Treatment Of Intra-articular Fractures Research Articles

Modern aspects in the treatment of intra-articular fractures and fractures of the proximal interphalangeal joints of the three-phalangeal fingers of the hand, as well as their consequences

BACKGROUND: Proximal interphalangeal joint intra-articular fractures are a prevalent problem in traumatology and orthopedics. Damage typically develops at the base of the middle phalanx due to a collision with the head of the proximal phalanx. As a result, the fingers function declines significantly, which inevitably impacts the function of the entire brush. Compared with long-standing injuries, treating patients with this pathology in the acute period of injury is more likely to result in limb function restoration. Suppose an intra-articular fracture is underestimated or missed in the early stages. In that case, the doctor may eventually encounter chronic pain syndrome, joint and/or stiffness, and more time-consuming treatment procedures. There are many methods of treatment for both acute and long-standing injuries, each with advantages and disadvantages.
 OBJECTIVE: To describe, in our opinion, the most effective modalities of therapy for patients with these injuries in the early stages (up to 4 weeks from the time of injury) and long-term periods (more than 4 weeks).
 MATERIALS AND METHODS: The Suzuki external fixation spoke device (pins and rubber traction system [PRTS]) was used to treat 26 patients with fractures and dislocations of the base of the middle phalanx of the three-phalangeal fingers of the hand in the acute period of injury. Arthroplasty of the base of the middle phalanx with a hook bone graft (hemihamate) with its modifications was used in the treatment of 23 patients with inadequately fused intra-articular fractures of the base of the middle phalanx of the three-phalangeal fingers of the hand. All patients underwent physical examinations, X-rays, and/or CT scans to diagnose and confirm or clarify the nature of the damage. All patients developed passive/active movements early in the operated section during the postoperative period.
 RESULTS: The patient estimated the VAS pain syndrome at 46 points on the scale; however, after 68 weeks, this indicator was 01 points. After 68 weeks, the amplitude of movements in the proximal interphalangeal joint of the fingers from the average of 3050 after 68 weeks, was reached the average of 1595. There was a 1520 extensor contracture in two patients.
 CONCLUSION: The treatment of patients with intra-articular fractures and fracture-dislocations in the proximal interphalangeal joint of the three-phalangeal fingers of the hand, as well as their consequences, is a complex current problem in traumatology and orthopedics with no one-word universal solution. To select treatment strategies, a comprehensive evaluation of the patient, correct verification and interpretation of the existing damage, and a thorough understanding of the anatomy of the fingers and the hand are required.

Treatment of intra-articular fractures and fracture-dislocations fingers of the wrist in acute and long-distant periods

This review is devoted to the problem of treating patients with intra-articular fracture dislocations affecting the finger proximal interphalangeal joint and their consequences. Although these traumas are quite common among hand injuries, there is currently no single universal approach to their treatment. The review was conducted using literature databases, PubMed and eLibrary. The work highlights the joint anatomy, injury mechanisms, diagnostic methods, classification variations, and treatment methods.

Clinical Results of Distal Radius Intraarticular Comminuted Fractures in the Elderly: A Retrospective Comparative Analysis of Different Fixation Methods.

IntroductionDistal radius intraarticular fractures in the elderly population are likely to cause impaired clinical outcomes. Intraarticular fracture treatment in the literature is a debatable issue with mixed results. Here, we aimed to present a tertiary trauma center experience with plate fixation and K wire-assisted external fixator in elderlies over 60 years old.Material and methodsPatients who were diagnosed with an unstable intraarticular distal radius fracture and received surgical treatment with plate fixation or K wire-assisted external fixator between 2016 January and 2020 January were included in the study. Patients were evaluated retrospectively in terms of radiologic stability criteria and clinical outcomes.ResultsThere were 27 patients; 14 in the volar plate group (group 1) and 13 (group 2) in the external fixator group. The mean age was 64.2 (60-72) in group 1 and 67.7 (60-76) in group 2. The mean follow-up time was 31.6 (12-63) in group 1 and 28.8 (12-59) in group 2. The mean quick disabilities of the arm, shoulder, and hand (Q-DASH) score was 25.7 (5-75) in group 1 and 24.4 (10-87) in group 2. The mean patient-reported wrist evaluation (PRWE) was 27.1 (6-87) in group 1 and 31.4 (10-87) in group 2. There was no statistical difference between groups in terms of clinical scores, hospital stay, follow-up, and complications. (p>0.05).ConclusionAlthough open reduction and plate fixation and K wire-assisted external fixator are viable options for providing radiologic union, unsatisfactory clinical outcomes were maintained independently of the fixation method in elderly patients.

