeks after surgery. The second group prospectively from January 2019 to March 2020, which assign patients to keep non-weight bearing for 8 weeks. The functional outcomes (Thai Foot and ankle ability measure subjective form, FAAM) were measured 6 months after surgery. The radiographic outcome (Bohler's angle and Gissane angle) was measured on the first day postoperative and 6 months follow-up, and the changes in these angles were recorded. Results: There were 28 patients in each group. The outcomes were collected and compared by a T-test. In the early weight-bearing group, The FAAM, Bohler's angle loss, and Gissane's angle change were 76.4 ± 14.8, 2.4 ± 3.5, and 6.6 ± 7.8, respectively. In the delayed weight-bearing group, The FAAM, Bohler's angle loss, and Gissane's angle change were 81 ± 14.8, 2 ± 1.8 and 2.6 ± 6.1, respectively. There was no statistically significant difference in FAAM score, Bohler's angle loss, and Gissane's angle change between early and delayed weight-bearing groups. Conclusion: Screws fixation in calcaneal fracture may be safe to allow early weight-bearing protocol.

Reliability of Registration in Imageless Navigation Total Hip Arthroplasty in Semilateral Decubitus Position.

Background: One of the limitations in imageless navigation is the variability in bony landmark registration among surgeons. If the bony landmark registration is different among surgeons, the final cup position determined by the navigation will also be different. Objective: To determine intra and inter-observer reliability of the bony landmark registration in three surgeons with varying experience in imageless navigation total hip arthroplasty (THA) in semilateral decubitus position. Material and Method: The authors reviewed 60 cases receiving cementless THA with imageless navigation between June 2014 and April 2015. All cases were registered for anterior pelvic plane (APP) by three surgeons. The first surgeon (S1-YS) is senior staff with experience in imageless navigation, the second surgeon (S2-JS) is junior staff with one year of experience in imageless navigation (with more than 50 cases), and the third surgeon (S3-AC) is a fourth-year orthopedic resident with no experience in imageless navigation. Using the final cup position of the experienced surgeon as the gold standard to determine the reliability of registration. Results: There were no significant differences in cup abduction angle between (S1) and (S2) (p = 0.27) and (S1) and (S3) (p = 0.79). There was no significant difference in cup anteversion angle between (S1) and (S2) (p = 0.1) but there was significant difference between (S1) and (S3) (p<0.001). For the intra-observer reliability, the ICCs of abduction angle was 0.95 for (S2) and 0.86 for (S3) and the ICCs of anteversion angle was 0.91 for (S2) and 0.86 for (S3). For the inter-observer reliability, the ICCs of abduction angle between (S1) and (S2) was 0.89 and between (S1) and (S3) was 0.87, the ICCs of anteversion angle between (S1) and (S2) was 0.8 and between (S1) and (S3) was 0.72. Conclusion: The reliability of registration was acceptable in abduction angle among surgeons. The reliability of registration was not acceptable only in anteversion angle between experienced (S1) and non-experienced surgeons (S3). For the surgeon with one year of experience in imageless navigation, the result of registration process was comparable to and reproducible with the experienced surgeon in both abduction and anteversion angles.