Bohler's Angle Research Articles

THE RELEVANCE OF BONE GRAFTS AND THE RELATIONSHIP OF BOHLER'S ANGLE IN INTRA-ARTICULAR CALCANEAL FRACTURES' PROGNOSIS

Background: The most frequently broken tarsal bone is the calcaneum. Even if the rehabilitation process can take a while and the treatment is challenging, the results are still very unexpected. As a result, calcaneal fractures place a significant socioeconomic strain on society. As a result, we looked for a factor, such as Bohler's angle, that we might link to the functional result of patients with intra-articular calcaneal fractures. Method: A calcaneum intra-articular fracture was present in 40 individuals. X-rays and CT scans were used to assess each patient before to surgery. With the use of a goniometer, Bohler's angle was manually determined on the lateral radiograph, and a record was created for future use. All patients were treated using open reductions and intermaxillary fixation with a plate, accompanied by or without bone transplant, according to a randomization process. Following surgery, Bohler's angle was assessed at follow-up visits at 2, 4, and 6 weeks as well as 2, 4, and 6 months. The American Orthopedic Foot and Ankle Score (AOFAS) was used to evaluate the patient's functional recovery at least 5 months following the injury. Results: Our analysis of 40 calcaneal fractures demonstrates that there was a statistically significant distinction in the functional outcomes of patients according to the surgically corrected Bohler's angle. Less comorbidities and statistically significant better outcomes were seen in surgical calcaneus fractures when Bohler's angle was restored within normal bounds. The benefit of autologous bone transplant in restoring calcaneal elevation and anatomic minimization was also proven by our research. Conclusion: We recommend using Bohler's angle as a key to achieving outstanding results in displaced calcaneal fractures as well as the use of autologous bone graft in attaining and maintaining normal Bohler's angle in light of the great results gained with Bohler's angle rehabilitation.

Prelom petne kosti - Sanders tip III fiksiran angularnom pločom - prikaz slučaja

Introduction. The calcaneus is a tarsal bone which plays a major role in transferring weight from the lower leg down through the ankle joint onto the forefoot and toes. It participates in the formation of the outer and inner longitudinal arch of the foot and has a significant role in walking and transferring body weight. Calcaneal fractures most often occur by jumping, falling from a height, or less often, in traffic accidents. Calcaneal fractures can be extra-articular and intra-articular. Intra-articular fractures can entirely damage joint surfaces, which results in deformity and immobility of the foot. They can be extra-articular and intraarticular, when disruption of the entire articular surfaces, deformity, and weakness of the foot occur. Case report. This case report presents a 40-year-old male with an intra-articular calcaneal fracture. He was injured by falling from a height of 3 meters and sustained an intra-articular fracture type IIIAB where one fracture line went laterally and the other centrally over the posterior calcaneal facet. Surgery was performed on the sixth day after the injury. The prepared locking plate for calcaneus was adapted and fixed with spongy screws in relatively preserved joint fragments: sustentaculum tali, tuberositas lateralis calcanei and tuber calcanei. In this way, we ensured the position of the repaired fragments, and then we placed 4 more spongy screws inside the healthy bone tissue, which was enabled with the use of this plate. With this procedure, the calcaneal axis, i.e. the varus deformity, height, width, length and angles of the bone (Bohler's and Gissane's angle) were corrected. From day one, the patient started to move his toes, and on the third day the patient started to move the ankle and began to walk with the help of props with no support on the leg. Conclusion. The preoperative value of Bohler's angle is a significant correlation between the severity of the injury and displacement of fragments in intra-articular calcaneal fractures. The goal of the surgery was to restore the posterior calcaneal articular facet, avoid soft tissue infection and form a normal shape and position of a foot.

