Displaced Intra-articular Calcaneal Fractures Research Articles

The Lateral Sinus Tarsi Approach in Fixation of Displaced Intra-Articular Calcaneal Fracture. A Systematic Review & Meta Analysis

Abstract Background Minimally invasive reduction and fixation techniques via a sinus tarsi approach (STA) have been developed in an attempt to avoid the potential complications associated with an extensile lateral approach (ELA) and to be less invasive. Objective Minimally invasive approach including sinus tarsi approach (STA) in displaced intra articular calcaneal fracture displaced intra-articular calcaneal fractures (DIACF) with reference to: Change from baseline in calcaneal height, change from baseline in calcaneal width, change from baseline in calcaneal length, change from baseline in Bohler angle, change from baseline in Gissane angle. Methodology This meta-analysis was carried out in accordance with the Cochrane Handbook of Systematic Reviews of Intervention and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to answer the question of minimal invasive of lateral sinus tarsi in displaced intra articular calcaneal fracture. The study protocol was registered into the International Prospective Register of Systematic Reviews on September 09, 2020 with a registration number (PROSPERO: CRD42022359197). Results Running our search strategy on PubMed 69 studies, and the Cochrane library resulting in 221 studies and trials. We discarded 12 studies after screening the title and Abstract. Then we screened 18 studies to assess their eligibility for inclusion; and in last 10 years. The total sample size for this meta-analysis was 12 participants. 484 patients who completed STA surgery and 514 patients completed ELA surgery. Data Sources Medline databases (PubMed, cochrane) and all materials available in the Internet till 2023. Conclusion In conclusion, using the minimally invasive sinus tarsi approach (STA) is associated with a significant change in calcaneal height and Gissane angle when compared to extended lateral approach (ELA) when used to manage the displaced intra-articular calcaneal fractures (DIACF).

Open Reduction and Internal Fixation with Plate and Screw versus Triplanar External Fixation in the Surgical Treatment of Calcaneal Fractures: A Retrospective Cohort Study.

Background: The treatment of displaced intra-articular calcaneal fractures (DIACF) is debated. This study compares open reduction and internal fixation (ORIF) with minimally invasive osteosynthesis (MIOS). Methods: We conducted a retrospective study on 70 patients with DIACF treated between January 2018 and September 2022, divided into ORIF (n = 50) and MIOS (n = 20) groups. Functional outcomes were assessed using the Maryland Foot Score (MFS) and the Creighton-Nebraska Health Foundation Assessment Scale (CNHFAS). Radiographic outcomes, complication rates, and reintervention rates were evaluated. A chi-square analysis examined the correlation between Sanders classification and treatment choice. Results: The chi-square analysis indicated no significant correlation between the complexity of the fracture and the type of treatment chosen (χ2 = 0.175, p = 0.916). Additionally, the Cochran-Armitage test for trend showed no significant trend in the choice of treatment based on fracture complexity (statistic = 0.048, p = 0.826). A Kaplan-Meier analysis showed a longer time to reintervention for MIOS (p = 0.029). Complication rates were similar, with specific complications varying between groups. Quality-of-life outcomes were comparable. Conclusions: ORIF is preferable for high-demand patients due to better anatomical outcomes, while MIOS suits high-risk patients by reducing reinterventions and complications. Further randomized trials are needed to confirm these findings.

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

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. Between January 2018 and April 2020, 86 consecutive patients with 92 closed displaced intra-articular calcaneal fractures underwent ORIF with 3.5mm screws constructed via a minimally invasive sinus tarsi approach by a single foot and ankle surgeon. 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 < 2mm step-offs. With postoperative CT scan assessment, the treatment of displaced intra-articular calcaneal fracture with 3.5mm 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.

