Maryland Foot Research Articles

Management of displaced intraarticular calcaneal fractures by minimally invasive technique: A prospective study

Introduction: Intra-articular calcaneal fractures are conventionally treated by extensive open surgical reduction to achieve anatomical reduction of the subtalar joint and also to maintain the calcaneal height and width. At the same time many studies have shown that they are associated with various complications like wound dehiscence, necrosis, infection and hard-ware problems. Our study is aimed at surgically treating displaced intra-articular fractures through minimally invasive techniques and study the outcome in terms restoration of Bohler’s angle, Gissane’s angle, calcaneal width and height. Materials and Methods: This is a prospective study done in Bokaro General Hospital from April 2017 to June 2018.It included 20 patients with displaced intraarticular calcaneal fractures. Patients were followed up for 3 months and assessed subjectively and objectively using Maryland foot score. Radiographs were taken to evaluate the Bohler’s angle, Gissane’s angle, calcaneal width and height. All data were Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) Version 20. Results: The final mean Maryland foot score was 86.62. 8 patients (38.1%), in the operated group had an excellent result, 10 (47.62%) had a good score. 2 patients (9.52%) showed fair result. Only 1 patient (4.76%) showed poor result. The Bohler’s angle, Gissanes’ angle, calcaneal height and width also showed improvement post-operatively. Conclusion: From our study it was confirmed that the operative treatment of intra-articular fractures of the calcaneum involving the subtalar joint, using minimally invasive techniques provided good results.

Functional outcome of patients after open reduction internal fixation in displaced intra articular calcaneal fractures

Background There are lot of controversies with management of calcaneal fractures. In this prospective study, we studied the functional outcome of surgically treated displaced intra-articular calcaneal fractures. Aim To evaluate the functional outcome of patients following open reduction internal fixation in displaced intra-articular calcaneus fractures under Dept. of Orthopaedics – Govt. Medical College Hospital, Thiruvananthapuram during the period of 2016-2017. Functional outcome is measured in terms of pain and function. Materials and Methods 72 patients admitted with displaced intra-articular calcaneal fractures and managed with Open Reduction Internal Fixation were observed for 6 months. All fractures were fixed with calcaneal plates, by an extensile lateral approach. Regular follow ups are made at 1 month and 6 months. Functional result was compared by using Maryland foot score and also Bohler’s angle. Results: Incidence is much more common in males (90.3%). 20-40 year age group is most commonly affected. The spinal injuries were the most common associated injury (30.6%). Of 72 fractures, 26 were Sander’s type IV (36.1%), 25 type II (34.7%) and 21 Type III (29.2%) fractures. 30 patients had Bohler’s angle 21-40, 42 had less than 20. The proportion of patients having Bohler’s angle

Repairing the bone and skin defect of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery

Objective: To evaluate the clinical outcome of repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery. Methods: Twelve patients of toe defect after reconstruction were repaired from March, 2015 to June, 2017 utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery in the Department of Hand and Foot Microsurgery of Xin'an Hospital, Dongguan City.Of which, there were 7 cases of great toe defect with fibular side of phalanx ungual and skin, 5 cases of second toe defect with proximal interphalangeal joints and the partial bone accompanied the great toe defect.Double bone flaps of one pedicles were used to repair first and second phalanx defect in 5 cases.The skin injured area: 5.5 cm×2.5 cm to 6.5 cm×10.0 cm. Bone defect size of great and second toe were 1.5 cm×1.0 cm×0.8 cm to 1.7 cm×1.0 cm×1.0 cm and 2.5 cm×1.0 cm×1.0 cm to 4.0 cm×1.0 cm×1.0 cm, respectively.The flap size ranged from 6.0 cm×3.0 cm to 6.5 cm×12.0 cm, and the bone flap size ranged from 1.5 cm×1.0 cm×0.8cm to 1.7 cm×1.0 cm×1.0 cm(great toe) and 2.0 cm×1.0 cm×1.0 cm to 3.5 cm×1.0 cm×1.0 cm(second toe). The wound of donor site of the leg was directly combined or local skin transfer sutured with 8 cases, skin-grafting in 4 cases. Results: All the bone-skin flaps survived.After 6-27 months of follow-up, the great toe flaps were found with normal color, good texture and moderate thickness, the two-point discrimination was 7-10 mm. The donor site of the leg showed little influence with normal function.No pain and discomfort in the foot were recorded, and the patients walked well.The healing time of bone flap was from 1.5 to 4 months, with an average of 2.5 months.Using the Maryland Foot Score, 5 cases of 7 feet got excellent and 2 cases of 2 feet got good result in the great toe group (7 cases of 9 feet), the good rate was 100%.Three cases got excellent and two cases got good result in the combined reconstruction group (5 cases), the good rate was 100%. Conclusion: Repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery can also repair bone and skin defect of the great and the second toe, keep the great and the second toe, and restore the appearance and function of the first and the second toe at utmost.

