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夏 燊, 赵 泽, 徐 永, 吕 乾, 浦 绍, 陈 汉, 齐 欣, 朱 跃. [Anatomical calcaneal external fixator self-designed according to the morphology of heel]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:475-481. [PMID: 32291984 PMCID: PMC8171517 DOI: 10.7507/1002-1892.201908149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The anatomical calcaneal external fixator was designed by measuring and calculating the morphological data of the heel. METHODS A total of 100 normal people were randomly selected to obtain 200 hind foot data, including 45 males and 55 females, with an average age of 43.9 years (range, 19-67 years). According to the principles of human engineering and local anatomy, the morphological data of the heel in the weight-bearing standing position and supine position were measured with the direct measurement mode. The heel length, heel width, heel height, medial ankle height, lateral ankle height, and calcaneal pitch angle (CPA) were measured by vernier calipers and ulnar markers in weight-bearing standing position, and the gender groups and left and right foot groups were compared; the shape of the hind foot in the supine position was measured by three-dimensional (3D) dot matrix inverse model method. According to the stereoscopic data of the comprehensive anatomical morphology of the heel, the anatomical calcaneal external fixator was designed with AutoCAD 2019 and other 3D industrial design softwares. RESULTS The measurements of shoe size, heel length, heel width, heel height, medial ankle height, lateral ankle height, and CPA in male were significantly higher than those in female ( P<0.05). There was no significant difference between the left and right feet in the other indexes except that the height of the medial malleolus of the left foot was significantly lower than that of the right foot ( t=-2.827, P=0.005). The measurement of 3D dot matrix inverse model in supine position showed that the heel part was non-circular arc edge, and many groups of arc edges fluctuate in a limited range. Based on the above data, an anatomical calcaneal external fixator was designed, which could fit the anatomic radian in theory, so as to be flexible in configuration. On this basis, the ordinary configuration, compression configuration, and orthodontic configuration were designed to meet the treatment needs of calcaneal fractures in different degrees. The ordinary configuration was suitable for patients with Sanders Ⅰ, ⅡA, and ⅡB calcaneal fractures with no or slight displacement of intra-articular fractures; the ordinary configuration was mainly used for simple fixing. The compression configuration was suitable for patients with Sanders ⅡC, ⅢA, and ⅢB, tongue fractures, and avulsion fractures with severe displacement of intra-articular fractures; the compression configuration used obliquely drawn console wires to fix the displaced bones. The orthodontic configuration was suitable for patients with Sanders ⅢC and Ⅳ calcaneal fractures with severe displacement of intra-articular fractures or severe calcaneal bone defects; the orthodontic configuration was a multi-module design, which took into account the stable fixation of the fracture and the arbitrary adjustment of the joint fixation angle. CONCLUSION The hind foot is special for morphology, so the external fixator designed based on the vernier caliper measurement method and 3D dot matrix measuring plate measurement method is an anatomical type and its configuration can theoretically meet stable and flexible clinical needs.
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Affiliation(s)
- 燊 夏
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 泽雨 赵
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 永清 徐
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 乾 吕
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 绍全 浦
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 汉芬 陈
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 欣 齐
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - 跃良 朱
- 昆明医科大学解放军联勤保障部队第九二〇医院临床学院(昆明 650032)Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
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Spierings KE, Min M, Nooijen LE, Swords MP, Schepers T. Managing the open calcaneal fracture: A systematic review. Foot Ankle Surg 2019; 25:707-713. [PMID: 30467055 DOI: 10.1016/j.fas.2018.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/24/2018] [Accepted: 10/16/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Open fractures of the calcaneus are rare. They are mostly caused by high-energy trauma. There are several treatment options for calcaneal fractures. However, treatment of open calcaneal fractures might need a different approach, as open calcaneal fractures are associated with high rates of complications. The purpose of this study was to provide a literature overview on the management of open calcaneal fractures, and deduct a more standardized treatment algorithm. MATERIAL AND METHODS A literature review was conducted in the databases of PubMed, EMBASE and the Cochrane Library for articles describing the management of open calcaneal fractures. Excluded were studies with less than 10 patients, studies describing combat injuries and reviews. Only articles published from 1998 to 2017 were included and there were no language restrictions. RESULTS A total of 18 articles were included with 616 open calcaneal fractures in 598 patients. Most wounds were Gustilo grade III and most fractures were Sanders type III. Definitive surgery was performed after a mean of 9.8days and in most cases in the form of ORIF via ELA. The complication rate was 21% and the mean AOFAS score was 73.7 points. CONCLUSION The complication rates of open calcaneal fractures are high and increase with the severity of the wound. A treatment algorithm is suggested. However, to produce a more evidence-based protocol and achieve consensus for treatment, additional research should be done, preferably in the form of a prospective multicenter database.
