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 explore the effectiveness of conservative dressing change method in treating skin necrosis after open reduction with internal fixation (ORIF) of calcaneal fracture. Methods Between November 2007 and June 2010, 21 cases of skin necrosis after ORIF of calcaneal fracture were treated, including 18 cases of Sanders type II and 3 cases ofSanders type III. There were 20 males and 1 female with an average age of 33.1 years (range, 23-60 years). All fractures were close fractures and were treated by ORIF with plate. Skin necrosis occurred at 3-5 days (mean, 4 days) after internal fixation. The interval of internal fixation and conservative dressing change was 3-10 days (mean, 6 days). Of 21 cases, 10 cases had superfacial skin necrosis with a size range of 1-10 cm in length and 0.5-1.5 cm in width, and 11 cases had deep skin necrosis with a size range of 1-8 cm in length and 0.5-1.5 cm in width. The conservative dressing change method was performed. Alcohol (75%) was used at the edge of the zone of skin necrosis, whereas sal ine in the central of the wound every 2-3 days. The necrosed tissue in the wound was reserved as more as possible. No patient was given antibiotic. Results Scab formed and subcrust heal ing was observed after 6-30 days (mean, 16 days) in 20 patients, 1 patient failed for discontinue treatment. No case had deep infection or osteomyl itis. The mean treatment time was 7.8 days (range, 6-14 days) in 10 cases of superfacial skin necrosis, and was 23.1 days (range, 14-30 days) in 10 cases of deep skin necrosis. All cases were followed up 92 days on average (range, 54-123 days). The scar was usually dark red and hard, protruding from the normal skin. No patient had difficulty in weight bearing or walking. Conclusion Skin necrosis after ORIF of calcaneal fracture can be cured by the conservative dressing change method, and this conservative method is effective and economic.
ObjectiveTo analyze the clinical outcomes of 3D-printing assisting minimally invasive fixation of calcaneal fractures. MethodsThe study included 12 patients who were diagnosed with calcaneal fractures between October 2014 and May 2015. Using a real-size 3D-printed calcaneus model, the calcaneal locking plate could be preshaped before the operation and used with a minimally invasive approach to achieve rigid plate fixation just as with the lateral approach. Complications and surgery time were recorded and functional results were evaluated using the American Orthopaedic Foot Society ankle-metapedes score (AOFAS). The reduction of fracture was evaluated using the Bohler angle and Gissane angle. ResultsThere was no relevant postoperative complications. All fractures got bone union. The mean postoperative Bohler angle was (29.4±6.1) ° and the mean postoperative Gissane angle was (121.4±12.6) °. The difference in Bohler angle and calcaneal Gissane angle before and after the surgery was significant (P ＜ 0.01) . The mean postoperative AOFAS score was 75.2±5.4, and the fine/excellent rate was 83.3%. ConclusionWe believe this novel technique can be useful for the operative treatment of displaced intra-articular calcaneal fractures.
To investigate the therapeutic effect of open reduction, bone grafting, and internal fixation with plastic ti-alloy plate on intra-articular calcaneal fracture. Methods From January 2005 to December 2007, 32 patients (37 feet) with intra-articular calcaneal fracture underwent open reduction, bone grafting of autogeneic il ium (30-80 g) and internal fixation of plastic ti-alloy plate. There were 21 males and 11 females aged 18-56 years old (average 42.1 years old). There were 5 cases of bilateral calcaneal fracture and 27 cases of unilateral calcaneal fracture, including 2 cases of open fracture and 30 cases of close fracture. According to Sanders classification system, there were 11 cases of type II, 18 cases of type III and 8 cases of type IV. Preoperatively, Bouml;hler angle was (— 9.6 ± 4.2)° and Gissane angle was (101.4 ± 10.6)°. Nine feet underwent emergency operation and 28 feet received operation 5-7 days after injury. Results The wounds of 34 feet healed by first intention. The wound margin of 3 feet was gray with a small amount of colorless exudates, and healed after dressing change. All patients were followed for 12-24 months (average 16 months). X-ray films displayed that the fracture all healed within 3-4 months after operation. At 6 months after operation, the Bouml;hler angle and the Gissane angle was (28.5 ± 6.1)° and (128.9 ± 4.8)°, respectively, indicating there were significant differences when compared with before operation (P lt; 0.05). According to Maryland foot score system, 15 cases were graded as excellent, 18 cases were good, 4 cases were poor, and the excellent and good rate was 89.19%. Conclusion Open reduction, bone grafting, and internal fixation with plastic ti-alloy plate is an effective method to treat intra-articular calcaneal fracture. Choosing right operational timing, performing subarticular surface grafting when necessary and using appropriate plastic ti-alloy plate internal fixation can minimize the incidence of postoperative compl ications
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.