Mini-plate fixation via sinus tarsi approach is superior to cannulated screw in intra-articular calcaneal fractures: A prospective randomized study

Intra-articular displaced calcaneal fractures are common fractures and are often treated with surgical interventions. Sinüs tarsi approach provides secure access to lateral wall and joint facets. The aim of the study is to compare cannulated screw (CS) fixation and mini-plate (MP) fixation via sinus tarsi approach with Sanders types 2 and 3 fracture of calcaneus. Sixty patients with Sanders types 2 and 3 calcaneal fracture underwent surgical intervention were randomly allocated into two groups as group MP fixation and group CS fixation regarding osteosynthesis method for 5-year period. Open reduction via sinüs tarsi approach was performed in both groups. Demographic variables, time to surgery (TS), operation duration (OD), length of hospital stay (LOS), surgical complications, and reoperations were recorded. Pre- and postoperative Gissane and Böhler angles; calcaneal length, height, and width; ankle anterior-posterior (AP) and lateral X-rays; and computed tomography were also recorded for radiological evaluation and fracture characteristics. Maryland Foot Score (MFS) was used to evaluate functional outcomes. Preoperative age, type of fracture, calcaneal length, height, and Gissane and Böhler angles, TS, LOS, and OD were not different between the groups. The postoperative calcaneal widening was significantly better restored in group MP compared with that of group CS. The incidence of reoperation and algoneurodystrophy was statistically higher in group CS than group MP. MFS in group MP was also higher than group CS at final visit. MP fixation via sinus tarsi approach is superior to CS fixation in Sanders types 2 and 3 calcaneal fractures.

3D CT scan assessment of the outcome of displaced intra-articular calcaneal fractures: operative versus non-operative treatment

IntroductionComputed tomography (CT) scan is helpful in identifying bone deformities resulting from intraarticular calcaneal fractures such as loss of calcaneal height, increased width of calcaneal wall, and disruption of the posterior articular facet. The aim of this study is to compare the result of spiral CT scan assisted analysis of calcaneum anatomy, articular congruity and onset of arthritic changes with intraarticular calcaneal fractures in patients treated either operatively or conservatively.Material and methodsTwenty patients were recruited, 9 in the operative group and 11 in the conservative group. CT scan of the injured foot and ankle were taken followed by detailed functional assessment based on the American Orthopaedic Foot & Ankle Society Score (AOFAS) and Maryland Foot Score (MFS). Calcaneal height, length and width were measured to assess the functional and radiological outcome in the patients. The presence and severity of arthritic changes were reviewed.ResultsThe calcaneal height, length and width were relatively restored in the operative group compared to the conservative group. A significantly larger posterior articular facet step was seen in the conservative group with accelerated onset and significantly higher (p = 0.001) grade of arthritis in the subtalar joints apart from having significantly higher (p = 0.038) incidences of calcaneocuboid arthritis. The operative group showed significant improvement (p = 0.009) in functional outcome based on MFS scoring system.ConclusionsOperative intervention with calcaneal locking plate provides good framework for near anatomical bone healing and redistributes the mechanical forces on the foot resulting in improved pain, function and alignment in patients.