A Comparison of Functional Outcome Following Conservative or Operative Treatment of Intra-Articular Fractures of Calcaneum

A Comparison of Functional Outcome Following Conservative or Operative Treatment of Intra-Articular Fractures of Calcaneum

Outcomes following the operative treatment of intra-articular fracture combined with medial patellofemoral ligament reconstruction after patellar dislocation

PurposeWe examine the outcomes following operative treatment of intra-articular fracture combined with medial patellofemoral ligament (MPFL) reconstruction after patella dislocation.MethodsPatients were retrospectively identified from medical records using diagnostic and surgical procedure codes. Radiological anatomical parameters and bony abnormalities of injured knees were assessed from magnetic resonance images (MRI). Inclusion criteria were traumatic patellar dislocation with chondral or osteochondral fracture and MPFL rupture, operative treatment of a chondral or osteochondral fracture combined with MPFL reconstruction, and minimum follow-up of 2 years. Outcomes were measured using the Kujala score, Tegner activity scale, and the Knee injury and Osteoarthritis Outcome Score Quality-of-Life subscale (KOOS-QLS).ResultsDuring 2012 and 2015, 322 patients were treated because of patellar dislocation. Thirty-three patients had chondral or osteochondral fracture. Eleven patients (five males and six females) with a mean [standard deviation (SD)] age of 17.0 (6.5) years at the time of surgery met the inclusion criteria and were included. Five of the 11 patients had a subchondral and six an osteochondral fracture. Eight patients had a fracture in the patella and three in the femur. All patients had bony abnormalities in the knee. Nine out of 11 patients scored over 90/100 points on the Kujala scale and had good results on the Tegner scale [before surgery 5.0 (2.7) points versus after surgery 5.3 (1.6) points] and the KOOS-QLS [4.1 (4.2) points] outcome measures.ConclusionThe removal or fixation of the fracture fragment combined with MPFL reconstruction is a feasible option in the treatment of symptomatic osteochondral or subchondral fragment in traumatic patellar dislocation. The short-term outcomes are encouraging.Level of evidence: Level IV, retrospective case series.

The use of bioresorbable implants in combined osteosynthesis of an intra-articular fracture of the distal humerus (case report)

Intra-articular fractures of the elbow joint are severe for the treatment of damage. Methods of treatment of intra-articular fractures of the distal humerus are immersion osteosynthesis with spokes and screws, bone and transosseous osteosynthesis. However, the percentage of complications and unsatisfactory outcomes of surgical treatment of these injuries remains high. The unsatisfactory results of treatment include contractures, ossification, post-traumatic arthrosis, as well as purulent-inflammatory complications of surgical treatment. Our accumulated experience of osteosynthesis of intra-articular fractures of the distal humerus with the help of submersible implants, experience of hardware treatment of joint injuries and their consequences (developed in the Department of Adult Orthopedics of the National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov), allowed us to offer surgical techniques for the combined use of these methods. The article presents a case of successful surgical treatment of a patient with a comminuted intra-articular fracture of the distal humerus by osteosynthesis with bioresorbable implants in combination with a hinge-distraction apparatus for external fixation by O.V. Oganesyan. A detailed description of the technique of osteosynthesis, postoperative rehabilitation is given. The described clinical case shows the effectiveness of the combined osteosynthesis technique and the advantages of using bioresorbable fixators over metal implants.

