Displaced Intra-articular Fractures Research Articles

Delayed Surgical Treatment of Displaced Intra-Articular Calcaneal Fractures in Major Trauma Is Safe and Effective.

To assess whether delaying operative fixation through the sinus tarsi approach resulted in a decreased wound complications rate or could hinder the quality of reduction in subjects with Sanders type II and III displaced intra-articular calcaneus fractures. From January 2015 to December 2019, all polytrauma patients were screened for eligibility. We divided patients into two groups: Group A, treated within 21 days after injury; Group B, treated more than 21 days after injury. Wound infections were recorded. Radiographic assessment consisted of serial radiographs and CT scans: postoperatively (T0) and at 12 weeks (T1) and at 12 months after surgery (T2). The quality of reduction of the posterior subtalar joint facet and calcaneal cuboid joint (CCJ) was classified as anatomical and non-anatomical. A post hoc power calculation was performed. A total of 54 subjects were enrolled. Four wound complications (three superficial, one deep) were identified in Group A; two wound complications (one superficial one deep) were identified in Group B. According to "mean interval between trauma and surgery" and "duration of intervention", there was a significant difference between the groups (p < 0.001). There were no significant differences between Groups A and B in terms of wound complications or quality of reduction. The sinus tarsi approach is a valuable approach for the surgical treatment of closed displaced intra-articular calcaneus fractures in major trauma patients who need delayed surgery. The timing of surgery did not negatively influence the quality of the reduction and the wound complication rate. level II, prospective comparative study.

Arthroscopic reduction and internal fixation (ARIF) for talar body fractures: systematic review.

This study aimed to systematically assess the available literature on the technique and results of arthroscopic reduction - internal fixation for displaced fractures of the talar body. A systematic review was made of the available literature on MEDLINE, EMBASE, and the Cochrane Library database, including studies from January 1985 to July 2021. The literature search, data extraction, and quality assessment were conducted by two independent reviewers. Surgical technique, perioperative management, clinical outcome scores, radiographic outcomes, and complication rates were evaluated. Out of 37 articles reviewed, 12 studies met the inclusion criteria. The studies included reported on the results of 22 patients. No complications were observed in any of the patients treated. The included studies had too many weaknesses to allow the pooling of data or meta-analysis. However, percutaneous arthroscopic talar internal fixation appears to be a good option for uncomplicated displaced intra-articular talar fractures. Appropriately powered randomized controlled trials with long-term follow-ups are required to confirm the effectiveness of this technique. Level IV, a systematic review of Level IV studies.

A Comparison Between Functional Results in Intra-Articular Displaced Calcaneus Fractures Managed with Conservative and Operative Treatment: A Randomized Controlled Trial

Aim: To make a comparison between functional results in intra-articular displaced calcaneus fractures which are treated conservatively and operative treatment Study design: A randomized controlled trial Place and Duration:This study was conducted at ward 17 JPMC Karachi from January 20221 to January 2022. Methodology: This study includes 32 individuals who had displaced intra-articular calcaneal fractures. These individuals were classified into two groups, each group with 16 individuals. They were randomly assigned to either operative or conservative treatment. Clinical results, as well as radiological results (Modified Rowe’s score), were assessed at a 1-year follow-up. Results: All results were measured using Modified Rowe’s score. With a 1-year follow-up of the operative group, according to Modified Rowe’s score, 6 individuals had excellent results representing 37.5%, 8 individuals had good results representing 50%, and only 2 individuals had satisfactory results representing 12.5%. On the other hand, with a 1-year follow-up of the conservative group, only 2 individuals had excellent results representing 12.5%, 7 individuals had good results representing 43.75%, 5 individuals had satisfactory results representing 31.25%, and 2 individuals had poor results representing 12.5%. A few challenges were seen in each group. In the operative group, delayed wound healing was a complication seen in 2 cases while in the conservative group, peroneal tendonitis, subtalar arthritis and malunion were seen as a complication. Conclusion: In conclusion, the operative group was seen to be more effective to cure displaced intra-articular calcaneus fractures rather than the comparative group. Only a few complications, better functional recovery, early rehabilitation, and early weight bearing were seen in the operative treatment. Keywords: Calcaneus fractures, functional outcome, rehabilitation, conservative treatment

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.