Sinus tarsus mini incision approach with percutaneous reduction and fixation for Sanders II、III calcaneal fractures

Objective To explore the methods and clinical effect of the sinus tarsus mini incision approach with percutaneous fixation technique in the treatment of Sanders II, III calcaneus fractures. Methods From January 2015 to May 2016, the clinical data of 64 cases with Sanders II, III calcaneus fractures who were treated by sinus tarsus mini incision approach with percutaneous reduction and fixation were analyzed retrospectively. The average age was 46.64±10.51 years (range, 25-68) and 49 patients were males and 15 patients were females. According to Sander's classification, 39 patients were Sanders II and 25 were Sanders III fracture. Calcaneal varus was corrected and the length, width and height of bone were reduced by sinus tarsus mini incision approach with percutaneous fixation technique. Calcaneal fracture was treated by calcaneal bone plate combined with percutaneous screw fixation. Complications and operation procedure were recorded post-operation. Anteroposterior, lateral and axial views of preoperative and postoperative X-ray and CT scan were taken to assess the classification, restoration and intertion status of fracture. Radiological assessment was performed using Bohler's angle and Gissane's angle. Functional outcome was assessed using the Maryland foot score (MFS). Results All of the sixty-four patients were followed up for 12-18 months (average, 14.80±2.03). After surgery, only 4 cases of superficial necrosis of the incision were found, and the incisions were all healed and no infection occurred after surgery. No tendon tenosynovitis was seen after surgery. There were no fracture displacement, internal fixation failure, and fracture deformity healing cases. The mean time of bone union was 9.44±1.38 weeks (8-12 weeks) without fracture deformity healing case. The mean time of bone union was 9.17±1.16 weeks for the 23 cases with bone graft. For the 41 cases without bone graft, the bone healing average time was 9.91±1.62 weeks, and there is no statistically difference between cases with and without bone graft (t=1.936, P=0.061). Bohler's angle was 6.625°±4.904° (range, -5°-15°) preoperative, and improved to 31.031°±4.660° (range, 24°-40°), which had statistically significant difference (t=-28.863, P=0.000). Gissane's angle was from preoperative 76.094°±12.981° (range, 55°-105°) to 127.328°±6.486° (range, 115°-140°) at the time of the latest follow-up, and the difference had statistically significant (t=-28.246, P=0.000). Maryland Score: excellent 30 cases (22 cases of type II, 8 cases of type III), good 27 cases (15 of type II, 12 of type III), fair 7 cases (2 of type II, 5 of type III). The overall good rate was 89.06% (57/64). Conclusion The tarsal sinus minimally invasive small incision reduction and internal fixation combined with percutaneous reduction and fixation technique in the treatment of calcaneal fractures, exerts the advantages of small trauma, clear surgical exposure for reduction, reliable fixation, and low incision complications, which is applicable to treat the Sanders II, III calcaneal fractures. Key words: Calcaneus; Fractures, bone; Fracture fixation, internal

Improved anatomical locking plate internal fixation through tarsal sinus incision in treating Sanders III-IV calcaneal fractures

To investigate clinical effects of improved anatomical locking plate internal fixation through tarsal sinus incision in treating Sanders III and IV calcaneal fractures. From February 2015 to October 2016, 35 patients with Sanders III and IV calcaneal fractures treated by improved anatomical locking plate internal fixation through tarsal sinus incision were collected, including 22 males and 13 females aged from 22 to 68 years old with an average of (42.3±12.7) years old. According to Sanders classification, 23 patients were type III and 12 patients were type IV. Postoperative complications were observed, Bö hler angle and Gissane angle before and after operation were compared, and Maryland foot function scoring standard was evaluated at 12 months after operation. All patients were followed up from 12 to 20 months with an average of (14.5±2.0) months, the length of incision ranged from 4.0 to 5.5 cm with an average of (4.7±0.4) cm. Superficial infection occurred in 1 patient, delayed union in 2 patients, gastrocnemius nerve injury in 1 patient. No complications such as steel plate exposure and fracture reduction loss occurred. Wound healing time ranged from 14 to 28 days with an average of(15.4±4.7) days, the fracture healing time ranged from 8 to 14 weeks with an average of (9.8±1.9) weeks. Bö hler angle increased from preoperative (9.81±14.28)° to 3 days after operation (26.35±11.04)°, and (25.96±10.79)° at 12 months after operation(P<0.05). Gissane angle ranged from preoperative (122.54±16.79)° to 3 days after operation (120.85±11.88)°, and (120.62±11.44)° at 12 months after operation and had statistical meaning. Maryland score increased from 12.66±4.10 before operation to 92.20 ±7.82 at 12 months after operation, and 32 patients got excellent results, 2 good and 1 moderate. Improved anatomical locking plate internal fixation through tarsal sinus incision in treating Sanders III and IV calcaneal fractures, which has advantages of less incision, less soft tissue injury, better fracture reduction and fixation, could receive good reduction and fixation. It is an effective method for Sanders III and IV fracture of calcaneus fracture.