Classification of intraarticular calcaneal fractures: comparison of two classification systems

PurposeAccurately classifying displaced intraarticular calcaneal fractures (DIACFs) is essential for orthopedic surgeons to choose optimal treatment methods and provide results evaluation and communication. Many authors studying used Sanders classification reported moderate intra- and interobserver reliability. Taking the software opportunity of 3D virtual exarticulation, Goldzak updated French tri-dimensional Utheza classification, providing an alternative framework for classifying DIACFs. The aim of this study was to compare the intra- and interobserver reliability of Sanders versus Goldzak classification systems.MethodsThe CT scans of 30 patients with displaced intraarticular calcaneal fractures, treated in the same trauma center between 2014–2018, were analyzed by 16 medical doctors (specialists and residents in orthopedic surgery, specialists and residents in radiology), and classified according to Sanders and Goldzak classifications. The same images were sent on two separate sessions, in a randomized order. Interobserver reliability and intraobserver reproducibility were assessed using Kappa statistics and Gwet’s AC1 coefficient.ResultsInterobserver reliability using Gwet reported a value of 0.36 for Goldzak classification and 0.30 for Sanders classification (corresponding to “fair assessment” in both cases). In absence of subclasses, “substantial assessment” was reported for Goldzak classification (Gwet of 0.61) and “moderate assessment” for Sanders classification (Gwet of 0.46). Goldzak system had a greater interobserver reliability in the group of radiology residents. Intraobserver reliability coefficient was 0.60 for Goldzak classification and 0.69 for Sanders classification, indicating a substantial agreement for both classifications.ConclusionDespite the better view of the fracture lines provided by 3D reconstructions, this study failed to prove the superiority of Goldzak classification compared to Sanders classification for DIACFs.

Postoperative complications after displaced intra-articular calcaneal fracture operations

BackgroundThe objective was to compare postoperative complications in the management of displaced intra articular calcaneal fractures (DIACF) between two groups; the open reduction and internal fixation (ORIF) group versus the percutaneous fixation (PF) group. MethodsA total of 243 DIACFs were diagnosed and 127 of them received operations either with ORIF 75 (59.1 %) or PF 52 (40.9 %) between 2004 and 2018. Postoperative complications, radiological Sanders’s classification and improvement of Böhler’s angle were analyzed. ResultsEarly complication rate (<6 weeks), rate of deep wound infections and wound edge necrosis were significantly better in PF than in ORIF patient group. There were no significant differences in late complications (>6 weeks from operation) nor in improvement of Böhler’s angle. ConclusionComplication rate is lower when using PF technique while fracture reduction remains the same compared to the ORIF. Level of evidenceIV retrospective cohort study at a single institution.

Correlation between Clinical Outcome and Radiologic Features After Open Reduction and Internal Fixation of Calcaneal Fractures.

We aimed to find probable correlation between postoperative radiologic variables and clinical outcomes of surgically treated calcaneal fractures. In a retrospective study, 70 unilateral displaced intraarticular calcaneal fractures in adults with follow-up more than 1 year were asked to have a visit. Weightbearing radiographs of both ankles were taken and radiologic parameters, including the differences in values in Böhler and Gissane angles in comparison with the uninjured side, and calcaneocuboid and subtalar joint arthritis based on the Kellgren-Lawrence grading scale, were evaluated. They were considered to find any correlation with clinical outcomes assessed by American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale, visual analogue scale, Foot Function Index, and Tegner Activity Scale. A total of 61 men (87.1%) and nine women (12.9%) with a mean age of 38.9 ± 12.7 years (range, 18-67 years) were included. Mean follow-up visit for the patients was 25.1 ± 12.7 months. Mean scores of American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale, visual analogue scale, Foot Function Index, and Tegner Activity Scale were 86.7 ± 12.9, 21.3 ± 22.2, 13.1 ± 15.4, and 5.2 ± 1.1, respectively. The mean Gissane angle and Böhler angle differences were -0.2 ± 8.6 and -3.7 ± 7.2, respectively. Regarding the calcaneocuboid arthritis, 50 (71.4%), 14 (20.0%), and six patients (8.6%) were categorized in grades 0, 1, and 2, respectively. Also, subtalar arthritis was seen in 15 (21.4%), 24 (34.3%), 20 (28.6%), and 11 patients (15.7%), categorized as grades 0, 1, 2, and 3, respectively. No statistical correlation was found between any of the radiologic variables and clinical scores. There was no significant correlation between Böhler and Gissane angles and the clinical outcomes in surgically treated calcaneal fractures. Also, functional outcomes do not change considerably among different grades of arthritis in calcaneocuboid and subtalar joints, at least during short- to mid-term follow-up periods. Radiologic findings after open reduction and internal fixation of calcaneal fractures are not predictors of function of the patients.