Screws Only Primary Subtalar Arthrodesis for Calcaneus Fractures

Category:Hindfoot; TraumaIntroduction/Purpose:The initial management of displaced intraarticular calcaneus fractures (DIACFs) is a difficult problem. The results of open reduction internal fixation (ORIF) have been disappointing. Alternatively, ORIF with primary subtalar arthrodesis (PSTA) has gained increasing popularity. The purpose of this study is to review patient-centered and radiographic outcomes of ORIF plus PSTA using screws alone through a sinus tarsi approach.Methods:A retrospective study of all patients from 2013-2019 who underwent ORIF+PSTA for DIACFs was conducted. The same surgical technique was utilized in all cases consisting of only screws, no plates were utilized. Delayed surgeries past 8 weeks were excluded. Demographic and radiographic data was collected. Worker's compensation (WC) claims were noted and analyzed separately. Plain radiographs were assessed preoperatively and post-operatively and Sander's classification was used to characterize injuries. Patient reported outcomes (PROs), complications, and need for revision surgeries was also noted and analyzed at final follow-up.Results:In total, forty-eight DIACFs underwent PSTA with a median follow-up of 194 days. Median time to weight-bearing was 60 days post-operatively. Three fractures were documented as Sanders II, 22 as Sanders III, and 23 as Sanders IV. Seventy-five percent of the WC group returned to work compared to just 58.3% in the non-WC group (p=0.0003). Patients in the WC group were more likely to have had an abnormal pre-operative Bohler's angle (p=0.047) but the two groups did not differ significantly in postoperative Gissane or Bohler angles. Nearly 85% (N=41) achieved >=2 zones of fusion on radiographs by final follow up and 95.8% (N=46) had at least one. Four patients had a complication and 3 required a return to the operative room.Conclusion:Utilizing Screws only primary subtalar arthrodesis for the treatment of DIACFs through a sinus tarsi approach shows promising results with high rates of return to work and fusion, even in the workers' compensation population.

Outcome of Operative Treatment of Intraarticular Fractures of Calcaneum

Backgroud: Calcaneum is the most commonly fractured tarsal bone. Approximately 75% are intra-articular fractures. Controversy continues regarding the management of calcaneal fractures. Earlier conservative management was preferred and surgical management considered inappropriate for these fractures. This trend is gradually changing with better understanding of disabling nature of injuries in combination with improved implant and routine use of intra-operative imaging. Closed treatment with cast invariably leads to long-term complications. However, still clinical evidence supporting operative treatment is limited and complications are frequently documented. Objectives: To evaluate the functional outcome of intraarticular fractures of calcaneum in terms of American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analogue Scale (VAS) score. Methods: This study was a retrospective analytic study. The study was conducted in the Department of Orthopaedics, B.P. Koirala Institute of Health Sciences, Nepal. Data collection and analysis of patients operated from July 2017 to June 2019 was done. Twenty six cases that fulfilled inclusion criteria were analysed. Results: Average age of the patients was 32 years. Sanders type 2B was the most common fracture pattern. There was significant improvement in Bohler angle (25.1°), calcaneal height (4.3cm) and width (3.9cm). Average AOFAS score and VAS score at final follow up were 81.4 and 7.9 respectively. Conclusion: Open reduction and internal fixation with plate is associated with good clinical and functional outcome in Sander type II and III fractures. With good surgical techniques, improved implant and proper use of fluoroscopy, proper restoration of Bohler angle, calcaneal height and width can be achieved.

Low Risk of Wound Complications With Sinus Tarsi Approach for Treatment of Calcaneus Fractures

BackgroundOperative management displaced intra-articular calcaneus fractures is commonly associated with wound complications. Open reduction internal fixation is traditionally performed through the extensile lateral approach has relatively high rates of wound complications. The sinus tarsi approach to displaced intra-articular calcaneus fractures is a less invasive approach to achieve fracture reduction and fixation as well as reduce wound healing complications. The purpose of this study is to report the rates of wound complications associated with the sinus tarsi approach in the treatment of displaced intra-articular calcaneus fractures. MethodsWe retrospectively identified patients treated with a limited sinus tarsi approach for displaced intra-articular calcaneus fractures from January 2009 to December 2018. Demographic and radiographic data were collected including age, gender, mechanism of injury, occupation, presence of diabetes mellitus, smoking status, Sanders classification, Bohler and Gissane angles. Postoperatively, we recorded the presence of complications, return-to-work time, and radiographic measurements. ResultsOne hundred and five fractures were identified in 100 patients who underwent open reduction internal fixation for displaced intra-articular calcaneus fractures. Using the Sanders computed tomographic classification, we identified 32% Type 2, 48% Type 3, 18% Type 4, and 2% tongue-type variants. For the preoperative Bohler's angle, 38% of fractures displayed a negative angle, 50% had an angle 0° to 20°, and 12% over 20°. Postoperatively, all patients demonstrated an improvement in Bohler's angle with 13% with 0° to 20° and 87% over 20°. Approximately, 72% of patients working prior to the injury had returned to work by 6 months, and 89% by 12 months. The wound complication rate was 11.9% (12/105), with 1.9% (2/105) requiring additional procedures. There was no significant difference in wound complication rates in smokers versus nonsmokers (11.9% vs 12.2%, p = .55). ConclusionOperative management of displaced intra-articular calcaneus fractures through the sinus tarsi approach allows restoration of calcaneal height with a low rate of wound complications, even among active smokers.