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.

Arthroscopically-assisted reduction and percutaneous screws fixation of Sanders type Ⅱ of calcaneal fractures

Category: Trauma Introduction/Purpose: Compared the clinical effect of arthroscopy assisted reduction and application of sinus tarsal approach reduction when treating Sanders Ⅱ calcaneal fractures. Methods: It was a retrospective comparative study since August 2014 to February 2017.There are 68 cases with Sanders type Ⅱ displaced calcaneal fractures which was divided into two groups. Group 1 with 31 cases was treated with arthroscopy assisted reduction and percutaneous headless screws fixation. Group 2 with 37 cases was treated with reduction and internal fixation. Results: No statistically significant difference was found between the two groups compared with the time of fracture healing, the Maryland foot score and AOFAS, and the differences was not statistically significant(P&gt;0.05). Compared with the open reduction group, arthroscopy group had lower VAS, the healing time of incision was significantly less, intraoperative and postoperative blood loss was less, and it had higher SF-36 score, the difference had statistical significance(P&lt;0.001). Conclusion: Two different kinds of surgical treatment of Sanders type Ⅱ calcaneal fractures had good clinical outcomes, but the treatment of arthroscopy group had less injury, less pain after surgery, less complications of incision, and it was more helpful to improve patients quality of life.

Outcomes of Operative Treatment of Displaced Intra-articular Calcaneal Fracture in Adult

Background and objectives: Management of calcaneal fractures is controversy. Many options of treatment have been described, but there is no agreement about absolute indications. A study of the functional outcome is carried out in surgically treated intra articular calcaneal fracture in this prospective study. We studied the functional outcomes and postoperative complications including; infection, impingement, varus, Synovitis and flap necrosis in operative management of intra articular calcaneal fracture. Methods: A total of 24 Patients with 26 calcaneal fractures operated over a period of 24 months (first January 2016 to first December 2017), in the study. Pre-operative computed tomography scans done in all patients. Maryland foot score was used to assess the functional outcome. Results: Twenty-four pa -tients (22 unilateral and 2 bilateral), the mean age is 35.41 years (range 18-60), consisting of 3(12.5%) female and 21(87.5%) male were included in this study. Most common mode of injury was fall from height in 23(95.8%) patients, while road traffic accident was in 1 (4.16%) patients. Results according to Maryland foot score were excellent in 25%, good in 62.5%, and 12.5% have fair outcome and none of them had poor results. Conclusion: Open reduction and internal fixation with restoring the articular congruity with low profile locking plate is the ideal treatment for Sanders Type II, III and IV. Even Sanders Type IV had a good result in short-term follow-up. Use of proper surgical timing, technique and asepsis can lead to excellent or good results in about (87.5%) of patients.

Application of lower leg perforator flap for repair of the soft tissue defects in the donor site of toe transplantation

Objective To explore the clinical effects of lower leg perforator flap in the treatment of the soft tissue defects in the donor site of toe transplantation. Methods From December 2015 to December 2016, 15 cases of thumb or finger defects were reconstructed by the transplantation of big toe nail flap, the fibula side flap of great toe and second toe wrap-around flap. Simultaneously, the free peroneal artery perforator flap or posterior tibial artery perforator flap was used to repair the soft tissue defects in donor site of toe transplantation. Results All the reconstructed fingers and thumbs survived. All the flaps used to cover donor site of the foot survived. The follow-up time ranged from 1 to 18 months with an average of 8.6 months. The donor site of toe transplantation recovered well without influence on wearing shoes and walking. According to the Maryland foot function scoring system issued by Sanders et al, the results were rated as excellent in 14 cases and good in 1 case. Conclusion Lower leg perforator flap for repair of the soft tissue defects in the donor site of toe transplantation can not only reconstruct the good appearance and function of thumbs and fingers, but also can restore the integrity of donor foot. The function and appearance of the foot are well recovered. Key words: Surgical flaps; Treatment outcome; Soft tissue defects; Toe donor site

Factors Influencing Functional Outcomes of Subtalar Fusion for Posttraumatic Arthritis After Calcaneal Fracture.