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Affiliation(s)
| | - Minoesch Min
- Trauma unit, Academic Medical Center, Amsterdam, The Netherlands
| | - Lynn E Nooijen
- Trauma unit, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Tim Schepers
- Trauma unit, Academic Medical Center, Amsterdam, The Netherlands.
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Iceman KL, Magnus MK, Roukis TS. Salvaging the Unsalvageable Severe Malunion Deformity After Displaced Intra-Articular Calcaneal Fractures: What Options Exist? Clin Podiatr Med Surg 2019; 36:339-347. [PMID: 30784541 DOI: 10.1016/j.cpm.2018.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A subset of calcaneal fractures is so severe that it may warrant primary conservative treatment. Unfortunately, nonoperative management of these fractures can lead to the development of a calcaneal malunion and cause significant patient morbidity. Surgical management of these deformities often requires increasingly complex reconstructive procedures. The goals of surgery include re-establishing calcaneal height, restoring the talocalcaneal relationship, and creating a stable, plantigrade foot. This article highlights the available surgical treatment options (including calcanectomy, calcaneal allograft transplantation, vascularized autografts, and calcaneal prostheses) for the management of severe calcaneal malunion deformities.
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Affiliation(s)
- Kelli L Iceman
- Gundersen Medical Foundation, Mail Stop CO3-006A, 1900 South Avenue, La Crosse, WI 54601, USA
| | - Mark K Magnus
- Gundersen Medical Foundation, Mail Stop CO3-006A, 1900 South Avenue, La Crosse, WI 54601, USA
| | - Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, Mail Stop CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA.
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Estudo comparativo entre três técnicas cirúrgicas para fraturas intra‐articulares de calcâneo: redução aberta e fixação interna com placa, fixação externa e minimamente invasiva. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Takasaka M, Bittar CK, Mennucci FS, de Mattos CA, Zabeu JLA. Comparative study on three surgical techniques for intra-articular calcaneal fractures: open reduction with internal fixation using a plate, external fixation and minimally invasive surgery. Rev Bras Ortop 2016; 51:254-60. [PMID: 27274478 PMCID: PMC4887438 DOI: 10.1016/j.rboe.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/10/2015] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate, compare and identify the surgical technique with best results for treating intra-articular calcaneal fractures, taking into account postoperative outcomes, complications and scoring in the Aofas questionnaire. Methods This was a retrospective study on 54 patients with fractures of the calcaneus who underwent surgery between 2002 and 2012 by means of the following techniques: (1) open reduction with extended L-shaped lateral incision and fixation with double-H plate of 3.5 mm; (2) open reduction with minimal incision lateral approach and percutaneous fixation with wires and screws; and (3) open reduction with minimal incision lateral approach and fixation with adjustable monoplanar external fixator. Results Patients treated using a lateral approach, with fixation using a plate had a mean Aofas score of 76 points; those treated through a minimal incision lateral approach with screw and wire fixation had a mean score of 71 points; and those treated through a minimal incision lateral approach with an external fixator had a mean score of 75 points. The three surgical techniques were shown to be effective for treating intra-articular calcaneal fractures, without any evidence that any of the techniques being superior. Conclusion Intra-articular calcaneal fractures are complex and their treatment should be individualized based on patient characteristics, type of fracture and the surgeon's experience with the surgical technique chosen.
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Affiliation(s)
- Missa Takasaka
- Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
| | - Cintia Kelly Bittar
- Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
| | - Fernando Saddi Mennucci
- Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
| | - Carlos Augusto de Mattos
- Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
| | - José Luís Amim Zabeu
- Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
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Ramos RR, de Castro Filho CDC, Ramos RR, Bittar CK, de Cillo MSP, de Mattos CA, Zabeu JLA, Mazzuia AR. Surgical treatment of intra-articular calcaneal fractures: description of a technique using an adjustable uniplanar external fixator. Strategies Trauma Limb Reconstr 2014; 9:163-6. [PMID: 25540120 PMCID: PMC4278970 DOI: 10.1007/s11751-014-0207-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 12/16/2014] [Indexed: 12/05/2022] Open
Abstract
Several surgical techniques are available for the treatment of intra-articular calcaneal fractures. The use of a uniplanar external fixator is an option for the treatment of fractures classified as Sanders types 2 and 3. Satisfactory reduction and stabilisation of the fracture are achieved by means of mini-incisions and fixator adjustment. The advantages of this technique include less soft-tissue damage, avoidance of internal implants and early weight-bearing with the potential to improve postoperative recovery.