Experience of extended transtriceps approach in osteosynthesis of complex fractures of the distal metaepiphysis of the humerus

Background. The preferred treatment for intra-articular displaced fractures is open reduction and internal fixation. The need to obtain a better visualization of the fracture geometry made it necessary to develop a large number of new approaches and their modifications.Material and methods. The study included 186 patients with an intra-articular fracture of the distal humerus, who underwent plate osteosynthesis using the standard technique. The main group included 112 patients who were operated on using ETTA. The comparison group included 74 patients with a similar type of fracture, who were operated on using chevron olecranon osteotomy. The groups were comparable in terms of age, gender, mechanism of injury, and nature of the fracture. Long-term results were evaluated in 186 patients (minimum follow-up period – 12 months).Results. Comparative analysis revealed that the time of surgery was reduced by an average of 20 minutes (p=0.03) in the main group. The immediate and medium-term results were assessed according to the data of physical examinations, control radiography, dynamics of the increase in the amplitude of motion in the elbow joint. The results were comparable. When assessing complications, the migration of fixators was detected in 5.5% in the main group and 16% in the comparison group. In the comparison group, failure of union of the olecranon after osteotomy, migration of wires with skin perforation, and reactive bursitis were observed.Conclusion. 1. The extended transtriceps approach provides good visualization for fixing fractures of the distal humerus. 2. Evaluation of treatment results confirms that osteosynthesis using this access allows to reduce the time and trauma of the operation, to avoid complications associated with osteotomy of the olecranon, and to carry out successful postoperative rehabilitation, achieving good functional results.

Operative Versus Non-Operative Management of Closed, Displaced Intra-Articular Calcaneus Fractures: a Randomized Control Trial

Aim: To determine whether internal fixation &amp; open reduction are superior to non-operative treatment for displaced intra-articular calcaneal fractures. Study Design: Randomized controlled trial Place and duration: This study was conducted at Muhammad Medical College and Hospital Mirpurkhas, Pakistan from 2019 and 2020 Methodology: Patients' Kerr-Atkins scores for pain and function at two years following injury were used as the main outcome measure in this study. Complications, hindfoot discomfort and function general health, life ‘quality, clinical examination, walking speed, &amp; symmetry of gait were all considered secondary outcomes. A treatment-oriented approach to analysis was used. Results: Total 151 patients were taken for this study. There were 95 percent follow-ups for the primary outcome (69 for patients who had surgery and 74 for those who had not), and 75 percent of patients fulfilled all secondary goals. There was no statistical difference in the primary outcome or any of the secondary outcomes between the both groups. Patients who had surgery experienced greater problems and needed additional surgeries Conclusions: Two years following surgery, individuals with a typical displaced intra-articular calcaneus fracture exhibited no clinical or functional improvement, and the risk of comorbidities rose. Open reduction plus internal fixation for these fractures is not suggested based on these results. Keywords: Displaced intra-articular calcaneus fractures, Operative management, Nonoperative management