Subtalar arthrodesis is a common salvage operation for posttraumatic subtalar arthritis. This study aimed to identify factors associated with functional outcomes and quality of life after subtalar fusion for posttraumatic subtalar arthritis after calcaneal fracture. This is a retrospective study with follow-up by questionnaire in two level 1 trauma centers. Patients who underwent subtalar arthrodesis for posttraumatic arthritis after a calcaneal fracture between 2001 and 2016 were identified and contacted for completion of a survey consisting of the Foot and Ankle Ability Measure (FAAM), Maryland Foot Score (MFS), Patient-Reported Outcomes Measurement System Physical Function (PROMIS PF, Short Form 10a) questionnaire, EuroQol 5-dimensional (EQ-5D) questionnaire, and EuroQol visual analog scale (EQ-VAS). Exclusion criteria were initial subtalar arthrodesis at an outside facility, primary arthrodesis for fracture, initial arthrodesis earlier than 2001, amputation of the fused foot or leg, younger than 18 years at time of fusion, and inability to communicate in English. A total of 159 patients met our inclusion criteria. Eighty-four patients completed the questionnaires, resulting in a response rate of 59%. Median FAAM score was 79 (interquartile range [IQR], 48-90), median MFS was 74 (IQR, 56-86), and median PROMIS PF was 45 (IQR, 38-51). Quality of life was significantly lower when compared to a reference population ( P = .001). Smoking was independently associated with worse outcomes. Complications after fusion (such as nonunion, implant failure, and infectious complications), high-energy trauma, and ipsilateral injury were also predictors for poorer outcomes. Acceptable functional outcomes and quality of life were observed after subtalar fusion. Smoking, complications after subtalar fusion, high-energy trauma, and presence of ipsilateral injuries were independently associated with worse functionality and quality of life. Prognostic level III, comparative series.

The Use of Cryotherapy for the Prevention of Wound Complications in the Treatment of Calcaneal Fractures

We analyzed the risk factors for skin infection and necrosis after calcaneal fracture surgery and evaluated the effect of cryotherapy in preventing postoperative skin infections and necrosis. We studied 129 calcaneal fracture patients (148 feet) who had undergone open reduction and internal fixation from January 2008 to December 2010. Three groups included were: control (44 patients; 49 feet), preoperative cryotherapy (43 patients; 48 feet), and perioperative cryotherapy (42 patients; 51 feet). The wound infection rate, Maryland foot score, and postoperative visual analog scale (VAS) score were compared. Risk factors for infection were analyzed using multinomial logistic regression. Both cryotherapy groups had lower infection rates, higher Maryland foot scores, lower VAS scores, and shorter hospitalizations than the control group (p < .05). The perioperative cryotherapy group had a lower infection rate, higher Maryland foot score, and shorter hospitalization (p < .05) but similar VAS score compared with the preoperative cryotherapy group (p > .05). Pre- and postoperative cryotherapy, postoperative drainage, surgical timing, smoking index, alcoholism, and suture method were risk factors for postoperative infection and necrosis. The risk of these can be largely reduced by patients not smoking and drinking alcohol and surgeons choosing the appropriate surgical timing, improving the suturing method, and performing postoperative drainage. Perioperative cryotherapy might be an effective method to decrease the postoperative infection rate, shorten the hospital stay, and reduce postoperative pain. Our findings require further validation in well-designed randomized controlled trials.

Clinical application of the sinus tarsi approach in the treatment of intra-articular calcaneal fracture.