PREDISPOSING FACTORS AND TREATMENT OF OSTEOARTHRITIS AFTER SURGERIES PERFORMED FOR TIBIAL FRACTURES


 
 
 Tibial fractures are very common injuries that require surgical management. For many cases, when the fracture involves the joint further complications occur, such as joint stiffness, osteoarthritis, aseptic necrosis of articular surfaces, ankylosis, infection complications, etc. To prevent joint stiffness open reduction and internal fracture fixation is used. That allows better positioning of fracture fragments forming joint surface and improve outcome. The article analyses results of surgical treatment of intraarticular fractures as well as biomechanical factors that are affecting the joint within the healing process and in later outcome period. Various treatment procedures are suggested to prevent development of osteoarthritis or to decrease its severity. The following options are used on all stages of treatment starting since the moment of injury, primary surgical procedures, rehabilitation period, and further non-surgical treatment in the internal medicine department. Important roles are assigned for use of chondroprotective drugs, intraarticular injections of Hyaluronic acid, physiotherapy and physical activity.
 
 

Treatment of intra-articular calcaneal fractures by plate fixation via lateral transverse incisions and double-window approaches

Objective To explore the clinical efficacy of plate fixation via the lateral transverse incisions and double-window approaches for the treatment of intra-articular calcaneal fractures. Methods A retrospective analysis was performed on the data of 21 intra-articular calcaneal fractures (22 feet) which had been treated at Department of Orthopaedics, The Second Affiliated Hospital to Anhui Medical University from May 2014 to April 2016. There were 19 males and 2 females, aged from 20 to 60 years (average, 38.3 years). The fracture affected 13 left feet and 9 right feet. According to the Sanders classification, 10 feet were type Ⅱ, 11 type Ⅲ and one type Ⅳ. They were treated by plate fixation via the lateral transverse incisions and double-window approaches. Early complications within 3 months after operation, the length, width, height, Bohler angle and Gissane angle of the calcaneus one year after operation, functional recovery of the affected feet at the last follow-up, and complications were recorded. Results The 21 patients were followed up for 21 to 44 months (mean, 36.7 months). Incisions were all healed at the first postoperative stage with no serious skin or soft tissue complications like superficial infection, deep infection or wound dehiscence. At the early stage, one patient suffered epidermal necrosis at the margin of incision, which was cured after dressing change. None of the patients developed subtalar arthritis by the last follow-up. The preoperative length, width, height, Bohler angle and Gissane angle of the calcaneus (respectively, 68.6±1.2 mm, 46.7±0.8 mm, 39.1±2.0 mm, 5.4°±12.1° and 104.3°±10.2°) were significantly improved to 71.7±1.6 mm, 48.8±2.0 mm, 32.8±1.3 mm, 29.2°±6.8°, and 120.8°±6.2° one year after operation(P<0.05). At the last follow-up, their AOFAS ankle-hind foot scores averaged 92.7 points (from 73 to 98 points); 17 feet were rated as excellent, 3 as good and 2 as moderate, giving an excellent and good rate of 90.1%. Conclusion Plate fixation via the lateral transverse incisions and double-window approaches can reduce incidences of postoperative soft tissue complications and subtalar arthritis, leading to good clinical results in the treatment of intra-articular calcaneal fractures. Key words: Calcaneus; Fractures, bone; Fracture fixation, internal; Surgical approach

Modified dynamic external fixator traction for the treatment of intra-articular fractures of the base of the middle phalanx