873 The Keystone Challenge- Volar Displaced Intra-Articular Distal Radius Fractures with Lunate Fossa Fragment

Abstract Aim Volar displaced fractures of the distal radius are unstable and warrant operative management. A subset of patients with volar displaced fractures also has a separate lunate fossa fragment, a specific injury with greater instability that may precipitate carpal subluxation. We aim to review our long-term experience in the management of this complex injury, exploring surgical technique which may improve treatment. Method We retrospectively reviewed all volar displaced distal radius fixations between 2015 and 2020. Inclusion criteria: any displaced intra-articular volar distal radius fracture with lunate fragment involvement undergoing volar fixation and over 16 years of age. Exclusion criteria: shaft fractures, extra-articular fractures, open fractures, fractures fixed using k-wires or external fixation, revision surgery and patients without follow-up. We adapted our surgical approach in order to address this more complex fracture pattern, and all operations were performed by specialist hand surgeons. Results 468 distal radius fractures were assessed, of which 29 (6%) cases included a lunate fossa fragment. 20 (69%) of patients were female, mean age was 59 years (SD 12.4). Mean length of stay was 5 hours and mean operative time was 96 mins (range 79-95). No patients had carpal subluxation, fracture fixation failure or return to theatre for any reason. Conclusions From our experience as a specialist orthopaedic institution, we recommend the extended FCR approach and intra-focal exposure to manage this complex injury. In particular, the lunate fossa fragment is the keystone which requires dedicated reduction prior to tackling the remaining fracture configuration.

Use of intramedullary locking nail for displaced intraarticular fractures of the calcaneus: what is the evidence?

Intramedullary locking devices (ILDs) have recently been advocated as a minimally invasive approach to manage displaced intraarticular calcaneal fractures (DIACFs), to minimise complications and improve outcomes. We reviewed clinical and biomechanical studies dealing with commercially available devices to identify their characteristics, efficacy and safety. Following a PRISMA checklist, Medline, Scopus and EMBASE databases were searched to identify studies reporting the use of ILDs for treating DIACFs. Biomechanical studies were first evaluated. Cohort studies were then reviewed for demographics, surgical technique, postoperative protocol, clinical and radiographic scores, complications and reoperations. The modified Coleman Methodology Score (CMS) was used to assess the quality of studies. Eleven studies were identified which investigated two devices (Calcanail®, C-Nail®). Three biomechanical studies proved they offered adequate primary stability, stiffness, interfragmentary motion and load to failure. Eight clinical studies (321 feet, 308 patients) demonstrated a positive clinical and radiographic outcome at 16-months average follow-up. Metalware irritation (up to 20%) and temporary nerve entrapment symptoms (up to 30%) were the most common complications, while soft tissue issues (wound necrosis, delayed healing, infection) were reported in 3-5% of cases. Conversion to subtalar fusion was necessary in up to 6% of cases. Four (50%) out of 8 studies were authored by implant designers and in 5 (62%) relevant conflicts of interest were disclosed. Mean (± standard deviation) CMS was 59 ± 9.8, indicating moderate quality. Treating DIAFCs with ILDs leads to satisfactory clinical outcomes at short-term follow-up, enabling restoration of calcaneal height and improved subtalar joint congruency. Metalware irritation and temporary nerve entrapment symptoms are common complications although wound complications are less frequent than after open lateral approaches. The quality of evidence provided so far is moderate and potentially biased by the conflict of interest, raising concerns about the generalisability of results. Level V - Review of Level III to V studies.

Functional Outcome Estimation of Calcaneum Fractures Treated by Open Reduction and Internal Fixation with Plate and Screws in A Tertiary Centre: A Descriptive Cross-sectional Study.

Calcaneum fractures constitute about 60% of all tarsal bone fractures. Intra-articular fractures account for 70% of all calcaneal fractures. There are controversies regarding the operative treatment of calcaneum fractures. Therefore this study aimed to estimate the functional outcomes of calcaneum fractures treated by open reduction and internal fixation with plate and screws. This descriptive, cross-sectional study was carried out at the tertiary care center in the western region of Nepal among the patients with displaced intra-articular calcaneum fractures from February 2017 to July 2020 after approval from the Institutional review committee. Convenient sampling was done to reach the sample size. Fifteen cases were included in the study. Data were recorded in proforma and Data analysis was done in the statistical package for social sciences. The American Orthopedic Foot and Ankle Society Hindfoot score was used to assess the final outcome. According to the American Orthopedic Foot and Ankle Society hindfoot scores, there were five excellent (33.33%), seven good (46.66%), two fair (13.33%) and one poor (6.66 %) results. In displaced intra-articular calcaneum fractures, open reduction and internal fixation with plates and screws result in a good number of satisfactory outcomes with very few unsatisfactory results. Hence it can be a better option of treatment in displaced intra-articular calcaneum fractures.

