ObjectiveTo compare the effectiveness of robot assisted internal fixation and traditional open reduction and internal fixation for calcaneal fractures.MethodsThe clinical data of 44 patients (44 feets) with calcaneal fracture admitted between October 2017 and December 2018 who met the selection criteria were retrospectively analyzed. According to different operation methods, they were divided into trial group (19 cases, treated with robot assisted percutaneous reduction and cannulated screw fixation through tarsal sinus incision) and control group (25 cases, treated with open reduction and internal fixation via traditional tarsal sinus incision). There was no significant difference in gender, age, injured side, cause of injury, fracture type, time from injury to operation, and preoperative Böhler angle, Gissane angle, calcaneus width, American Orthopedic Foot and Ankle Association (AOFAS) score, and other general data between the two groups (P>0.05). The operation time, intraoperative fluoroscopy frequency, and fracture healing time were recorded and compared between the two groups. Before operation and at 6 months after operation, the Böhler angle and Gissane angle were measured on the lateral X-ray film, and the calcaneal width was measured on the axial X-ray film of the calcaneus to evaluate the recovery of the deformity and collapse after surgical treatment; the AOFAS score was used to evaluate the function of the affected foot and ankle joint.ResultsThe operation time of the trial group was significantly longer than that of the control group (P<0.05), but the intraoperative fluoroscopy frequency was significantly less than that of the control group (P<0.05). In the control group, 1 case had skin necrosis, and 1 case had a little leakage from the incision; the rest of the two groups had no skin- and incision-related complications. Patients in both groups were followed up 6-12 months, with an average of 9.5 months. At 6 months after operation, the Böhler angle, Gissane angle, and calcaneal width in the two groups were significantly improved when compared with preoperative ones (P<0.05), and there was no significant difference between the two groups (P>0.05); the fractures in the two groups were healed, there was no significant difference in healing time (t=–1.890, P=0.066); the AOFAS scores of the two groups were significantly higher than those before operation (P<0.05), and the AOFAS score of the trial group was significantly higher than that of the control group (t=–3.135, P=0.003).ConclusionCompared with traditional C-arm fluoroscopic internal fixation for calcaneal fractures, robot-assisted internal fixation via tarsal sinus incision for calcaneal fractures significantly improves the function of the affected foot and maintains the accuracy of nail implantation after fracture reduction, reducing intraoperative fluoroscopy times, and the fracture heals well.
Objective To evaluate the clinical results of subtalar arthrodesis and calcaneal thalamus reconstruction for malunion of calcaneal fractures and to discuss the indications and its advantages of the management. Methods From December 1994 to January 2006, 84 cases(96 feet) of malunion of calcaneal fractures were treated with subtalar arthrodesis and calcaneal thalamus reconstruction. The L-shaped approach lateral to calcaneus was used. The bone autograft was harvested from iliac crest. Fiftyone cases were male and 33 cases were female, aging from 21 to 58 years (mean 385 years).One side was in volved in 72 cases and two sides in 12 cases. The injury was caused by falling from height in 57 cases, by traffic accident in 22 cases and other in 5 cases. It was 6-31 months from injury to operation (mean 9.5 months). Results Among the patients, all cases were followed up 1 to 132 months. The total excellent and good rate was 87.5%, including excellent in 31 feet, good in 53 feet and fair in 12 feet,according to Hindfoot scores system (American Orthopaedics Foot and Ankle Society). The B[AKo¨]hler’s and Gissane’s angles, the height of calcaneal thalamus and width of calcaneus were significant different from those of preoperation (Plt;0.01). Conclusion The treatment by bone autograft combined with subtalar arthrodesis and calcaneal thalamus reconstruction is an effective operation for malunion of calcaneal fractures, with advantages of correcting deformity, restoring the function of indfoot and relieving the pain of walking.