Three-dimensional printed cast assisted screw fixation of calcaneal fractures: a prospective study

BackgroundTreatment of displaced intra-articular calcaneal fractures (DIACFs) with percutaneous screw fixation remains defective in some aspects. A novel three-dimensional (3D) printed cast was devised to assist screw placement. This study assessed the radiological and functional outcomes of 3D-printed cast assisted screw fixation for patients with DIACFs.MethodsPatients with unilateral Sanders type II or III DIACFs admitted to a single-centre hospital underwent either 3D-printed cast assisted screw fixation (3D group) or minimally invasive plate fixation (control group) from September 2020 to November 2022. All patients were assessed at one, two, three, and six months of follow-up. Comparison between groups was conducted in operative duration, fluoroscopic times, radiographic measurements of the calcaneus, and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score.ResultsA total of 32 patients were enrolled (19 in the 3D group versus 13 in the control group). Significant differences were detected between the 3D group and control group in operative duration (53.63±8.95 min, 95.08±8.31 min, P <0.001), fluoroscopic times (7.37±1.21, 16.85±1.57, P <0.001). At a follow-up of six months, the 3D group showed better restoration than the control group in calcaneal width, height, Bohler angle, and AOFAS Ankle-Hindfoot scores (all P <0.001). No significant differences were shown in calcaneal length and Gissane angle (P >0.05). No wound-related complications occurred in either group.ConclusionThe 3D-printed cast assisted screw fixation has shown superiority over minimally invasive plate fixation in the operative duration, fluoroscopic exposure, morphological restoration of the calcaneus, and functional outcomes in the treatment of DIACFs.

Percutaneous fixation of displaced intraarticular fractures of the calcaneus. A retrospective case series study and a review of the literature

PurposeTo evaluate the outcome of displaced intraarticular calcaneal fractures (DIACFs) of a case series of patients who were treated with a percutaneous fixation technique. Materials and methodsEight patients were operated for DIACFs and they were evaluated for the outcome and complications in a mean follow up of 9 months (range: 6 – 12 months). At the last follow up the AOFAS score, the Boehlers’ angle and the presence of any complication were noted. The time from injury to surgery was also reported. The correlation of the AOFAS score and the development of post traumatic subtalar arthritis to the type of fracture, to the post operative Boehler's angle and to the time from injury to surgery were investigated. ResultsThe overall mean AOFAS (Americal Orthopaedic Foot and Ankle Society) score was 84,625 (Range: 73 – 96). The mean AOFAS score of type II and type III fractures was 87,667 and 75,500 respectively. The mean AOFAS score for fractures with a postoperative Boehler's angle of less than 10° and more or equal to 10° was 76,750 and 92,500 respectively. This difference was found to be statistically significant. The mean AOFAS score for fractures who were treated less or equal to six days and more than six days post injury was 91,250 and 78 respectively. Two out of four patients with a post operative Boehler's angle less than 10° developed post traumatic subtalar arthritis. No patient out of four for whom a Boehler's angle of more than 10° has been achieved, developed subtalar arthritis. No infection occurred in any of the patients. ConclusionPercutaneous fixation is a safe and effective way of treating DIACFs. The outcome is directly related to the quality of reduction, which is significantly dependent to the timing of surgery. The earlier the fracture is operated the better the reduction by closed means is.

Comparison of sinus tarsi approach versus extensile lateral approach in the management of displaced intra-articular calcaneal fractures: A single-center study.