Clinical radiological and functional outcome of calcaneal fractures undergoing fixation with contoured locking plate

Objectives: With the advancement in surgical technique and newer fixation devices the treatment outcome of calcaneal fractures have improved. Therefore it is paramount to identify the appropriate treatment techniques for better functional outcomes in terms of better stability and early weight bearing without pain. Hence this study was carried out to study the functional outcomes of displaced Intra-articular Calcaneal fractures, treated with operative management using contoured locking plate. Material and Methods: This study was carried out as a prospective study. Fifty (50 fractures) patients with acute, displaced Intra-Articular fractures of calcaneum aged above 18 years, were enrolled in the study. Open fractures and fractures older than two weeks were excluded. The functional outcome was measured by the “American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot scoring system” at twelve months. Results: Of the 50 patients, all were males. Five patients had bilateral fractures. 35 patients had left sided fractures, while 15 had right sided fractures and mode of injury for all the patients was fall from height. Post operatively all 50 patients had swelling, 20 patients had persisting pain, 5 had superficial infections and 2 had deep infection. Superficial infections healed with antibiotics and dressings, while the patient with deep infection had persistent pain and difficulty in walking with discharge from surgical wound site. Both of them underwent implant removal and debridement after a year. Of the 50, 32 had good results, 14 had fair results and 4 had poor results. Hence we conclude from the above findings that contoured plate fixation helps in improving the functional outcome of the patients in view of their physical and radiological findings. Conclusion: A relatively better functional outcome was observed in displaced and comminuted fractures in plating, provided that the Bohler's angle was restored. The technique of contoured plate fixation with a lateral approach is good with regards to fracture union and functional outcome.

Sinus Tarsi Approach for Open Treatment and Internal Fixation of Displaced Intra-articular Calcaneal Fractures in High-Risk Patients: The New Gold Standard?

Category:Ankle, Diabetes, Hindfoot, TraumaIntroduction/Purpose:Intra-articular calcaneal fractures offer unique challenges. Wound problems and infection are significant complications in the surgical treatment of calcaneal fractures which in turn can be debilitating to patients and outcomes. The literature suggests varying wound complication rates but 21% up to 33% using the traditional extensile lateral approach in some studies. The extensile lateral approach has historically been accepted as the gold standard for fixation and treatment of these fractures. Recently there has been resurgent interest in alternative approaches to the fixation of intra-articular calcaneal fractures. Of interest is the potential of the sinus tarsi approach to decrease wound complications while having comparable reduction quality to the higher wound risk extensile lateral approach.Methods:A multi-center retrospective chart review study was implemented. The study objective was to review wound complication of the sinus tarsi approach compared with outcomes from the traditional extensile approach for fixation of displaced intra-articular calcaneal fractures. Specifically; examining a population of patients considered at high risk for wound issues, comparing radiographic and clinical outcomes.Results:In the high-risk group, only one primary complications resulted, including one patient with a history of an open fracture. All fractures healed with adequate maintenance of alignment. Chi- squared analysis resulted in a statistically significant difference in complication rates between sinus tarsi and the traditional extensile lateral approach at the 95% confidence level.Conclusion:In both high-risk and lower-risk cohorts of patients, a low rate of infection and wound problems was encountered. A limited approach through a sinus tarsi incision provides a viable option to treat displaced intra-articular calcaneus fracture patients with risk factors for wound issues. The patients all healed both their soft tissue wounds and fractures. Functional return was consistent with other study populations. Our study adds another cohort of patient data demonstrating the advantage of the sinus tarsi approach when compared to the extensile lateral in terms of decreased wound complications while maintaining quality of reductions and clinical outcomes.