Objective To explore the clinical efficacy of modified dynamic external fixator traction for the treatment of intra-articular fractures of the base of the middle phalanx. Methods From March 2015 to February 2018, 22 patients with fractures of the base of the middle phalanx were treated with close reduction and self-made modified dynamic external fixator traction. Among them, 5 patients suffered from comminuted fracture of the base of the middle phalanx, and 17 patients suffered from palmar edge fractures. The joint mobility and hand grip were measured at the last follow-up. Results All the patients achieved bony union. The flexion and extension exercises were performed after operation, and the flexion and extension of interphalangeal joints were good. No nail infection, pain and joint stiffness occurred. All the patients were follow-up from 8 to 20 months with an average 11.5 months. According to the total active motion (TAM) score system, the results were rated as excellent in 16 cases, good in 5 cases and fair in 1 case. Conclusion The modified dynamic external fixator traction is reliable in the treatment of intra-articular fractures of the base of the middle phalanx. It does not destroy the blood supply and soft tissue at the fracture end. It is conducive to fracture healing. The external fixator has simple structure and does not need to fix joints. It can exercise flexion and extension function of interphalangeal joint in early stage, and is conducive to restoring hand function as soon as possible. Key words: Finger phalanges; External fixators; Intra-articular fracture

Surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation

Objective To evaluate the surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation. Methods From February 2014 to June 2017, 15 patients (15 feet) with intra-articular calcaneal fracture associated with peroneal tendon dislocation were treated at Department of Foot and Ankle Surgery, Orthopaedics Hospital of Zhengzhou. There were 9 males (9 feet) and 6 females (6 feet), and 8 left feet and 7 right feet. The patients were aged from 20 to 55 years (average, 42.5 years). After reduction of calcaneal fractures, titanium plates and screws were used for fixation. The bone canal was established on the lateral malleolus, and the torn superior peroneal retinaculum was fixed to the lateral malleolus by suture after reduction of the peroneal tendon. The ankle joint was immobilized with a plaster brace in the metatarsal flexion for 6 weeks. The postoperative outcomes were evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS) score and visual analogue scale (VAS); complications were recorded. Results All the 15 patients were followed up for 12 to 36 months (average, 20.5 months). All the calcaneal fractures fully healed and no re-dislocation of the peroneal tendon occurred. The AOFAS hindfoot-ankle scores ranged from 80 to 95 points, averaging of 87.4 points; the VAS scores ranged from 0 to 5 points, averaging 1.5 points. Delayed wound healing was observed in one case but primary healing was achieved eventually with regular dressing change. Another case presented with symptoms of injury to the cutaneous branch of the sural nerve which disappeared after oral administration of neurotrophic drugs for 6 months. Another case suffered from subtalar arthritis accompanied by persistent pain which disappeared after subtalar arthrodesis. No other complications were observed in the other patients. Conclusion In the surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation, the peroneal tendon dislocation should be treated simultaneously with the intra-articular calcaneal fracture to achieve satisfactory clinical outcomes. Key words: Calcaneus; Fractures; Fracture fixation, internal; Peroneal tendon; Dislocation

Diagnostic value of radiography for intra-articular fracture of distal radius with wrist instability

Objective To study the clinical value of radiographic diagnosis of intra-articular fractures of distal radius with instability of wrist joint. Methods From July 2017 to June 2018, 72 patients with intra-articular fracture of distal radius with wrist instability in Yiwu Central Hospital were divided into two groups according to random digital table, with 36 patients in each group.The control group was examined by X-ray.The observation group was diagnosed by X-ray and CT.The results of diagnosis and treatment of intra-articular fracture of distal radius with wrist instability were compared between the two groups. Results In the observation group, the detection rates of the radius shortened(58.33%), the ulnar angle changed(86.11%), the dorsal articular surface compressed and collapsed(83.33%), the articular surface separated(77.78%), the bone mass of the articular surface more than 3 (63.89%), fracture with ulnar subluxation (69.44%) were higher than those of the control group(33.33%, 58.33%, 61.11%, 52.78%, 41.67%, 44.44%), the differences were statistically significant(χ2=4.532, 6.923, 4.431, 4.963, 4.531, 4.589, all P<0.05). The 1-month recovery rate(88.89%) and 2-month recovery rate(94.44%) in the observation group were higher than those in the control group(69.44%, 77.78%), the differences were statistically significant(χ2 =4.126, 4.181, all P<0.05). Conclusion The combined use of X-ray and CT in the diagnosis of intraarticular fracture of distal radius with instability of wrist joint has a higher diagnostic accuracy and can provide valuable reference for clinical treatment. Key words: Radius fractures; Intra-articular fractures; Wrist joint; Radius; Arthrogryposis; Dislocations; Radiography; Tomography, X-ray computed