Controversy still exists for optimal treatment for displaced intra-articular calcaneal fractures (DIACFs). Conven-tionally, the extensile lateral approach (ELA) has been the most preferred approach. Although ELA provides excellent fracture access and direct evaluation of the depressed posterior facet, this approach has a high rate of serious complications, such as hematoma, superficial/deep infection, and wound healing issues. To overcome such complications, more minimally invasive techniques including external fixation, percutaneous fixation, arthroscopic assisted fixation, and sinus tarsi approach (STA) have been recently described. The primary aim of this study was to compare STA and LEA in the treatment of DIACFs. Patients who were operated for DIACFs in our clinic were included in the study. Patients with closed DIACFs of Sanders Type II, III, IV, and over 18 years of age were identified. Physical examinations and radiological evaluations of the patients were per-formed, and clinical scores were filled. Patients were divided into subgroups according to the Sander's classification and comparisons were made again according to these subgroups. There were 37 patients (four female and 33 male) in STA group and 44 patients in LEA group (six female and 38 male). The mean age was 44.42±13.57 years (range, 18-61) for STA group and 37.32±11.09 years (range, 18-56) for the LEA group. In clinical outcomes, except for short-form survey (SF-12)/MCS-12 (Mental Score) and visual analog scale score, all the parameters were signifi-cantly better in STA group compared to LEA group. No significant difference was observed between the two groups in radiographic results, except for the Böhler angle. Significantly less infection occurred in the STA group compared to LEA group (P=0.021). According to Sander's classification, American Orthopedic Foot and Ankle Society, foot and ankle disability index, and SF-12/PCS-12 and foot function index scores, no significant differences were determined between STA and LEA groups for Sanders Type 2, whereas the values were considerably higher in STA group than in LEA group for Sanders Type 3 and 4. In DIACFs, STA is considered a safe and effective method for restoring the width, height, and length of the calca-neus and reconstruction of joint alignment and has now become our standard technique for all calcaneal fractures requiring operative treatment.

A novel minimally invasive percutaneous treatment for Essex-Lopresti joint depression-type DIACFs by ligamentotaxis

ObjectiveTo compare the clinical efficacy of minimally invasive percutaneous treatment by ligamentotaxis with traditional open reduction and internal fixation in the treatment of Essex-Lopresti joint depression-type displaced intra-articular calcaneal fractures (DIACFs).MethodsThe medical records of patients with calcaneal fractures admitted to our department from January 2016 to December 2020 were retrospectively analyzed, and patients who met the inclusion criteria were finally included for analysis. Twenty-one patients underwent minimally invasive percutaneous treatment by ligamentotaxis (Group A), while eighteen patients were treated by traditional open reduction and internal fixation through an extended lateral approach (Group B). The preoperative waiting time, operative time, hospital stay, radiologic parameters (calcaneal height, width, length, Böhler angle and Gissane angle), American Foot and Ankle Surgery Association (AOFAS) hindfoot scores, Maryland Foot Score (MFS), visual analogue scale (VAS), and incidence of complications of the included patients were all recorded and analysed.ResultsThirty-nine patients with Essex-Lopresti joint depression type DIACFs were finally included. According to the Sanders classification, 22 were type II, 12 were type III and 5 were type IV. The preoperative waiting time and the hospital stay of Group A were 3.7 ± 1.6 d and 7.2 ± 1.7 d, respectively, which were significantly shorter than those of Group B (6.9 ± 2.0 d and 12.4 ± 1.5 d) (P < 0.05). There was no significant difference in the operative time between the two groups (88.8 ± 9.8 min vs. 91.3 ± 12.1 min; P > 0.05). No significant differences were shown in the radiological parameters (calcaneal height, width, length, Böhler angle and Gissane angle) or the satisfactory rate of joint surface reduction (SRJSR) of the two groups immediately postoperatively. All patients were followed up for 14 to 56 months [(30.2 ± 10.4) months]. All fractures healed. At the final follow-up, there were no significant differences in the radiological parameters or the SRJSR between the two groups (P > 0.05). No significant differences were shown in the AOFAS scores, MFS or VAS scores between the two groups [(89.5 ± 8.2) vs. (89.4 ± 9.0), P > 0.05; (87.5 ± 8.3) vs. (86.3 ± 8.9), P > 0.05; and (2.1 ± 1.2) vs. (2.2 ± 1.2), P > 0.05]. The excellent and good rates of the AOFAS scores and MFS were 90.5% and 85.7%, respectively, in Group A and 88.9% and 88.9%, respectively, in Group B (P > 0.05). Four patients experienced wound complications, including 1 superficial incision infection, 2 skin necrosis around the incision edge and 1 deep infection in Group B, while there were no wound complications in Group A (P < 0.05). One patient in each group suffered traumatic arthritis (P > 0.05).ConclusionsIn the assessment of Essex-Lopresti joint depression type DIACFs, minimally invasive percutaneous treatment by ligamentotaxis has similar clinical outcomes to traditional open reduction and internal fixation through an extended lateral approach. However, the former has the advantages of shorter preoperative waiting time and hospital stay, and lower incidence of incision complications.