The Association of Bohler's Angle With Postoperative Pain and Gender for Displaced Intra-Articular Calcaneal Fracture, Multicenter Retrospective Study—TRON Study

A relationship between Böhler angle (BA) before or after surgery and clinical outcomes remains unclear. This retrospective multicenter cohort study aimed to compare pain and functional outcomes between a group in which the reduction angle was preserved and a group in which the reduction angle was lost during follow-up, and to clarify the risk factors leading to loss of last follow-up BA. From 2014 to 2018, 271 cases of calcaneal fractures were surgically treated at ten facilities. We divided patients into Group L (lost reduction of fracture) and Group P (preserved reduction of fracture). We matched subjects between the 2 groups according to age, sex and BA before surgery and compared American Orthopedic Foot and Ankle Society (AOFAS) score between the groups. We investigated the correlation between the amount of BA loss and postoperative pain. The factors leading to loss of last follow-up BA were examined by logistic regression analysis. Ultimately, 112 patients were eligible. After matching, each group included 38 patients. There was no difference between the 2 groups in total AOFAS score. However, the pain component of AOFAS score at 6 months and 12 months were worse in group L than in group P (p = .011, p = .031, respectively). We also showed a weak correlation between the amount of BA loss and postoperative pain. Logistic regression analysis revealed that female and BA before surgery independently predicted loss of reduction (odds ratios: 4.66, 95% CI: 1.15-18.9 and odds ratios: 0.90, 95% CI: 0.82-0.99, respectively). We clarified that reduction and preservation of BA within its normal range should lead to decrease postoperative pain. Female and lower pre-BA were risk factors leading to loss of reduction of BA in operative treatment of calcaneal fractures.

Clinical results of the Keck and Kelly Wedge Osteotomy approach in Haglund's deformity: Minimum 3-year follow-up

Background and purposeThe Haglund’s deformity, which may be difficult to treat non-surgically, is caused by a prominent bone hump in the posterosuperior region of the calcaneus and may be associated with bursitis and foot pain. Many surgical treatments for resistant Haglund deformities have been described. Here, we evaluate the AOFAS scores, pain and other characteristics of patients undergoing removal of the dorsally based wedge from the posterior calcaneus with the Keck and Kelly procedure. Materials and methodsThe study included 20 patients who had undergone the Keck and Kelly procedure at our center, from 2011 to 2019, and had attended follow-up for at least three years. Analyses were performed retrospectively. Preoperative (immediately before surgery) and postoperative (at last assessment) American Orthopedic Foot and Ankle Society (AOFAS) and visual analog pain scale scores (VAS) were determined, and calcaneal inclination angles were radiologically measured. Additionally, calcaneal pitch angle (CPA), Fowler and Philip angle (FPA), and Bohler angle were recorded. ResultsFourteen patients were female, and six were male, mean age was 45.8 ± 8.1 years. AOFAS scores were significantly increased, whereas VAS scores were significantly decreased after surgery. Postoperative AOFAS scores were correlated with preoperative VAS, CPA, and FPA values. Preoperative VAS scores were correlated with CPA, FPA, and Bohler angle values. FPA and CPA values were correlated positively. ConclusionsIt was found that ankle functions improved, and pain levels decreased after Keck and Kelly Wedge Osteotomy was applied for the treatment of Haglund’s deformity. CPA and FPA were associated with both pain levels and ankle function. The Keck and Kelly Wedge Osteotomy procedure appears to be a preferable approach for the surgical treatment of Haglund’s deformity.

Comparative study on curative effect of minimally invasive locking plate for the treatment of intra-articular calcaneal fractures via sinus tarsi approach

To compare clinical efficacy of minimally invasive locking plate and anatomic locking plate in treating intra-articular calcaneal fractures via sinus tarsi approach. A retrospective analysis was conducted of 48 patients with intra-articular calcaneal fractures treated with surgery via sinus tarsi approach from July 2016 to June 2017. According to differernt methods of internal fixation, the patients were divided into minimally invasive locking plate group and anatomic locking plate group. In minimally invasive locking plate group, there were 14 males and 10 females, aged from 27 to 46 years old with an average age of (38.70±5.58) years old, 18 patients were typeⅡand 6 patients were type Ⅲ according to Sanders classification. In anatomic locking plate group, there were 17 males and 7 females, aged from 26 to 46 years old with an average age of (37.10±6.44) years old, 16 patients were typeⅡ and 8 patients were type Ⅲ according to Sanders classification. Operative time, visual analogue scale (VAS), postoperative complications between two groups were compared, and Böhler angle, Gissane angal, calcaneal width and height were recorded and compared between two groups at 1 week after operation and final follow up. The functional effect was assessed according to Maryland foot function score at final follow up. All patients were followed up for (14.10±1.94) months (ranged 12 to 18 months). All patients were obtained bone union from 8 to 16 weeks with an average of (10.60±2.25) weeks. Operation time, VAS score and complication rate in minimally invasive locking plate group were (69.50±7.51) min, (2.80±1.07) and 2 cases respectively, and (77.50±7.15) min, (3.80±1.09) and 8 cases in anatomic locking plate group respectively, there were statistical difference between two groups (P<0.05). However, there were no statistically differences in Maryland foot function score, Böhler angle, Gissane angle, calcaneal width and height at 1 week after opertaion and final follow-up between two groups (P>0.05). Compare with anatomic locking plate, minimally invasive locking plate via sinus tarsi approach for Sanders typeⅡ and Ⅲ intra-articular calcaneal fractures could obtain similar reliable fixation and functional recovery with more simple operation, shorter operative time, lighter postoperative pain and less complications.