Comparative study of conservative versus operative management of closed displaced intraarticular fracture of calcaneum

Intraarticular fractures of calcaneum are frequently complex injuries, requiring experience in the diagnosis and management, for favourable results. The historical aspects of calcaneal fracture treatment are difficult to appraise, secondary to varied forms of treatments, classifications, numerous retrospective studies and mixture of diagnoses and results. Significant controversy remains over the results of non-operative treatment. Due to the lack of standardization, accurate comparisons cannot be made between reported surgical and conservative treatment modalities to precisely determine the long term and short-term functional results between each method. Here is a cohort prospective study to compare patients of closed displaced intra-articular fracture of calcaneum. 30 patients were taken for this study out of which fifteen patients were treated operatively and fifteen patients were treated non-operatively. Patients were followed up to an average of 1 year. The functional outcome was measured by AOFAS hind foot score. It was observed that under the operative group 73.3% of the patients had excellent results, 13.3% had good result and 6.7% each had fair and poor results. Similarly, under the conservative group 53.3% of the patients had fair results, 26.7% had good result, 20% had poor result and none of the patients had excellent results. Further, it was observed that there was a significant difference in results between the two groups (p value

K. wire fixation versus conservative treatment of closed displaced intra-articular calcaneal fractures

Background: Calcaneus is a spongy cancellous bone with rich blood supply , its fracture heals more rapidly providing no occurrence of infection and soft tissue injury around ,no gross malposition of fragments. The associated pain leads to a major impairment in life quality. The aim of treatment for calcaneal fractures is the decrease of pain and rebuilding of walking ability for patients with normal foot shape and the ability to wear normal foot wear. To reduce complications, a minimally invasive technique for the treatment of displaced intra-articular fractures of the calcaneus was preferred to use.&#x0D; The purpose of this study was to determine whether the closed reduction and percutaneous K. wire fixation of displaced intra-articular calcaneal fractures results in better functional outcome at a minimum one year follow up after the injury compared with those after non-operative management.&#x0D; Methods: One hundred and eleven displaced closed intra-articular calcaneal fracture in 105 patients (six were bilateral) were seen at the orthopedic department of Al-Kindy teaching hospital and Shaih Zaid hospital , only 45 cases included in this study and prospectively evaluated with an average follow-up time of minimum of one year (1–3years follow-up). For radiographic evaluation, plain radiographs and CT scans were obtained. The Maryland Foot Score was used for clinical estimate. Sanders type II, III and IV fractures were diagnosed.&#x0D; Results: The incidence of subtalar arthritis was correlated with the severity of fracture. Böhler’s angle was restored in 70.1% (47 of 67) of the cases. The majority (77.7%) of patients were content with their treatment result. The rate of significant complications was 6.5%.&#x0D; Discussion: Percutaneous K. wire fixation of displaced intra-articular calcaneal fractures presented minimally invasive technique which showed comparable results with a low rate of serious complications and is a viable alternative for the treatment of intra-articular, dislocated calcaneal fractures.&#x0D; Conclusions: the functional results after K. wires fixation of displaced intra-articular calcaneal fractures were better than those after non-operative care.

A study of calcaneum fractures treated by different methods

Background: Calcaneal fracture is a complex injury that represents 1%–2% of all fractures. However, they make up 60% fractures of the midfoot bones. Due to debatable management of calcaneal fractures, we decided to evaluate the long term outcome of the same.Method: In this study, we have treated 38 feet with calcaneum fractures of 30patients, out of which 18 feet were treated conservatively and 20 feet were treated operatively. This was comparable to other study. Maryland foot score has been chosen, being based on results rather than radiographic criteria. Our average duration of follow is 18 months. Results: In this study total 38 feets of 30 patients were included, Out of this excellent out comes was seen in 13 (34.22%), good in 17 (44.74%), fair in 5(13.15%) and poor in 03(7.89%). Complication included infection, plantar fascitis, subtalar arthritis. Conclusion: Results of extraarticular fractures are good whatever be the method of treatment. Outcome of intraarticular displaced fracture is better with operative intervention than with conservative management.