Factors associated with nonunion of the posttraumatic subtalar arthrodesis after displaced intra-articular calcaneal fractures

BackgroundThis study investigated the incidence of and risk factors for nonunion in patients with posttraumatic subtalar arthrodesis (SA). MethodsWe retrospectively reviewed 165 posttraumatic SA cases. Nonunion was diagnosed at 6 months after surgery based on the findings of clinical evaluations, plain radiographs, and CT scans. Patient-specific factors and surgeon-specific factors were evaluated as potential risk factors. ResultsThe overall nonunion rate was 13.3 % (22 of 165 cases). In the final multivariate logistic regression analysis, smoking (odds ratio [OR] = 3.64; 95 % confidence interval [CI] = 1.23–10.75), parallel screw configuration (OR = 5.70; 95 % CI = 1.62–20.06), and freeze dried iliac crest (OR = 9.16; 95 % CI = 2.28–36.79) were demonstrated as risk factors for nonunion of posttraumatic SA. ConclusionPatients with a history of smoking, parallel screw configuration fixation, and those who received freeze dried iliac crest as an interpositional graft, had a significantly higher rate of nonunion.

Comparison of screw versus locking plate fixation via sinus tarsi approach for displaced intra-articular calcaneal fractures

BackgroundThe optimal treatment of displaced intra-articular calcaneal fractures (DIACF) is controversial. This study compared the fixation stability of screws and locking plates in DIACF treated via the sinus tarsi approach (STA). MethodsWe retrospectively evaluated 118 DIACF cases treated via STA and extracted data that could affect treatment outcomes. Loss of Böhler’s angle after surgery was measured to compare fixation stability. ResultsThe loss of Böhler’s angles was significantly smaller in the locking plate group than in the screw group (2.6 ± 2.7º vs. 5.6 ± 5.3º, P < 0.01). There was no difference in the clinical outcomes between the groups. On multivariate logistic regression analysis, screw fixation was significantly associated with loss of Böhler’s angle by> 10º (odds ratio, 8.63; 95% confidence interval, 1.16–64.4; P < 0.05). ConclusionsLocking plate fixation is more reliable than screw fixation for preventing correction loss in DIACF treated via STA. Level of evidenceIII

C-Nail® locking nail versus conventional plate for thalamic calcaneal fractures

BackgroundSurgery for displaced intra-articular calcaneal fractures (DIACFs) is often followed by skin complications that adversely impacts the functional outcomes. Minimally invasive techniques have been developed to decrease the risk of skin complications. The objective of this study was to compare C-Nail® locking-nail fixation to conventional plate fixation for DIACFs. HypothesisC-Nail® fixation restores calcaneal anatomy similarly to conventional plate fixation and decreases the frequency of skin complications compared to conventional plate fixation, while providing satisfactory functional outcomes. Material and methodsIn this case-control study of DIACFs, fixation was with a non-locking plate in 30 patients treated between January 2016 and June 2017 and with the C-Nail® in 25 patients treated between April 2017 and April 2018. Computed tomography was performed before surgery then bilaterally after surgery for measurements of the following calcaneal parameters: height, length, width, joint-surface step-off and inter-fragmentary distance. The values of these parameters were compared between the two groups. Postoperative skin complications were recorded. The functional outcome was assessed by determining the AOFAS score 1 year after the injury. ResultsThe two groups showed no significant differences for age, sex or fracture type. Wound healing was delayed in 3 patients in the plate group. The mean postoperative values of the calcaneal parameters were not significantly different between the two groups. The mean AOFAS score was 85.3±10.4 (range, 50–100) in the plate group and 87.0±12.0 (range, 64–100) in the C-Nail® group (p>0.05). DiscussionMinimally invasive C-Nail® fixation provides similar restoration of calcaneal anatomy as does conventional plate fixation. Level of evidenceIII, retrospective case-control study.

