Sanders Classification Research Articles

Sinus tarsi approach with trans-articular fixation for displaced intra-articular fractures of the calcaneus.

The charts and radiographs of 99 patients with 106 intraarticular fractures of the calcaneus were retrospectively reviewed. There were 75 men and 24 women. The average age was forty-two (range, 17 to 81). Fifty-seven of the fractures were left and 49 were right. The mechanism of injury was a fall from a height in 69 patients and motor vehicle accident in 30 patients. According to Sanders classification, seventy-one cases (67%) had type II fractures, 25 cases (23.6%) had type III, and ten cases (9.4%) had type IV. All the patients had operative management through a limited sinus tarsi approach with minimal fixation of the fracture with one or several pins. One of the pins was usually applied from the talus to the calcaneus through the fracture after reduction of the posterior facet. Nine cases (8.5%) developed postoperative infection, four cases (3.8%) had superficial wound infection, four cases (3.8%) had pin tract infection and one case (0.9%) had osteomylitis. Our follow-up at an average of 29 months (range, 12 to 84 months) showed that the American Orthopedic Foot and Ankle Society, Ankle-Hindfoot Score for the all group was 77.6 (range, 31-91). Forty-one fractures (38.8%) were graded excellent, 39 fractures (36.7%) good, 14 fractures (13.2%) fair, and 12 fractures (11.3%) were failures. Although radiological degenerative changes in the subtalar joint were seen in 41 cases (38.7%), only six cases (5.6%) required subsequent subtalar fusion. The authors conclude that the operative method used in the current study which followed the principle of minimal soft tissue damage and minimal internal fixation may be a good option for management of calcaneus fractures.

しょう骨関節内骨折の治療経験

From 1990 to 1998, 26 displaced intra-articular calcaneal fractures were treated operatively using lateral approach fundamentally. Results were evaluated using the Sanders classification with computed tomography and Maxifield clinical evaluation. Good postoperative evaluation results with CT scan, and anatomical reduction were achieved in 85% of these patients. Irrespective of the grades of the Sanders classification, the postoperative evaluation results of the CT scan were more or less satisfactory. The Maxifield clinical evaluation results were excellent in 42%, very good in 58%, fair and poor in 0%. Our clinical evaluation results more or less agreed with postoperative evaluation results by CT scan. We conclude that open reduction and internal fixation are effective in the treatment of displaced intra-articular calcaneal fractures.

Treatment of intraarticular calcaneal fractures in adults. A treatment algorithm

Significant progress has been made in terms of the management of calcaneal fractures. This is reflected in the marked decrease in complication rates associated with the current intervention of these potentially devastating injuries. The treatment priorities that, in the authors opinion, are key to achieve best results in a displaced calcaneal fracture are anatomic reconstruction of the entire calcaneus: articular surfaces, height, alignment, and length, with a function directed postoperative management. The value of these priorities are confirmed by the authors longterm follow-up results as presented here. To reemphasize, conservative treatment should be considered only in cases of extraarticular fractures, minor displaced intraarticular fractures in nonambulatory patients, and in cases where there is a clear contraindication for surgery. Regarding the technical requirements for an anatomic reconstruction, the os calcis fracture should be categorized as a procedure for experts. In two-part fractures, according to the Sanders classification, an anatomical reduction is obtainable in more than 80%-90% of cases. However, in consideration of the articular cartilage damage, a 70% rate of good to excellent clinical results seems realistic. In three-part fractures, anatomic reduction is attainable in about 60% of cases with a 70% rate of good results. These two subgroups comprise about 90% of all calcaneus fractures. It is the authors recent experience to optimize the extended lateral approach using posteromedial and anterolateral windows, so that an anatomic reduction in more than 60% of Sanders Type III os calcis fractures can be achieved. Further scientific work in this area of trauma orthopedics would benefit most from a general consensus on a fracture classification system and on a clinical scoring system, with 5 year follow-up studies using these treatment methods and evaluation systems.