Case control study on the application of artificial bone and autogenous bone in internal fixation of complex calcaneal fracture with special-shaped plate

To compare clinical effects of artificial bone and autogenous bone in internal fixation of complex calcaneal fracture with profitated plate. From April 2015 to April 2019, 60 patients with complex calcaneal fractures were treated with open reduction and heteromorphic plate internal fixation, and were divided into experiment group and control group by implant bone substitutes, and 30 patients in each group. In experiment group, there were 21 males and 9 females aged from 18 to 71 years old with an average of (36.85±7.42) years old;19 patients were classified to type Ⅲ and 11 patients were type Ⅳ according to Sanders classification;implanted with artificial bone. While in control group, there were 23 males and 7 females aged from 20 to69 years old with an average of (37.26±7.38) years old;18 patients were classified to type Ⅲ and 12 patients were type Ⅳ according to Sanders classification; implanted with autogenous bone. Operation time, intraoperative blood loss, drying time of incision, fracture healing time and complications were compared between two groups, changes of preoperative and postoperative Böhler angle and Gissane angle were also compared, and Maryland scoring was applied to evaluate recovery of affected foot. Both of two groups were followed up from 3 to 15 months with an average of (10.15±2.67) months. Operation time and intraoperative blood loss in experiment group were (89.32±12.43) min, (101.64±5.13) ml, respectively;while in control group were (112.45±13.82) min, (119.01±5.26) ml, respectively;and there were statistical difference between two groups (P<0.05). There were no differences in drying time of incision, fracture healing time and complications between two groups(P>0.05). Preoperative and postoperative Böhler angle at 3 months in experiment group were (14.19± 2.47)°, (34.52±4.41)°;while in control group were (14.08±2.35)°, (33.67±4.36)°;preoperative and postoperative Gissane angel at 3 months in experiment group were (90.16±6.43)°, (131.45±9.83)°;while in control group were (90.11±6.37)°, (130.87±9.24)°;there were statistical significance in Böhler angle and Gissane angel compared with 3 months after operation and before operation between two groups (P<0.05);while no difference at 3 months after operation between two groups (P> 0.05). There were no statistical meaning in Maryland items, total score and good rate between two groups at the final following up (P>0.05). Artificial bone and autogenous bone in internal fixation of complex calcaneal fracture with irregular plate have similar function in promoting fracture healing, drying time of incision, fracture healing time and complications, while artificial bone has better effects in reducing intraoperative blood loss, shorten operation time.

Case control study on anatomical locking plate and ordinary steel plate for the treatment of closed calcaneal fracture with SandersⅡand Ⅲ

To compare clinical efficacy between anatomical locking plate (ALP) and ordinary steel plate (OSP) in treating closed calcaneal fractures with SandersⅡ and Ⅲ. From May 2016 to May 2018, 68 patients with closed Sanders typeⅡ and Ⅲ calcaneal fractures were retrospectively analyzed, and were divided into anatomical locking plate group (ALP group) and ordinary steel plate group (OSP group) according to two kinds of plate fixation, and 34 patients in each group. In ALP group, there were 21 males and 13 females aged from 20 to 63 years old with average of (35.16±8.45) years old; 14 patients were typeⅡand 20 patients were type Ⅲaccording to Sanders classification;treated with ALP. In OSP group, there were 20 males and 14 females aged from 19 to 63 years old with average of (35.05±8.39) years old;19 patients were typeⅡand 15 patients were type Ⅲ according to Sanders classification;treated with OSP. Operative time, intraoperative blood loss and complications between two groups were observed and compared;preoperative and postoperative Böhler angle and gissane angle were also compared;American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hind foot scores, foot and ankle disability index (FADI) scores were applied to evaluate clinical effect. All patients were followed up from 11 to 14 months with an average of (12.06±0.81) months. There were no statistical differences in opertive time, intraoperative blood loss, incision infection and refracture rate in complications between two groups (P>0.05);while there was significant difference in the number of screw loosening (P<0.05). Böhler angle and Gissane angle in ALP group at 6 and 12 months after opertaion were higher than that of OSP group (P<0.05), and the degree of improvement of Böhler angle and Gissane angle in ALP group were also higher than that of OSP group (P<0.05). Postopertaive AOFAS score and FADI score at 6 and 12 months in ALP group were higher than that of OSP group (P<0.05), while no statistical difference in AOFAS grading between two groups(P>0.05). Compared with OSP, ALP in treating SandersⅡ and Ⅲ calcaneal fractures could achieve better therapeutic effect, avoid screw loosening, reduce complications, and improve limb function in further.