Minimally Invasive Intra-Calcaneal Fractures vs Conservative Treatment: A Propensity Score Matched Cohort Series

Category: Trauma; Hindfoot Introduction/Purpose: We prospectively assessed the impact of minimally invasive internal fixation of displaced intra-articular calcaneal fractures (DIACF) results in better health outcomes up to 2 years post- injury than non-operative management. Methods: All isolated calcaneal fractures were reviewed and the decision to treat was made by a multidisciplinary meeting. Operative-treatment protocol involved sinus-tarsi approach or per-cutaneous reduction &amp; internal fixation under the care of a fellowship-trained-foot and ankle surgeon. Non-operative protocol involved symptomatic management with no attempt at closed reduction. All fractures were classified, and the MOXFQ/EQ5D-L scores were used to assess general and disease-specific outcomes respectively. Secondary outcome measures included return to work and return to leisure activity levels. Statistical analysis was performed to assess normality of data (Shapiro Wilk test/Q-Q plots). Propensity matching was conducted using nearest neighbour matching, followed by regression analysis and modelling to compare baseline covariates between the two different groups. Results: Between 2015-2019 total of 93 patients met the inclusion criteria. After propensity score matching 44 patients were found in the surgical/ treatment group. The mean age was 40 (vs. 43.3) in the surgical group, no significant difference in age, sex, peripheral vascular disease, smoking status, laterality, and baseline Bohlers and Guisane angle in the propensity score matched sample. The surgically treated group had a higher Sanders class(p&lt;0.05), higher MOXFQ at 12 months (p&lt;0.05) and EQ-5DL scores at 24 months(p&lt;0.05) and were more likely to return to work at 12m (95% vs 77%)(p&lt;0.05), and physical activity levels at 12m (57% vs 36%)(p=0.054). The wound complication rate was 14.8%, no patients required further surgery; whilst non-operative- treatment mandated surgery for arthritis (6), and or/an injection (7 vs.3). Conclusion: Both non-operative and operative treatments are valid in DIACF. MIS-surgery offers better functional outcomes for severer injury patterns, and a less-likely need for arthritis intervention at 2yrs.

Sinus tarsi approach in high-risk patients with displaced intra-articular calcaneus fractures: A case series

PurposeThough research exists regarding calcaneal fractures, the treatment approach for displaced intra-articular calcaneal fractures (DIACF) remains controversial. The most common approach, the extensile lateral approach (ELA), for the treatment of DIACFs has high rates of wound complications reported. In contrast, the sinus tarsi approach (STA) is becoming more popular due to its minimally invasive technique. The objective of this retrospective study is to investigate the incidence of wound complications in high-risk patients with DIACF following operative fixation via the STA. MethodsFollowing IRB approval, a retrospective chart review was performed between 2007 and 2013 to assess high-risk patients for the presence of wound complications, including deep infections and delayed wound healing, following the use of STA for the management of DIACF's (n = 36). Demographics, risk factors, and secondary outcomes such as time to surgery were recorded. ResultsOf the 36 high-risk patients included in our study, seven had post-operative complications following operative fixation via the STA. Specifically, four patients had delayed wound healing, and three developed deep infections. Time to surgery had the greatest negative effect on postoperative complications and was influenced by age, sex, and the presence of a concomitant injury. ConclusionIn conclusion, this study demonstrates that the STA is a viable option for high-risk patients with displaced intra-articular fractures. Additionally, time to surgery should be minimized, when possible, to reduce risks of post-operative complications, including infections and delayed wound healing.