Homeopathic closed leverage anatomical plate with compression bolt for treatment of displaced intra-articular calcaneal fractures

Objective To compare the treatment of displaced intra-articular calcaneal fractures by homeopathic closed leverage anatomical plate with compression bolt through small posterior lateral approach vs. traditional open reduction and internal fixation. Methods A retrospective case control study was made on 98 cases of displaced intra-articular calcaneal fractures admitted from September 2012 to May 2015. According to the random number table, the subjects were assigned to homeopathic closed leverage anatomical plating with compression bolt through small posterior lateral approach (experiment group, 58 cases, 66 sides) and open reduction and internal fixation through L-shape approach (control group, 40 cases, 45 sides). Experiment group consisted of 50 male and eight females cases aging from 27-56 years (mean, 41.9 years), and the Sanders classification was 40 cases of type Ⅱ, 24 type Ⅲ and two type Ⅳ. Control group consisted of 36 male and four female cases aging from 25-58 years (mean, 43.7 years), and the Sanders classification was 25 cases of type Ⅱ, 18 type Ⅲ and two type Ⅳ. Operation time, bone reduction, postoperative Bohler's angle, width of the calcaneum, and incision healing were recorded. Functional outcomes were evaluated with Maryland hindfoot scoring system at last follow-up. Results Operation time was (52.6±11.2)min in experiment group, significantly shorter than that in control group [(86.4±14.1)min] ( P 0.05). Postoperative Bohler's angle was (28.0±6.2)° in experiment group, and (26.8±7.0)° in control group (P>0.05). Width of the calcaneum was (31.3±3.6)mm in experiment group and (34.9±4.0)mm in control group (P 0.05). Conclusion Homeopathic percutaneous leverage and anatomical plate with compression bolt through small posterior lateral approach is an effective method for treatment of displaced intra-articular calcaneal fractures, for it has advantages of minimal invasion, less operation time, good reduction and function, and less wound complications. Key words: Calcaneus; Intra-aticular fractures; Percutaneous leverage

Comparison of uniaxial and polyaxial locking plate fixation for complex intraarticular calcaneal fractures

Objective To compare the radiographic and clinical outcomes of uniaxial and polyaxial locking plates used in the treatment of complex intraarticular calcaneal fractures. Methods A retrospective comparative study was performed on the 50 patients with intraarticular calcaneal fracture (Sanders types Ⅲ and Ⅳ) who had been treated by uniaxial locking plates (n=26) or polyaxial locking plates (n=24) between January 2013 and June 2015. Operation time, intraoperative bleeding, union time, radiological and functional outcomes and functions by the Maryland foot score were compared between the 2 groups. Results All the patients were followed up for 12 to 44 months(average, 20.8 months). There were no significant differences between the 2 groups in average operation time (105.2±18.2 min versus 95.5±17.7 min), average intraoperative bleeding (125.2±23.4 mL versus 120.3±21.5 mL), or union time (12.1±3.7 weeks versus 11.8±3.7 weeks) (P>0.05). All patients obtained bony union. The polyaxial locking plates group displayed significantly better Bohler and Gissane angles at 3 and 12 months after operation than the uniaxial locking plates group (P< 0.05). Evaluated by the Maryland foot score, the excellent and good rate for the polyaxial locking plates group [91.7%(22/24)] was insignificantly higher than that for the u-niaxial locking plates group[84.6%(22/26)] (P=0.267). Conclusions Both uniaxial locking and polyaxial locking plates can lead to satisfactory therapeutic outcomes for complex intraarticular calcaneal fractures, but polyaxial locking plates may be superior in stability and functional recovery. Key words: Calcaneus; Fractures, bone; Bone plate; Fractures fixation, internal