A COMPARATIVE STUDY OF OPERATIVE AND CONSERVATIVE TREATMENT OF INTRAARTICULAR DISPLACED CALCANEAL FRACTURES.

The methods of treatment of displaced intra-articular calcaneal fractures have always been surrounded by controversies, whether operative treatment is better or conservative. We conducted a prospective study to compare operative and non-operative treatment for intra-articular displaced calcaneal fractures. Patients were assigned to two groups based on the treatment given (operative and nonoperative) and were regularly followed for a period of 1 year. The outcome measures were assessed by Modied Rowe's Score (MRS), Visual Analogue e Scale (VAS) and The American Orthopaedic Foot and Ankle Society (AOFAS) scale. The outcome related to patient's job was noted after one year and compared with pre-injury status. 30 patients with 41 calcaneal fractures were studied. Thirty of them were operated and 21were treated conservatively. Out of 20 operated cases, Bohler's angle was restored in 15 cases and these had good results with all three outcome scores at 1 year follow up and remaining 5 cases showed fair results (Mean MRS: 74.783, VAS: 3.348, AOFAS: 78.783). 21 cases treated with cast also showed fair results (Mean MRS: 57.368, VAS: 4.944, AOFAS: 71.211). The overall outcome of operated cases were better than non-operated cases (unpaired T test MRS: 5.807 p&lt;0.001, VAS: 4.387 p&lt;0.001, AOFAS: 2.728 p=0.008) . Operative treatment of displaced intra-articular calcaneal fractures gave good results at one year follow up, provided Bohler's angle was restored to normal range. Non operative treatment gave fair results. Complications were seen both with operative and non-operative tr

Does Sectioning and Then Repairing of the Calcaneofibular Ligament at Subtalar Approach Lead to Residual Lateral Ankle Instability?

The calcaneofibular ligament is cut to increase vision in surgical field in minimally invasive surgery of displaced intraarticular calcaneus fractures with subtalar incision. We aimed to investigate whether this causes talar tilt instability in ankle stress radiographs due to the calcaneofibular ligament deficiency in postoperative period. The files of 38 patients who were operated with the diagnosis of displaced calcaneus fracture between 2013 and 2018 were examined retrospectively. All the cases underwent with subtalar approach and the calcaneofibular ligament was repaired after the operation. The age, sex, injury mechanism, follow-up length, type of fracture by the Sanders classification, preoperative and postoperative Bohler's and Gissane's angle measurements, talar tilt measurements of intact and fractured side, postoperative calcaneal length, calcaneal height and calcaneal width of the cases were recorded. The obtained data were evaluated statistically. 31 (81.6%) of the cases were men, seven (18.4%) were women. The average age was 31.92±7.95 years. The average follow-up time was 15.82±3.33 months. The preoperative Bohler's angle was 14.16±3.67 degree, while the postoperative Bohler's angle was 31.53±4.60 degree (P<0.05). The average talar tilt was 0.96±0.87 degrees on the intact side and 1.19±1.12 degrees on the fractured side (P:0.001). Although the talar tilt values were statistically higher on the fractured side than the intact side, no radiological instability finding was found in any case. The average postoperative Gissane's angles were 126.45±6.69 degrees. The calcaneal length (P:0.665), calcaneal width (P:0.212) and calcaneal height (P:0.341) were statistically similar between the postoperative fractured foot and intact foot. Sectioning of the calcaneofibular ligament in the surgical treatment with subtalar approach does not cause lateral ankle instability in stress radiographs but may cause laxity. Possible postoperative lateral ankle injuries can be prevented by ankle proprioception exercises.

Malunited calcaneal fracture: the role and technique of osteotomy-a systematic review.