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Affiliation(s)
- Randal Rudge Ramos
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - Carlos Daniel Candido de Castro Filho
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - Roger Rudge Ramos
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - Cíntia Kelly Bittar
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - Mario Sérgio Paulilo de Cillo
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - Carlos Augusto de Mattos
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - José Luís Amim Zabeu
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - Antenor Rafael Mazzuia
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
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Chen K, Zhang H, Wang G, Cheng Y, Qian Z, Yang H. Comparison of nonlocking plates and locking plates for intraarticular calcaneal fracture. Foot Ankle Int 2014; 35:1298-302. [PMID: 25125513 DOI: 10.1177/1071100714547520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal treatment of displaced intraarticular calcaneal fractures remains challenging. Currently, there is no uniform method to treat such fractures. The purpose of this study was to compare the radiographic and clinical outcome of nonlocking plates and locking plates in the treatment of intraarticular calcaneal fractures. METHODS A retrospective comparative study was performed including 42 patients with intraarticular calcaneal fractures that were treated by nonlocking plate (n = 18) or locking plates (n = 24) between January 2010 and June 2012. Radiological and functional outcomes were compared between the 2 groups. RESULTS At the final follow-up, all fractures were healed, and the patients with a locking plate had a significantly better Bohler's angle and Gissane's angle compared with the nonlocking plate group (P < .05). No complications occurred for the patients in the locking plate group, and 3 patients in the nonlocking plate group had implant loosening that led to loss of reduction (P < .05). The average American Orthopaedic Foot and Ankle Society hindfoot score in the locking plate group was significantly higher than that in the nonlocking plate group (P < .05). No statistically significant difference between the 2 groups was found regarding SF-36 (P > .05). CONCLUSION This study supports the view that locking plates may provide better stability and functional recovery in the treatment of intraarticular calcaneal fractures. LEVEL OF EVIDENCE Level III, comparative case series.
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Affiliation(s)
- Kangwu Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongtao Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Genlin Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Cheng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhonglai Qian
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Schade VL. Partial or total calcanectomy as an alternative to below-the-knee amputation for limb salvage: a systematic review. J Am Podiatr Med Assoc 2013; 102:396-405. [PMID: 23001733 DOI: 10.7547/1020396] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Below-the-knee amputations are regarded as definitive treatment for calcaneal osteomyelitis. They may be less than desirable in patients with a viable midfoot and forefoot. Partial and total calcanectomies have been reported as an alternative for limb salvage. However, the durability of the residual limb is questionable. METHODS A systematic review was undertaken to identify material relating to the potential for limb salvage with partial or total calcanectomy in ambulatory patients with calcaneal osteomyelitis. Studies eligible for inclusion consecutively enrolled ambulatory patients older than 18 years who underwent partial or total calcanectomy without adjunctive free tissue transfer for the treatment of calcaneal osteomyelitis and had a mean follow-up of 12 months or longer. RESULTS Sixteen studies involving 100 patients (76 partial and 28 total calcanectomies) met all of the inclusion criteria. Weighted mean follow-up was 33 months. Minor complications with subsequent healing occurred in less than 24% of patients. Most major complications were related to residual soft-tissue infection and osteomyelitis. Approximately 10% of patients required a major lower-extremity amputation. Major complications and major lower-extremity amputations occurred more frequently after total calcanectomy and in patients with a diagnosis of diabetes. Eighty-five percent of patients maintained or improved their ambulatory status postoperatively. Only 3% of patients decreased their ambulatory status postoperatively, becoming unlimited household ambulators. CONCLUSIONS This systematic review provides evidence that partial or total calcanectomy is a viable option for limb salvage in ambulatory patients with calcaneal osteomyelitis.
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Affiliation(s)
- Valerie L Schade
- Limb Preservation Service, Vascular/Endovascular Surgery Service, Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Dr, MCHJ-SV, Tacoma, WA 98431 USA.
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Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base. INTERNATIONAL ORTHOPAEDICS 2012. [PMID: 22576080 DOI: 10.1007/s00264-012-1563-0.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
PURPOSE Controversy still surrounds the optimal treatment for patients with displaced intra-articular calcaneal fractures (DIACF). An up-to-date meta-analysis was performed to evaluate clinical effectiveness of surgical treatment for DIACF compared with nonsurgical treatment. METHODS We systematically searched four electronic databases (Medline, BIOSIS, Cochrane library and Google Scholar) to identify randomised controlled trials (RCTs) and clinical controlled trials (CCTs) in which surgical treatment was compared with nonsurgical treatment of DIACF from 1980 to 2011. Trial quality was assessed using the modified Jadad scale and effective data were pooled for meta-analysis. RESULTS Ten studies (six RCTs and four CCTs) with a total of 891 participants were screened. Results showed that surgical treatment was superior to nonsurgical treatment in better recovery of the Böhler angle (P < 0.0001), more stable calcaneal height (P = 0.0009) and width (P < 0.00001). Moreover, fewer surgically treated patients needed increased shoe size (P = 0.0004) and more were able to resume pre-injury work (P = 0.004) than the nonsurgical patients. No significant difference was identified between the two methods regarding the incidence of residual pain (P = 0.49). However, operative management was associated with a higher risk of complications (P = 0.008). CONCLUSIONS Although surgical repair may increase the complication probability, it is the price that has to be paid for better reconstruction of the calcaneus and better functional results. Taken as a whole, surgery is probably the optimal choice in DIACF treatment.