Pathoanatomy of intra-articular fractures of the calcaneus.

Radiographs of 220 calcaneal fractures (205 patients) were reviewed retrospectively. One hundred and sixty-three fractures were intra-articular; thirty (18 per cent) of the 163 fractures were a tongue-type injury, and 133 (82 per cent) were a joint-depression injury. Plain radiographs and computerized tomography scans in the coronal and axial planes were available for 116 intra-articular fractures (106 patients). These studies were reviewed, and the 116 fractures were grouped according to the Sanders classification of calcaneal fractures and the anterior extension of the primary fracture line was evaluated. Sixty-two primary fracture lines (53 per cent) extended into one articular surface; twenty-three (20 per cent), into two articular surfaces; twenty-three (20 per cent), into a periarticular location; and eight (7 per cent), into a medial or lateral location. Sixty-seven (58 per cent) involved the calcaneocuboid joint, thirty-one (27 per cent) involved the anterior facet of the talocalcaneal joint, and ten (9 per cent) involved the middle facet of the talocalcaneal joint. A distinct anterolateral fragment was identified in 108 fractures (93 per cent). Plain radiographs failed to demonstrate the anterior extension of fifty-one (47 per cent) of the primary fracture lines. The prevalence of involvement of the anterior facet was significantly greater in Sanders type-III fractures (sixteen of thirty-five; 46 per cent) than in the other types (p < 0.01). The prevalence of involvement of the calcaneocuboid joint and the middle facet was evenly distributed among the fracture types. The primary fracture line typically extends anterior to the angle of Gissane, creating a relatively consistent anterolateral fracture fragment. The primary fracture line cannot be reliably seen on plain radiographs and is better visualized on computerized tomographic scans.

Integrated Homology Modelling and X-Ray Study of Herpes Simplex Virus I Thymidine Kinase: A Case Study

Knowledge-based homology modelling together with site-directed mutagenesis, epitope and conformational mapping is an approach to predict the structures of proteins and for the rational design of new drugs. In this study we present how this procedure has been applied to model the structure of herpes simplex virus type 1 thymidine kinase (HSV1 TK, HSV1 ATP-thymidine-5′-phosphotransferase, EC 2.7.1.21). We have used, and evaluated, several secondary structure prediction methods, such as the classical one based on Chou and Fastman algorithm, neural networks using the Kabsch and Sander classification, and the PRISM method. We have validated the algorithms by applying them to the porcine adenylate kinase (ADK), whose three-dimensional structure is known and that has been used for the alignment of the TKs as well. The resulting first model of HSV1-TK consisted of the first β-strand connected to the phosphate binding loop and its subsequent α-helix, the fourth β-strand connected to the conserved FDRH sequence and two α-helix with basic amino acids. The 3D structure was built using the X-ray structure of ADK as template and following the general procedure for homology modelling. We extended the model by means of COMPOSER, an automatic process for protein modelling. Site-directed mutagenesis was used to experimentally verify the predicted active-site model of HSV1-TK. The data measured in our lab and by others support the suggestion that the FDRH motif is part of the active site and plays an important role in the phosphorylation of substrates. The structure of HSV1 TK, recently solved in collaboration with Prof. G. Schulz at 2.7 Å resolution, includes 284 of 343 residues of the N-terminal truncated TK. The secondary structures could be clearly assigned and fitted to the density. The comparison between crystallographically determined structure and the model shows that nearly 70% of the HSV1 TK structure has been correctly modelled by the described integrated approach to knowledge based ligand protein complex structure prediction. This indicate that computer assisted methods, combined with manual” correction both for alignment and 3D construction are useful and can be successful.

Operative Treatment of Intra-articular Fractures of the Calcaneus by Sanders Classification

Operative Treatment of Intra-articular Fractures of the Calcaneus by Sanders Classification