The research is aimed to introduce various corrective osteotomies utilized in treating calcaneal malunions in published papers, to further analyze the results, and to summarize recommended indications. The relevant research screening was conducted on the following search engines: the Cochrane Library, Web of Science, PubMed, Embase, Medline, and Academic Search Premier. Key words input included "calcaneal/calcaneus", "malunion," and "malunited fracture(s)" with Boolean operators "AND" and "OR." The inclusion criteria were researches containing surgical procedures treating calcaneal malunion with corrective osteotomy and published in the English language. For included research article, such information was extracted and analyzed: the type of calcaneal malunion, the time from initial injury to corrective surgery, the method of osteotomy, outcomes of each osteotomy (score systems, Bohler angle, talocalcaneal height and width of calcaneus, etc.), the function of the affected limb, post-operative complications, and patients' satisfaction. For included review, descriptive, commentary, or indicative sentences about corrective osteotomy were highlighted, analyzed, and summarized. Ten research articles (170 patients with 184 feet) and ninereviews were included in this review, presenting seventypes of corrective osteotomies (lateral wall exostectomy, Dwyer osteotomy, lateral wedge opening osteotomy, Romash osteotomy, tongue osteotomy, sagittal resection osteotomy, and modified Dwyer osteotomy). A different corrective osteotomy with/without arthrodesis is recommended to be utilized based on the classification of the malunion and the condition of the cartilage in treating malunited calcaneal fractures. With adequate postoperative care and rehabilitation, the results of treatment could be associated with patients' satisfaction and good function.

Calcaneal fractures: 3D-printing model to assist spatial weaving of percutaneous screws versus conventional open fixation-a retrospective cohort study.

This study compared the clinical effectiveness and wound complications of a three-dimensional model-assisted spatial weaving screw fixation (3D-SWSF) versus open reduction and internal fixation (ORIF) via an L-shaped extensile lateral approach for calcaneal fractures. This single-centre retrospective cohort study was conducted with two cohort groups in which patients with Sanders II and III calcaneal fractures underwent 3D-SWSF or conventional ORIF. The clinical outcome measures included operation duration, time to operation, wound complications, blood loss volume, hospital stays, American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and visual analog scale (VAS) score. The pre-operative, post-operative, and one-yearfollow-up Gissane's angle (GA), Böhler's angle (BA), height, and width and length of the calcaneal fractures were also compared between the two groups. From Oct 2015 to Oct 2019, 31 patients received 3D-SWSF and 41 received conventional ORIF. A total of 11 (26.8%) patients in ORIF group had wound complications, compared with only two (6.5%) in 3D-SWSF group (p = 0.032). Operative time, blood loss, and hospital stay in 3D-SWSF group were lesser than those in ORIF group. The patients treated with 3D-SWSF had better AOFAS and VAS scores than those treated with ORIF at the last follow-up. The post-operative and one-year follow-up radiographic indexes as well as the GA, BA, length, width, and height of the calcaneal fractures were relatively comparable between the two groups. Our study revealed that 3D-SWSF could effectively decrease the risk of wound complications, shorten operation time, reduce length of hospitalization, and improve post-operative rehabilitation.

Acute Fixation of Displaced Intra-articular Calcaneus Fractures Is Safe Using the Sinus Tarsi Approach.

To analyze the correlation between surgical timing and outcomes for calcaneus fractures treated using a sinus tarsi approach (STA). Single Level-1 trauma center. Retrospective. Seventy consecutive intra-articular calcaneus fractures (OTA/AO 82C; Sanders II-IV) treated operatively using STA with a minimum of 1-year follow-up. Open management using STA. Surgery timing, wound complications, American Orthopaedic Foot and Ankle Society ankle and hindfoot and Patient-reported Outcomes Measurement System scores. Patients were primarily men (68.6%) averaging 46 years (range, 18-77 years). Nineteen (27%) were obese, 27 (38.6%) were smokers, and 3 (4.3%) were diabetic, and 10 (14.3%) had open fractures. Sanders III fracture patterns were most common (45.7%). Mean time to surgery was 4.9 days (range, 0-23 days). Three patients (4.2%) developed postoperative infections requiring surgical debridement and antibiotics. Forty patients (57%) underwent operative repair within 72 hours of injury, 9 (22.5%) of which had open fractures. Of this group, only one patient developed wound necrosis. Restoration of Bohler angle and angle of Gissane and reductions in calcaneal varus angle and heel width were achieved (all P < 0.001). No differences in Ankle Society ankle and hindfoot or Patient-reported Outcomes Measurement System scores were noted between patients treated within or beyond 72 hours from injury. Intra-articular calcaneus fractures can be treated acutely within 72 hours of injury using STA with minimal wound complications and without compromising short-term functional outcome. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Efficacy of calcium phosphate cementing in the surgical treatment of Sanders Type II and III calcaneal fractures using screw fixation with sinus tarsi approach.