ObjectiveTo investigate the short-term effectiveness of modified tarsal sinus approach and traditional tarsal sinus approach in the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures.MethodsBetween January 2015 and August 2017, 53 patients with Sanders Ⅱ-Ⅲ type calcaneal fractures were selected and divided into observation group (21 cases, using modified tarsal sinus approach for fracture reduction after exposure of the subtalar joint below the long and short fibular tendon) and control group (32 cases, using traditional tarsal sinus approach) by random number method. There was no significant difference between the two groups in terms of gender, age, side, cause of injury, fracture type, injury to operation time, and preoperative Böhler angle, Gissane angle, visual analogue scale (VAS) core (P>0.05), which were comparable. The operation time, postoperative drainage volume, postoperative Böhler angle, Gissane angle, and postoperative angle improvement values of the two groups were recorded and compared. VAS score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and short-form 36 health survey scale (SF-36) score were used to evaluate the effectiveness.ResultsAll the 53 patients successfully completed the operation without serious complications such as vascular and nerve injury and perioperative death. There was no significant difference in operation time and postoperative drainage volume between the two groups (P>0.05). Patients in both groups were followed up 12-36 months (mean, 17 months). No infection, fracture displacement, failure of internal fixation, and malunion of fracture occurred after operation. None of the patients underwent secondary joint fusion. There was no significant difference in fracture healing time between the two groups (t=0.30, P=0.77). The postoperative Böhler angle and Gissane angle at 2 days in the two groups were significantly improved when compared with those before operation (P<0.05); however, there was no significant difference in Böhler angle, Gissane angle, and improvement value between the observation group and the control group at 2 days after operation (P>0.05). VAS scores at 24 hours and 1 year after operation were significantly improved when compared with that before operation in both groups (P<0.05). There was no significant difference in VAS scores between the two groups at 24 hours and 1 year after operation (P>0.05). There was no significant difference in AOFAS scores between the two groups at 1 year after operation (t=1.46, P=0.15). However, the SF-36 scale score at 1 year after operation was significantly higher than that of the control group (t=2.08, P=0.04). At last follow-up, 2 patients in the observation group and 8 patients in the control group presented subtalar joint stiffness or pain, and there was no significant difference in the incidence between the two groups (χ2=1.98, P=0.16).ConclusionThe modified tarsal sinus approach for the treatment of Sanders Ⅱ-Ⅲ type calcaneal fractures has the advantages of minimal invasion, clear reduction under direct vision, reliable reduction and fixation, and low incision complications.
Objective To evaluate the effectiveness of three-dimensional (3-D) printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation. Methods A retrospective analysis was performed of the 19 patients (19 feet) with intraarticular calcaneal fracture who had been treated between March 2015 and May 2016. There were 13 males and 6 females with an average age of 38.2 years (range, 24-73 years). There were 3 open fractures and 16 closed fractures. By Sanders classification, 12 cases were type Ⅱ, 7 cases were type Ⅲ. By Essex-Lopresti classification, 13 cases were tongue type, 6 cases were joint-depression type. The time from injury to surgery was 1-10 days (mean, 4.7 days). A thin slice CT scan was taken of bilateral calcaneus in patients. By using the mirror imaging technique, the contralateral mirror image and the affected side calcaneus model were printed according to 1∶1 ratio. The displacement of fracture block was observed and contrasted, and the poking reduction was simulated. Calcaneal fracture was treated by percutaneous minimally invasive poking reduction and cannulate screw fixation. The Böhler angle and Gissane angle at immediate after operation and last follow-up was measured on X-ray films, and compared with preoperative measurement. The functional recovery was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) scores. Results The operation time was 25-70 minutes (mean, 45 minutes). The intraoperative blood loss was 10-40 mL (mean, 14.5 mL). All the incisions healed by first intention and had no relevant postoperative complications such as skin necrosis, nail tract infection, and osteomyelitis. All the patients were followed up 12-25 months (mean, 14.6 months). All patients obtained fracture healing, and the fracture healing time was 8-14 weeks (mean, 10.3 weeks). No screw withdrawal or breakage occurred during follow-up; only 1 patient with Sanders type Ⅱ fracture, whose calcaneus height was partially lost at 6 weeks after operation, the other patients had no reduction loss and fracture displacement, and no traumatic arthritis occurred. The Böhler angle and Gissane angle at immediate after operation and last follow-up were significantly improved when compared with preoperative ones (P<0.05), but there was no significant difference between at immediate after operation and last follow-up (P>0.05). The AOFAS score was 76-100 (mean, 88.2), and the results were excellent in 10 feet, good in 7, and fair in 2, the excellent and good rate was 89.5%. Conclusion 3-D printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation can reduce the surgical trauma, improve the quality of reduction and fixation, and make the operation more safe, accurate, and individualized.
Objective To review the application progress of minimally invasive technique in the treatment of calcaneus fractures and to analyze the advantages and disadvantages of each method as well as to predict the trend of development in the field. Methods Domestic and abroad literature concerning the minimally invasive technique applied in calcaneus fractures in recent years was reviewed extensively and analyzed thoroughly. Results There are both advantages and limitations of each minimally invasive technique including percutaneous reduction and fixation, limited incision, external fixator, arthroscopic assisted reduction, and balloon expansion reduction. But every technique is developing rapidly and becoming more and more effective. Conclusion A variety of minimally invasive technique can not only be used independently but also can be applied jointly to complement one another. It needs further study how to improve the effectiveness and expand the indications. And the theoretical basis of evidence-based medicine needs to be provided more.