A prospective comparative study between percutaneous cannulated screws and Kirschner wires in treatment of displaced intra-articular calcaneal fractures

PurposeSeveral minimally invasive procedures were used to treat displaced intra-articular calcaneal fractures (DIACFs). No agreement among different authors about either the ideal fixation method or which technique is minimally invasive. The aim of this study was to compare functional and radiographic outcomes of two minimally invasive techniques in treatment of Sanders type II and III DIACFs by using K-wires or cannulated screws without bone grafts.MethodsA prospective randomized controlled study was conducted on 28 patients (34 feet) with Sanders type II or III DIACFs, treated by closed reduction and fixation using cannulated screws or K-wires, at the Orthopedics Department of Sohag University Hospital, between April 2020 and February 2022. Functional assessment was done by American Orthopedic Foot and Ankle Society (AOFAS) score and VAS for pain. Radiographic assessment was done by measurement of three calcaneal angles (Gissane, Böhler’s, and posterior facet inclination angles) and three calcaneal distances (height, length, and width of the calcaneus).ResultsMean ages of patients at the time of operation were 34.8 years for the cannulated screw group and 36.6 years for the K-wire group. A vast majority of patients were males (78.6%). Involvement of the right side in the cannulated screw group was 57.1% and that in the K-wire group was 47.9%. Mean operative time was significantly shorter among the K-wire group (42 min) compared to the cannulated screw group (57 min). Mean AOFAS score was higher among the cannulated screw group (85.9 points) compared to the K-wire group (75.8 points). Final VAS was significantly better among the cannulated screw group compared to the K-wire group. Mean time of radiographic union in the cannulated screw group was 8.9 weeks and that in the K-wire group was 10.1 weeks.ConclusionBoth techniques avoided wound complications associated with ORIF with the advantage of a shorter hospital stay. Patients in the cannulated screw group had better functional and radiographic outcomes and a lower rate of subtalar arthritis than patients in the K-wire group. K-wires had advantages of reduced operative time, and easy removal as an outpatient procedure.

Treatment of displaced intra-articular calcaneal fractures: A single-center experience study with 20 years follow-up

IntroductionThis study was conducted to identify the patient characteristics, classification, treatment, complications, and functional outcomes of operatively treated displaced intra-articular calcaneal fractures (DIACFs) in a level-I trauma center over a 20-year period. MethodsPatients with a DIACF classified as Sanders ≥2 and operatively treated with percutaneous reduction and screw fixation (PSF) or open reduction and internal fixation (ORIF) between 1998 and 2017 were identified. Pre- and postoperative radiological assessments were performed. Functional outcomes were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Maryland Foot Score (MFS). General health and patient satisfaction were assessed using the Short Form-36 Health Survey (SF-36) and the visual analog scale (VAS). ResultsIn total, 120 patients with a DIACF that were operatively treated with PSF or ORIF. Of these patients, 72 with a total of 80 DIACFs completed the questionnaires (60%). The average follow-up was 130 months. Mean scores for PSF and ORIF were 74 and 75 for AOFAS, 78 and 78 for MFS, 68 and 61 for SF–36, and 7.7 and 7.5 for VAS, respectively. An infection was the most common complication associated with ORIF (31%), and hardware removal (58%) was the most common complication in patients treated with PSF. Overall, 36 patients (68%) were able to return to work after a median time 6 months (IQR, 3–7) and 6 months (IQR, 3,25–6,75) for PSF and ORIF treated, respectively ConclusionThis long-term follow-up study reviews ORIF using ELA and PSF in the treatment of DIACFs. This study shows that both treatments are capable of restoring the Böhler angle and yield relatively good long-term functional outcomes. Differences in complication rates were apparent, infectious problems are inherent to ORIF using ELA, and hardware removal is associated with PSF.

An evaluation of the efficacy of percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III displaced intra-articular calcaneal fractures