To observe the clinical outcome of the sinus tarsi approach in the operative treatment of intra-articular calcaneal fractures.Forty-nine intra-articular calcaneal fractures in 45 patients were managed surgically with sinus tarsi approach. The anatomical plate and compression bolts were applied in 14 feet. The anatomical plate and screws were applied in 35 feet. Maryland foot score system was used to evaluate the function of the hindfoot at the followup.The reduction of the posterior facet was graded as nearly anatomical (less than 2 mm articular displacement) in 46 feet (93.9%). The width, height, and Böhler angle were significantly improved in all patients (P < .01). After a mean follow-up period of 18.7 months (14.5–29 months), the Maryland foot scores were: 34 feet scored 90–100 points (excellent), 6 feet scored 80–90 points (good), 6 feet scored 70–80 points (fair), and 3 feet scored 60–70 points (poor). Incision-edge necrosis occurred in 2 cases. One case suffered from incomplete medial plantar nerve injury. One case suffered from heel pad branch of the tibial nerve injury. Six cases suffered from sural nerve injury, and 4 cases sustained a lateral wound dehiscence due to a hematoma. No case suffered from lateral impingement syndrome. Up to now, no patient had to accept subtalar arthrodesis.Sinus tarsi approach provides good exposure to the subtalar joint. Open reduction and internal fixation of calcaneus fractures through a sinus tarsi approach allows adequate reduction with low risk of wound-healing complications.

Clinical curative effect of the exceed-calcaneocuboid-joint plate fixation in the treatment of Sanders III/IV calcaneal fracture

Objective To investigate the clinical curative effect of the exceed-calcaneocuboid-joint plate in the treatment of Sanders III/IV calcaneal fracture. Methods 58 cases(67 feet) with Sanders III/IV calcaneal fractures were selected.The patients were followed up for 1 year postoperation.The patients′ age, fracture classification, Maryland foot score, complications, and postoperative 1 day, postoperative 1 year Bohler corner, Gissane angle, height, and length of the calcaneus were recorded. Results The preoperative Bohler corner, Gissane angle, height and length of calcaneus were (7.9±4.2)°, (85.2±6.9)°, (30.6±2.6)mm, (65.5±2.1)mm, respectively, which of postoperative 1 day were (31.8±4.7)°, (128.6±8.1)°, (43.7±2.3)mm, (70.3±2.6)mm, respectively, which of postoperative 1 year were (31.9±4.8)°, (128.7±7.7)°, (43.5±2.1)mm, (70.2±2.8)mm, respectively.Compared with preoperation, the postoperative data were significantly improved, and the differences were statistically significant(postoperative 1 day compared with preoperation: t=7.13, 3.59, 4.14, 6.95, postoperative 1 year compared with preoperation: t=8.76, 3.92, 5.02, 7.17, all P<0.05). The excellent rate in exceed-calcaneocuboid-joint plate group was 91.04%. Conclusion Using exceed-calcaneocuboid-joint plate internal fixation for Sanders III/IV calcaneal fractures, can significantly improve the prognosis of patients and better restore height and length of the calcaneus, it is worthy of clinical application. Key words: Calcaneus fracture; Bone wires; Fracture fixation

Clinical and radiological outcomes of a cohort of 9 patients with anatomical fractures of the cuboid treated by locking plate fixation.

Cuboid fractures are very rare. Hence, their treatment has not been standardized. Advances in imaging techniques, particularly three-dimensional computed tomography (3D CT), and the introduction of cuboid-specific plates has improved the care of these injuries. The aim of this study was to determine the radiological and clinical outcomes of anatomical reconstruction of comminuted cuboid fractures with a locking plate. Fixation of comminuted cuboid fractures with a cuboid-specific locking plate leads to stable anatomical reduction and good functional outcomes. This was a retrospective study of 9 consecutive cases of comminuted cuboid fracture treated at a single hospital between January 2009 and December 2015. A 3D CT scan was performed preoperatively with subtraction of the posterior tarsal bone to allow the articular facets to be viewed and analyzed. Fracture fixation was done with a Locking Cuboid Plate (DePuy Synthes™). Associated lesions in the foot were treated during the same procedure. The patients were reviewed by an independent observer who performed a clinical examination, and determined the AOFAS and Maryland Foot Score. The success of the reconstruction was determined by comparing the parameters on weight-bearing X-rays views between the fixed and non-operated cuboid. The mean follow-up was 4.1 years (range 1-6). The Maryland Foot Score was 93.1 [86-100] and the AOFAS was 91.9 [82-100]. The reconstruction was anatomical and long lasting in all 9 cases. There was no foot misalignment in the frontal plane, based on the radiographs (hindfoot axis 5.5° [0-9]). The mean Djian-Annonier angle was 123.9° [108-130]. Cuboid fractures can be treated effectively through appropriate imaging and with a cuboid-specific locking plate as evidenced by very good midterm clinical and radiological outcomes in this study. IV Retrospective study.