A short term prospective study of the functional outcome of comminuted displaced intra-articular fracture of the distal radius treated with volar locking compression plate

Distal radius fracture accounts for approximately 17% of all fractures. More than half of these fractures are intra-articular and associated with Distal Radio Ulnar Joint (DRUJ) injuries. Several treatment modalities have been described like plaster cast, external fixation and open reduction and internal fixation with plate osteosynthesis. Superiority of open reduction and internal fixation with plate osteosynthesis has been established well, as it provide angular stability and allow for early mobilization, thereby achieving early functional recovery. In this prospective study, done over a period of 36 months and with a minimal follow-up of at least 12 months, we were able to recruit 56 patients conforming to our inclusion criteria. We had followed the Melone Classification and had operated all cases using the Ellis approach with distal radius volar side specific locking compression plates. We had evaluated the functional outcome of wrist function using the Demerit point system of Gartland and Werley at the end of 12 months of follow-up. Our study concluded that ORIF is an effective surgical management protocol for unstable intra-articular distal radius fracture. In our short term study the overall complication rate was 17.86%. The functional outcome excellent to good in 75% of cases, it was fair in 17.9% of cases and poor in only 7.1% of cases.

Mid-term results of calcaneal plating for displaced intraarticular calcaneus fractures

Introduction: Calcaneum fractures account for approximately 2% of all fractures, with displaced intra-articular fractures comprising 60% to 75% of these injuries. There are many methods of stabilization of calcaneal fractures, each having their own merits and demerits. The plate fixation has improved the functional results, limited indication for bone grafting, and shortened the duration of treatment. Materials and Methods:30 displaced calcaneal fractures were surgically treated in GMC Jammu between January 2015 and May 2017 were included in this study. Ten were excluded due to lack of follow up, which left the study group of 20 displaced intraarticular calcaneus fractures. Only closed fractures were included in this study. Fractures were classified according to Sanders Classification and only Sanders type 2 and type 3 fractures were included in this study. The extended lateral incision was used in all patients. All patients were evaluated according to the Maryland foot score and on their last follow-up day. Results: The average follow-up time was 18 months (12 to 24 months). Twelve fractures were Sanders type 2 (60%), 8 were type 3 (40%). According to Maryland foot score, very good results were obtained in 6 patients (3.33%) and good results in 4 patients (20%) in Sanders type 2 fractures; good results were obtained in 8 patients (40%) and average results in 2 fractures (10%) in Sanders type 3 fractures. Conclusion: In light of both the available literature and our own experience, we conclude that open reduction and a stable fixation method yield more satisfactory results when compared to the conservative treatment methods in the treatment of displaced intraarticular calcaneus fractures.

Outcomes and financial implications of intra-articular distal radius fractures: a comparative study of open reduction internal fixation (ORIF) with volar locking plates versus nonoperative management

BackgroundTo evaluate the functional and radiographic outcomes, as well as the treatment costs, of closed displaced intra-articular distal radius fractures treated with either open reduction internal fixation (ORIF) with volar locking plates or nonoperative treatment with plaster cast immobilisation.Materials and methodsA total of 60 patients (32 receiving ORIF, 28 receiving nonoperative treatment) with closed intra-articular distal radius fractures were included. The mean age was 52.1 and 57.4, respectively. Functional and radiographic assessments were carried out at 12 months post-injury. Patients’ treatment costs, median salaries and lengths of medical leave were obtained.ResultsDASH and MAYO wrist score in the ORIF group did not differ significantly from those in the nonoperative group. Apart from superior ulnar deviation in the ORIF group (p = 0.0096), differences in the range of motion of the injured wrists were not significant. Similarly, there were no significant differences in grip strength and visual analog scale for pain. Volar tilt (p = 0.0399), radial height (p = 0.0087), radial inclination (p = 0.0051) and articular step-off (p = 0.0002) were all significantly superior in the ORIF group. There was a 37-fold difference in mean treatment costs between ORIF (SGD 7951.23) and nonoperative treatment (SGD 230.52).ConclusionOur study shows no difference in overall functional outcomes at 12 months for closed displaced intra-articular distal radius fractures treated with either ORIF with volar locking plates or plaster cast immobilisation, and this is independent of radiographic outcome. A longer follow-up, nevertheless, is needed to determine whether the development of post-traumatic arthritis will have an effect on function. The vast difference in treatment costs should be taken into consideration when deciding on the treatment option.Level of evidenceLevel 3.