BackgroundThe aim of this retrospective monocentric study was to investigate the clinical efficacy of percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III displaced intra-articular calcaneal fractures (DIACFs).MethodsThe medical records of calcaneal fractures patients who were admitted to our department from January 2018 to January 2020 were retrospectively reviewed, and those meeting the inclusion criteria were fnally included for analysis. All patients were treated with percutaneous reduction and screw fixation, and no patients received bone grafting. The radiologic parameters evaluated included the BÖhler angle and the calcaneal height. In addition, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, Maryland Foot Score (MFS), and visual analog scale (VAS) score were determined.ResultsThirty-eight patients with Sanders Type-II and Type-III DIACFs were finally included, including 30 males and 8 females aged 21 to 61 years [(42.6 ± 9.6) years]. According to the Essex-Lopresti classification, 27 of the fractures were the tongue type, and 11 were the joint compression type. According to the Sanders classification, 27 of the fractures were type II, and 11 were type III. Immediately postoperatively, the calcaneal height had recovered to 39.8 ± 2.1 mm, the BÖhler angle had recovered from 4.2° ± 13.6° preoperatively to 27.2° ± 3.4° (P = 0.000). All patients were followed up for 18–42 months [(25.2 ± 9.5) months]. All fractures healed. No differences were found in the outcome measures six-months postoperatively (BÖhler angle, p = 0.24; calcaneal height, p = 0.82) or at final follow-up (BÖhler angle, p = 0.33; calcaneal height, p = 0.28) compared to the immediately postoperative values. At the final follow-up, the AOFAS score was 91.7 ± 7.4 points, with an excellent and good rate of 92.1%; the MFS was 90.3 ± 7.8 points, with an excellent and good rate of 92.1%; and the VAS score was 2.2 ± 1.5 points. None of the patients had incision complications, and one patient developed traumatic arthritis.ConclusionPercutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III DIACFs can achieve good recovery and maintenance of the BÖhler angle and calcaneal height. Moreover, it has the advantage of a low complication rate.

A PROSPECTIVE STUDY FOR EVALUATION OF FUNCTIONAL OUTCOMES OF PLATE OSTEOSYNTHESIS FOR CLOSED INTRAARTICULAR CALCANEAL FRACTURES

Background: Calcaneal fractures account for 65% of tarsal injuries most (70%) of them are intra articular. It is the most repeatedly fractured tarsal bone. Axial loading is the most common mode of injury,falls from height, especially in male construction workers are the most frequent cause. Other fractures associated with falls from height have to be excluded such as pelvic and spinal fractures. Aims and Objective: To analyze the functional outcome of closed displaced intraarticular calcaneal fractures treated by plating. Materials and methods:This is a prospective study of 16 patients with displaced intraarticular fractures (Type–II Sanders and above) of calcaneum, which were admitted to the hospital and operated on with platingthrough extensile lateral approach, between November 2019to October 2021. Result: In our study functional outcome according to the AOFAS(American Orthopaedic Foot And Ankle Society) score was Good(&gt;75) in 14 cases(87.5%) and Fair(50-74) in 2(12.5%) and mean AOFAS score is 87.123. Conclusion: Open reduction and internal fixation of displaced intra-articular calcaneal fractures by locking calcaneal plate maintain the joint congruity and decrease the incidence of subtalar arthritis. Althoughconservative treatment was considered the gold standard previously, there is an increased tendency toward internal fixation with excellent results.This study concludes that displaced intra-articular fractures of calcaneum give good results by open reduction and internal fixation with locking plates.

Surgeon case volume and the risk of complications following surgeries of displaced intra-articular calcaneal fracture

PurposeThis study aimed to address the relationship between surgeon volume and the risk of complications following surgeries of displaced intra-articular calcaneal fractures (DIACFs). MethodsWe retrospectively reviewed the medical records and the follow-up registers for patients who underwent open reduction and internal fixation with plate/screws in our center between January 2015 and June 2020. Surgeon volume was defined as the number of surgically treated calcaneal fractures within the past 12 months, and was dichotomized on basis of the optimal cut-off value. The outcome measure was the documented overall complications within 1 year after surgery. Four logistics regression models were constructed to examine the potential relationship between surgeon volume and complications. ResultsAmong 585 patients, 49 had documented complications, representing an overall rate of 8.4%. The overall complication rate was 20.0% (22/111) in patients operated on by the low-volume surgeons and 5.7% (27/474) by the high-volume surgeons, with a significant difference (p < 0.001). The 4 multivariate analyses showed steady and robust inverse volume-complication relationship, with OR ranging from 3.8 to 4.4. The restricted cubic splines adjusted for total covariates showed the non-linear fitting “L-shape” or “reverse J-shape” curve (p = 0.041), and the OR was reduced until 10 cases, beyond which the curve leveled. ConclusionsOur findings reflected the important role of maintaining necessary operative cases, potentially informing optimized surgical care management.