Ultrasound Guidance Does Not Improve the Results of Shock Wave for Plantar Fasciitis or Calcific Achilles Tendinopathy: A Randomized Control Trial.

To establish whether the use of ultrasound to direct shock waves to the area of greater calcification in calcaneal enthesopathies was more effective than the common procedure of directing shock waves to the point where the patient has the most tenderness. Two-armed nonblinded randomized control trial with allocation concealment. The Sports Clinic at Sydney University. Participants 18 years or older with symptomatic plantar fasciitis (PF) (with heel spur) or calcific Achilles tendinopathy (CAT). Seventy-four of 82 cases completed treatment protocol and 6-month follow-up. Patients were randomized to receive either ultrasound-guided (UG) or patient-guided (PG) shock wave at weekly intervals over 3 to 5 weeks. Reduced pain on visual analog scale (VAS) and improved functional score on Maryland Foot Score (MFS) (for PF) or Victorian Institute of Sport Assessment-Achilles (VISA-A) (for CAT). Follow-up was at 6 weeks and 3 and 6 months. Comparative 6-month improvements in MFS for the 47 PF cases were PG +20/100 and UG +14/100 (P = 0.20). Comparative 6-month improvement in VISA-A score for the 27 CAT cases were PG +35/100 and UG +27/100 (P = 0.37). Comparative (combined PF and CAT) 6-month improvement in VAS pain scores for all 38 PG cases were +38/100 with +37/100 for all 36 UG shock wave cases. Although both treatment groups had good clinical outcomes in this study, results for the 2 study groups were almost identical. This study shows that there is no major advantage in the addition of ultrasound for guiding shock waves when treating calcaneal enthesopathies (PF and CAT).

Surgical Treatment of Confirmed Intraosseous Lipoma of the Calcaneus: A Case Series

Intraosseous lipoma of the calcaneus is a benign lesion formed by mature adipose tissue. When the lesion is symptomatic, the most frequent presentation is localized pain and soft tissue swelling. Because these lesions can regress spontaneously, conservative treatment methods are recommended. Operative excision is mostly required for painful lesions and pathologic fractures. The data from 14 patients with calcaneal intraosseous lipoma, who had undergone surgery in our clinic, were evaluated retrospectively. Using Milgram’s classification system, 9 lesions were classified as stage 1, 4 as stage 2, and 1 as stage 3. All lesions were occupying 100% of intracalcaneal cross-section in the coronal plane and >30% in the sagittal plane of magnetic resonance imaging sections. The mean preoperative visual analog scale score was 5.29 ± 1.14 (range 4 to 7), and the mean postoperative visual analog scale score at the last follow-up visit was 1.14 ± 0.36 (range 1 to 2), which was significantly better (p < .01). The mean Maryland foot score at the last follow-up visit was 97.71 ± 2.02 (range 95 to 100). The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score was 97.86 ± 2.11 (range 94 to 100) at the last follow-up visit. The differences between the pre- and postoperative values were statistically significant (p < .01). No recurrence had been detected within a median follow-up period of 84 months. Operative management of symptomatic lesions related to intraosseous lipoma of the calcaneus provides better results compared with the preoperative state.