Surgical treatment of displaced intraarticular calcaneus fractures using anatomical lateral frame plate.

The present study evaluated the results obtained from the anatomical lateral frame plate treatment of displaced intraarticular calcaneus fractures. Overall, 14 displaced intraarticular fractures of 13 patients (3 females, 10 males; Mean age, 37.5 years) were included in the present study. Surgery was performed using widened lateral approach and supported by auto grafts following joint line reduction in all patients. They were then fixated by anatomical lateral frame plate. All the joints were stabilized by casting after the operation. All patients were prescribed controlled and full weight bearing at 6-8th and 12th weeks, respectively. Mean follow-up of patients was 28 months. The fractures were classified according to Sanders system. Clinical scoring of the patients was performed according to American Orthopaedic Foot and Ankle Society, Creighton-Nebraska, and Maryland systems. According to these systems, the mean scores of the patients were 83.7, 75.7, and 88.5 respectively. In the present study, we have defined the results of anatomical lateral frame plate treatment in patients with displaced intraarticular calcaneus fractures. We have obtained clinically and radiologically satisfactory results with the anatomical compatibility of plate to the lateral surface of the calcaneus.

Overview of Emerging Technology in Orthopedic Surgery: What is the Value in 3D Modeling and Printing?

Three-dimensional printing and modeling has evolved significantly since first introduced in the 1980s. In the last 5 years, this revolution in technology has become far more accessible and affordable, and is already mainstream in many areas of medicine. Nowhere is this more apparent than in orthopedics, and many surgeons already incorporate aspects of 3D modeling and virtual procedures in their routine clinical practice. However, this technology promises to become even more prevalent as creative applications continue to be developed, and further innovations are certain to come. There are important public policy aspects to consider, both economic and regulatory. Regulatory issues are currently still under development, but will need to take into account sterilization, quality assurance, and product liability. The mechanical integrity of 3D-printed implants is influenced by the unique characteristics of the print process, including the energy density of the laser, the resolution of the print, and the orientation of the print on the build platform. Introduction of expensive new technology should only be done after careful consideration of the costs associated, the potential benefits, and the value that can be derived. The value in 3D modeling and printing can be considered relative to the initial costs, the experience of a 3D modeling unit, the complexity of a particular case, and the clinical expertise of the surgeons involved. There is significant potential value derived from modeling most displaced intra-articular fractures, once a 3D modeling unit is established and proficient. However, the greatest value comes from modeling the most highly complex cases. When the pathology is most abnormal, 3D modeling/printing can be a valuable clinical adjunct for even the most expert and experienced surgeons. Although currently hospital-based 3D modeling/printing units are uncommon, they will soon become far more common. For surgeons in developing nations, 3D printing may currently be prohibitively expensive, but 3D modeling is relatively inexpensive and therefore far more accessible. As 3D printer prices continue to fall, the ability to rapidly manufacture prototypes and patient-specific models will inevitably spread through these regions as well. However, the future for 3D-printed medical models, devices, and implants will be limited unless we are able to document their clinical superiority and confirm their value with respect to patient outcomes. Level of Evidence: Level V—expert opinion.

Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children.

Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6-16 years), and average follow-up time was 42.8 months postoperatively (range, 12-72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, -5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (P<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52-68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [Orthopedics. 2016; 39(4):e744-e748.].