Minimally invasive internal fixation combined with external fixator for treatment of intra-articular fracture of the base of the first metacarpal

Objective To investigate the method and clinical outcomes of minimally invasive internal fixation combined with external fixator for treatment of intra-articular fracture of the first metacarpal base. Methods From September 2014 to April 2016, eleven patients with intra-articular fractures of the base of the first metacarpal were treated. All the fractures were preliminarily fixed with Kirschner wire using minimally invasive technique to avoid open reduction. Small incision was made for these that could not be fixed with closed reduction. Then an external fixator was applied to distract the first carpometacarpal joint for 2 to 3 mm and maintain the reduction. The forearm was immobilized with a plaster cast. Results The time of fracture healing was 7 to 9 weeks, the average being 7.6 weeks. The external fixator was removed at 5 to 6 weeks postoperatively when functional exercise was resumed. Postoperative follow-up ranged from 4 to 18 months with an average of 10.5 months. Functions of the involved thumb were evaluated by the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association at final follow-up, which revealed excellent results in 8 cases, good in 2 cases, and fair in 1 case. Conclusion For intra-articular especially comminuted fractures of the base of the first metacarpal, application of external fixator combined with Kirschner wire to fix the fracture and distract the MP joint gives rise to satisfactory results. Key words: Metacarpal bones; External fixators; Intra-articular fracture; Comminuted fracture

Dynamic external traction combined with internal fixation for treatment of comminuted intra-articular fractures of the base of the thumb proximal phalanx

Objective To document the efficacy of our modified dynamic external traction system that is applied concomitantly with internal fixation for comminuted fractures at the base of thumb proximal phalanx. Methods From March 2009 to July 2014, 7 cases of comminuted fractures at the base of thumb proximal phalanx with metacarpophalangeal(MP) joint involvement (AO type C fractures) were treated with open or close reduction and internal fixation. Meanwhile a dynamic external traction system was applied. Postoperative exercise started early.Range of motion of the MP joint, pinch strength and postoperative complications were evaluated. Results Postoperative follow-up period ranged from 13 to 32 months, with an average of 18 months. The mean plaster splint immobilization time was 7.7 days (range, 3 to 14 days). The external fixator was removed at 4.3 weeks on average (range, 4 to 6 weeks). The internal fixation hardware removal time was 7.2 weeks postoperatively on average (range, 6 to 9 weeks). All the patients were able to return to their original jobs. The average active range of motion for the MP joint of the thumb was 8.6° (range, 5° to 10°) extension and 42.4° (range, 35° to 50°) flexion. Mean pinch strength was 89% of that of the contralateral side. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 5 cases and good in 2 cases. Conclusion Dynamic external traction system combined with internal fixation can provide reliable fracture fixation and allow early mobilization of the MP joint. The variable traction force can effectively maintain joint stability during movement and reduce adhesion and contracture of the joint. Key words: Thumb; Finger phalanges; Intra-articular fractures; Dynamic traction

Arthroscopy Assisted 2 Cannulated Screw Fixation for Transverse Glenoid Fracture: A Case Report

Arthroscopy is recognized as an important adjunct in treatment of intra-articular fractures. The author reports on successful treatment of a displaced transverse glenoid cavity fracture, reduced and fixed with arthroscopic assist, using two cannulated screws perpendicular to the fracture surface, in a patient with frail chest. One screw passed through the Neviaser portal, and the other screw passed through the base of the coracoid process. Arthroscopy assisted reduction and 2 cannulated screw fixation through the Neviaser portal and coracoid base appears to be a good method for treatment of transverse glenoid fractures.