Clinical effect of vacuum sealing drainage in the treatment of complex fracture and dislocation of foot with severe soft tissue injury

Objective: To observe the clinical effect of vacuum sealing drainage (VSD) in the treatment of complex fracture and dislocation of foot with severe soft tissue injury. Methods: From March 2012 to January 2015, a retrospective analysis of 108 cases of the foot closed complex fracture dislocation with severe soft tissue injury in Department of Foot and Ankle, the Second Hospital of Tangshan City, Tangshan.Injury mechanisms included press and crush injury, traffic accident.According to the operation the cases were divided into the VSD group (56 cases) and the control group (52 cases). The injury foot swelling after treated by open reduction and internal fixation or fusion joint fracture and dislocation. VSD technique was used to cover the wound and wound in group VSD. The wound was sutured, the sterile dressing was covered and the dressing was changed regularly in the control group. Results: Preoperative hospitalization time: 16 days in group VSD, 28 days in the control group; the total hospitalization time: 33 days in group VSD, 53 days in the control group; wound healing: 29 cases in VSD group, 12 cases in the control group; prolonged healing after dressing: 16 cases in VSD group, 13 cases in the control group; after skin grafting healing: 9 cases in VSD group, 17 cases in the control group; healed after flap transposition: 2 cases in VSD group and 10 cases in thecontrol group.The difference of the data of the two groups was statistically significant, P<0.05.Maryland foot score: 55-98 (average: 88.8, median: 91.5) points in VSD group, 38-97 (average: 84.85, median: 91) points in control group, compared with median by rank sum test, Z value: -2.755, the difference was statistically significant, P< 0.05.The late recovery effect rating: 39 casesexcellent, good 12 cases, can be 5 cases, no poor in VSD group, excellent 29 cases, good 8 cases, can be 11 cases, poor 4 cases in the the control group, the difference was statistically significant, P<0.05. Conclusion: VSD can shorten the preoperative waiting time and total hospitalization time, improve the wound healing rate directly, reduce the skin grafting and flap transfer replacement rate, reduce the secondary injury, increased fracture risk reduction and internal fixation, reduce joint fusion rate in the treatment of foot closed complex fracture and dislocation with severe soft tissue injury.

A new self-designed locking plate assembly for treatment of Sander II & III calcaneal fractures

Objective To report a new self-designed locking plate assembly suitable for treatment of displaced calcaneal fractures of Sanders types Ⅱ &Ⅲ via sinus tarsi approach. Methods We designed a new locking plate assembly suitable for treatment of displaced calcaneal fractures of Sanders types Ⅱ & Ⅲ via sinus tarsi approach. Its biomechanical performance was tested by standard electronic and mechanical devices. From March 2014 to October 2015, 18 patients with displaced calcaneal fracture were treated with our self-designed new locking plate assembly. They were 14 men and 4 women, aged from 32 to 66 years (average, 50.4 years). All the fractures were unilateral closed ones, with 7 cases of the left side and 11 ones of the right side. By the Sanders classification, 14 cases belonged to type Ⅱ (8 to type Ⅱa, 4 to type Ⅱb and 2 to type Ⅱc) and 4 to type Ⅲ (2 to type Ⅲab, one to type Ⅲac and one to type Ⅲbc). The Bohler angle, Gissane angle, and height, width and length of the calcaneus were measured and compared at preoperation, postoperative 3 months and final follow-ups. The clinical outcomes were evaluated using Maryland foot score system atfinal follow-ups. Results This new locking plate assembly could tolerate a maximum vertical load of 1,396.03 N and a maximum horizontal anti-bending load of 427.15 N. It broke after it had been subjected to 93,003 loadings in a repeated 500 N stress test. All the 18 patients were followed-up for an average of 9.3 months (from 6.0 to 13.5 months). Follow-ups at 3 months postoperation showed significant improvements in Bohler and Gissane angles and calcaneal height, width and length compared with pre-operative parameters (P 0.05). Maryland foot scores demonstrated 12 excellent cases, 3 good ones and 3 fair ones. No incision infection, implant failure, nonunion or malunion happened in this series. Conclusions This new locking plate assembly suitable for sinus tarsi approach can be used in clinic because it has advantages of easy placement, rigid fixation, satisfactory functional recovery of the foot and limited complications. Key words: Calcaneus; Surgical procedures, minimally invasive; Fracture fixation, internal; Bone plate assembly