This study aimed to determine the effectiveness of calcium phosphate cementing in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach. In this retrospective study, 85 feet of 84 patients (74 males, 10 females; mean age 43 [17-61] years) in whom screw fixation was performed using the sinus tarsi approach for Sanders type II or III calcaneal fractures were included. The mean follow-up was 28 (14-39) months. Patients were categorized into 2 groups on the basis of whether calcium phosphate cement (CPC) was used. Group 1 had 37 patients with CPC (38 calcaneal fractures) and group 2 had 47 patients without CPC (47 calcaneal fractures). In the clinical assessment, the American Orthopedic Foot Ankle Society (AOFAS) hind foot score and the Maryland Foot Score (MFS) were used at the final follow-up. In the radiological assessment, Bohler's angle on plain radiograph and posterior facet step-off on computed tomography were measured pre-and postoperatively. At the final follow-up, the mean Bohler's angle was 26.2° (20°-33°) in group 1 and 26° (17°-30°) in group 2 (P = 0.85). The mean posterior facet step-off was 1.6 (0-5) mm in group 1 and 1.5 (0-5) mm in group 2 (P = 0.85). The mean AOFAS score was 83.8 (59-100) in group 1 and 85.8 (60-100) in group 2 (P = 0.5). The mean MFS was 86.3 (66-100) in group 1 and 87.7 (66-100) in group 2 (P = 0.62). Evidence from this study have shown that CPC may have no significant effect on clinical and radiological outcomes in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach.

Automatic analysis system of calcaneus radiograph: Rotation-invariant landmark detection for calcaneal angle measurement, fracture identification and fracture region segmentation

Background and objectiveCalcaneus is the largest tarsal bone to withstand the daily stresses of weight-bearing. The calcaneal fracture is the most common type in the tarsal bone fractures. After a fracture is suspected, plain radiographs should be taken first. Bohler's Angle (BA) and Critical Angle of Gissane (CAG), measured by four anatomic landmarks in lateral foot radiograph, can guide fracture diagnosis and facilitate operative recovery of the fractured calcaneus. This study aims to develop an analysis system that can automatically locate four anatomic landmarks, measure BA and CAG for fracture assessment, identify fractured calcaneus, and segment fractured regions. MethodsFor landmark detection, we proposed a coarse-to-fine Rotation-Invariant Regression-Voting (RIRV) landmark detection method based on regressive Multi-Layer Perceptron (MLP) and Scale Invariant Feature Transform (SIFT) patch descriptor, which solves the problem of fickle rotation of calcaneus. By implementing a novel normalization approach, the RIRV method is explicitly rotation-invariance comparing with traditional regressive methods. For fracture identification and segmentation, a convolution neural network (CNN) based on U-Net with auxiliary classification head (U-Net-CH) is designed. The input ROIs of the CNN are normalized by detected landmarks to uniform view, orientation, and scale. The advantage of this approach is the multi-task learning that combines classification and segmentation. ResultsOur system can accurately measure BA and CAG with a mean angle error of 3.8○ and 6.2○ respectively. For fracture identification and fracture region segmentation, our system presents good performance with an F1-score of 96.55%, recall of 94.99%, and segmentation IoU-score of 0.586. ConclusionA powerful calcaneal radiograph analysis system including anatomical angles measurement, fracture identification, and fracture segmentation can be built. The proposed analysis system can aid orthopedists to improve the efficiency and accuracy of calcaneus fracture diagnosis.

