Abstract
The development of minimally invasive procedures and implant materials has improved the fixation strength of implants and is less traumatic in surgery. The purpose of this study was to propose a novel “double-point fixation” for calcaneal fractures and compare its biomechanical stability with the traditional “three-point fixation.” A three-dimensional finite element foot model with a Sanders type IIIAB calcaneal fracture was developed based on clinical images comprising bones, plantar fascia, ligaments, and encapsulated soft tissue. Double-point and three-point fixation resembled the surgical procedure with a volar distal radius plate and calcaneal locking plate, respectively. The stress distribution, fracture displacement, and change of the Böhler angle and Gissane’s angle were estimated by a walking simulation using the model, and the predictions between the double-point and three-point fixation were compared at heel-strike, midstance, and push-off instants. Double-point fixation demonstrated lower bone stress (103.3 vs. 199.4 MPa), but higher implant stress (1,084.0 vs. 577.9 MPa). The model displacement of double-point fixation was higher than that of three-point fixation (3.68 vs. 2.53 mm). The displacement of the posterior joint facet (0.127 vs. 0.150 mm) and the changes of the Böhler angle (0.9° vs. 1.4°) and Gissane’s angle (0.7° vs. 0.9°) in double-point fixation were comparably lower. Double-point fixation by volar distal radius plates demonstrated sufficient and favorable fixation stability and a lower risk of postoperative stress fracture, which may potentially serve as a new fixation modality for the treatment of displaced intra-articular calcaneal fractures.
Highlights
Displaced intra-articular calcaneal fractures (DIACFs) are highly disabling injuries usually caused by high-energy trauma and represent treatment challenges to orthopedic surgeons (Dhillon and Prabhakar, 2017)
Given that the deviations in the validation metrics between the finite element (FE) prediction and measurement were less than 5%, we believed that the FE analysis demonstrated good agreement with the physical measurement and was considered adequately reliable (Wong et al, 2021)
The fracture lines of DIACF often occur anterior to the posterior joint facet and run through the middle of the calcaneal tuberosity that continues with the upper longitudinal lines and anterior transverse lines (Ni et al, 2021)
Summary
Displaced intra-articular calcaneal fractures (DIACFs) are highly disabling injuries usually caused by high-energy trauma (e.g., fall from height) and represent treatment challenges to orthopedic surgeons (Dhillon and Prabhakar, 2017). Recovery after treatment is often prolonged, with poorer functional results compared with other orthopedic conditions (van Tetering and Buckley, 2004). Conservative interventions were once recommended and demonstrated to provide comparable outcomes with operative treatments (Ibrahim et al, 2007). Several studies have shown that nonoperative interventions often lead to delays in the reconstruction of deformed fractures, leaving patients with painful, stiff feet and permanent disability (Bruce and Sutherland, 2013). Since the mid-1990s, surgical treatment using open reduction and internal fixation (ORIF) was advocated and became the standard treatment for DIACFs, producing anatomical reduction and satisfactory functional outcomes (Sanders, 2000)
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