Fracturas de calcáneo: controversias y consensos

Calcaneal fractures are the most common tarsal fractures, 75% of them considered as intra-articular. Definitive treatment remains today debated. We intend in this update to highlight the points of controversy and clarify the consensus, especially in the treatment of intra-articular fractures, and to describe the management of major complications.

Оперативное лечение внутрисуставных переломов дистального отдела бедренной кости в условиях городского хирургического стационара

Оперативное лечение внутрисуставных переломов дистального отдела бедренной кости в условиях городского хирургического стационара

Fixation of intra-articular calcaneal fractures aided by self-designed director for sustentaculum tali screwing

Objective To evaluate our self-designed director for sustentaculum tali screwing used to fixate intra-articular calcaneal fractures in comparison with a conventional screwing director. Methods From May 2012 to October 2013, a total of 40 patients received surgical treatment of intra-articular calcaneal fracture at our department. Our self-designed director for sustentaculum tali screwing was used in 20 of them (24 feet, group A) while a conventional screwing director was used in the other 20 patients (22 feet, group B). The 2 groups were compatible in preoperative clinical data, showing no significant differences (P>0.05). The operation time, fluoroscopy frequency, rate of accurate screwing, and Maryland foot scores were compared between the 2 groups. Results The patients were followed up for an average of 15 months (range, 12 to 24 months). Group A had shorter operation time (77.8±9.5 min) than group B (84.4±9.4 min), lower fluoroscopy frequency (2.5±0.9 times) than group B (4.1±1.3 times), a higher rate of accurate screwing (91.7%) than group B (68.2%), and a higher excellent to good rate by Maryland foot scoring (91.7%) than group B (63.6%). The above differences were all statistically significant (P< 0.05). Conclusion In the treatment of intraarticular calcaneal fractures, our self-designed director for sustentaculum tali screwing can significantly enhance the accuracy in fixation of sustentaculum tali to ensure good clinical outcomes. Key words: Calcaneus; Fractures, bone; Fracture fixation, internal; Director for sustentaculum tali screwing

Individualized reconstruction plate for treatment of calcaneal fractures via tarsal sinus incision

Objective To investigate the clinical efficacy of individualized reconstruction plate in the treatment of calcaneal fractures through the tarsal sinus incision. Methods From May 2010 to September 2012, we treated 46 cases of calcaneal fracture (51 feet) involving talocalcaneal joint. They were 35 males and 11 females, 17 to 65 years of age (average, 35 years). The injury affected the left foot in 24 cases, the right foot in 17, and both feet in 5. By the Sander's classification, 30 feet were type Ⅱ and 21 type Ⅲ. The fractures were reduced through the tarsal sinus incision before internal fixation with individualized reconstruction according to the morphology of fracture. When necessary, fixation with hollow screws was added. The Bohler and Gissane angles were compared between preoperation and postoperation. The clinical efficacy was evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) system. Results The patients were followed up for 8 to 14 months (average, 12 months). No such complications as incision infection, skin necrosis, plate loosening or exposure occurred in this group. There were significant differences in the Bohler and Gissane angles between preoperation and postoperation [(31.70°±5.50° and 122.10°±6.79° at 3 days postoperation) and (30.95°±3.47° and 122.49°±4.83° at 6 months postoper-ation) versus (6.14°±1.58° and 91.63°±4.76° at preoperation)] (P 0.05). All the patients obtained bony union at 6 months postoperation. According to the AOFAS scores, 38 feet were ex-cellent, 9 feet good and 4 feet fair, giving an excellent to good rate of 92.2% . Conclusion In the treatment of intra-articular calcaneal fractures through the tarsal sinus incision, application of individualized reconstruction plate can lead to fine fracture reduction, rigid internal fixation, early exercise, and decreased incision-related complications. Key words: Calcaneal fracture; Fracture fixation, internal; Bone plates