Treatment of Calcaneal Fracture by Calcaneal Plate

Background: Calcaneal fractures are not uncommon, accounting for 2% and 60.0% of all adult and tarsal fractures, respectively. Its treatment is still controversial. Aim of the work: To assess results and complications of calcaneal fractures treatment by fixation with calcaneal plate on clinical and radiological basis. Patients and Methods: A convenient sample of 20 patients, with calcaneal fractures and treated by calcaneal plate fixation were included. They were assessed in preoperative period in a systematic manner. Then, treated with a locking plate. Postoperatively, immediate X-rays, examination of the neurovascular status had been done. Anti-edematous, pain therapy, intravenous antibiotics and anticoagulation medication were administered. All patients had been followed up at 8, 16 weeks after operation and assessed for functional and anatomical state. RESULTS: According to the American Orthopedic Foot Ankle Society [AOFAS] Ankle-Hindfoot Score, the outcome was excellent [30.0%], good [40.0%], fair [20.0%] and poor [10.0%]. At the last follow‑up, Bohler’s angle was restored to normal [20°-40°] in 17 feet [85 %] while 3 feet [15 %] was less than normal. Wound infection was seen in [10%], each of varus heel deformity and flexion deformity of big toe was found in one patient [5.0%] and two case had reflex sympathetic dystrophy.Finally, there was no association between fracture type and subtalar arthritis. However, patients with subtalar arthritis had significantly lower AOFAS score when compared to patients with no subtalar arthritis [76.22±6.24 vs 87.0±6.05 respectively, p < 0.001]. Conclusion: Displaced calcaneal fractures treated surgically are associated with a relatively better functional outcome, provided that, Bohler's angle was restored to its normal or near normal values.

Comparison of the modified sinus tarsi approach versus the extensile lateral approach for displaced intra-articular calcaneal fractures.

BackgroundThis study sought to assess and compare the clinical efficacy and complications of a modified sinus tarsi approach (MSTA) and the extensile lateral approach (ELA) in the treatment of displaced intra-articular calcaneal fractures.MethodsThis retrospective study enrolled 108 patients (117 feet) with Sanders II–IV calcaneal fractures, including 52 patients (56 feet) in the MSTA group and 56 patients (61 feet) in the ELA group. The functional and radiological results of the affected feet were analysed retrospectively. Functional evaluation included American Orthopaedic Foot and Ankle Society (AOFAS), visual analog scale (VAS), and Short Form-36 Health Survey (SF-36). Radiological evaluation included preoperative and postoperative changes in the Bohler Angle, Gissane Angle, length, width, and height of the calcaneus. The postoperative complications were also collected and analysed. The independent-samples t-test and analysis of variance (ANOVA) were employed to compare differences between the two groups. Differences within the same group were compared by paired Student’s t-test, and categorical variables were compared using the chi-square test.ResultsThe postoperative functional and radiological results showed that the mean AOFAS, VAS and physical component summary of SF-36 scores in the MSTA group were higher than those in the ELA group (P<0.05). After surgery, the Bohler and Gissane angles were significantly improved in both groups, as were the length, width, and height of the calcaneus; no statistically significant differences existed between the two groups. The incidences of wound healing complications and postoperative sural nerve injury were lower in the MSTA group than in the ELA group (P<0.000).ConclusionsThe MSTA can achieve similar effects to the ELA in terms of anatomical reconstruction and functional recovery. It also can also effectively reduce the incidences of wound healing complications and postoperative sural nerve injury, and shorten the length of hospital stay.

MANAGEMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES WIILIZAROV RING FIXATIO

Objective: Calcaneal fractures are caused by a high velocity force to the heel, mostly in road trafc accidents or fall from height. Debate continues regarding the best management of calcaneal fractures. We aim at evaluating the radiological and functional outcomes of displaced intra-articular calcaneal fractures treated with Ilizarov ring xation. Methods: intra-articular calcaneal Eighteen consecutive patients with fractures [Sanders type II (10), Sanders type III(6), and Sanders type IV (2)] were treated with the Ilizarov ring xator from Sep 2017 to June 2020. Patients were evaluated in terms of associated injuries and x-rays of anteroposterior, lateral and axial views of the calcaneus. CT scan was done to assess the amount of comminution and articular depression. Patients were followed up clinically and radiologically at least for 1 year. Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society (AOFAS) scale. Radiological assessment was done by Bohler's angle and Gissane's angle along with measurement of calcaneal height and width. Results: At average follow-up of 18.5 months, average AOFAS score was 80.5 (range 71 to 90), with 6.25% having excellent, 75% having good, 12.5% having fair and 6.25%having poor results. All patients had stable ankle joint with all having dorsiexion and plantar exion more than 30°. All patients are able to wear their previous size shoes. The mean Bohler's angle, mean Gissane's angle, calcaneal height and width were 21.5°, 126.3°, 4.36 cm and 3.80cm respectively at nal follow-up. Four patients had supercial pin tract infection. One patient had collapse of posterior facet after removal of xator with peroneal tendinitis. All fractures united and none needed secondary bone grafting. Patients returned to work on an average of 5.5 months. Conclusion: Ilizarov external ring xation gives good functional outcomes, manifested by restoring near normal anatomic reconstruction of morphology and alignment of the calcaneus. The added advantages of these procedures are the considerably shortened operating time and hospital stay, no need of highly equipped operation theatres and the reduced risk of complications related to surgical exposure.