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Jiang N, Lin QR, Diao XC, Wu L, Yu B. Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base. INTERNATIONAL ORTHOPAEDICS 2012. [PMID: 22576080 DOI: 10.1007/s00264-012-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Controversy still surrounds the optimal treatment for patients with displaced intra-articular calcaneal fractures (DIACF). An up-to-date meta-analysis was performed to evaluate clinical effectiveness of surgical treatment for DIACF compared with nonsurgical treatment. METHODS We systematically searched four electronic databases (Medline, BIOSIS, Cochrane library and Google Scholar) to identify randomised controlled trials (RCTs) and clinical controlled trials (CCTs) in which surgical treatment was compared with nonsurgical treatment of DIACF from 1980 to 2011. Trial quality was assessed using the modified Jadad scale and effective data were pooled for meta-analysis. RESULTS Ten studies (six RCTs and four CCTs) with a total of 891 participants were screened. Results showed that surgical treatment was superior to nonsurgical treatment in better recovery of the Böhler angle (P < 0.0001), more stable calcaneal height (P = 0.0009) and width (P < 0.00001). Moreover, fewer surgically treated patients needed increased shoe size (P = 0.0004) and more were able to resume pre-injury work (P = 0.004) than the nonsurgical patients. No significant difference was identified between the two methods regarding the incidence of residual pain (P = 0.49). However, operative management was associated with a higher risk of complications (P = 0.008). CONCLUSIONS Although surgical repair may increase the complication probability, it is the price that has to be paid for better reconstruction of the calcaneus and better functional results. Taken as a whole, surgery is probably the optimal choice in DIACF treatment.
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Affiliation(s)
- Nan Jiang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China
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Jiang N, Lin QR, Diao XC, Wu L, Yu B. Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base. INTERNATIONAL ORTHOPAEDICS 2012; 36:1615-22. [PMID: 22576080 DOI: 10.1007/s00264-012-1563-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 04/23/2012] [Indexed: 01/13/2023]
Abstract
PURPOSE Controversy still surrounds the optimal treatment for patients with displaced intra-articular calcaneal fractures (DIACF). An up-to-date meta-analysis was performed to evaluate clinical effectiveness of surgical treatment for DIACF compared with nonsurgical treatment. METHODS We systematically searched four electronic databases (Medline, BIOSIS, Cochrane library and Google Scholar) to identify randomised controlled trials (RCTs) and clinical controlled trials (CCTs) in which surgical treatment was compared with nonsurgical treatment of DIACF from 1980 to 2011. Trial quality was assessed using the modified Jadad scale and effective data were pooled for meta-analysis. RESULTS Ten studies (six RCTs and four CCTs) with a total of 891 participants were screened. Results showed that surgical treatment was superior to nonsurgical treatment in better recovery of the Böhler angle (P < 0.0001), more stable calcaneal height (P = 0.0009) and width (P < 0.00001). Moreover, fewer surgically treated patients needed increased shoe size (P = 0.0004) and more were able to resume pre-injury work (P = 0.004) than the nonsurgical patients. No significant difference was identified between the two methods regarding the incidence of residual pain (P = 0.49). However, operative management was associated with a higher risk of complications (P = 0.008). CONCLUSIONS Although surgical repair may increase the complication probability, it is the price that has to be paid for better reconstruction of the calcaneus and better functional results. Taken as a whole, surgery is probably the optimal choice in DIACF treatment.
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Affiliation(s)
- Nan Jiang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China
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Abstract
OBJECTIVE To assess the results of a standardized staged treatment strategy for displaced open calcaneal fractures with medial wounds. DESIGN Retrospective case series. SETTING Level I trauma center. PATIENTS/PARTICIPANTS Fourteen displaced open Type II or Type IIIA Orthopaedic Trauma Association (OTA) 73 Type B or C calcaneal fractures treated between January 2000 and December 2007 who were managed with a standardized regimen. INTERVENTION Patients were treated in a staged fashion with antibiotics, irrigation, débridement, and percutaneous Kirschner wire fixation followed by definitive open reduction and internal fixation when soft tissues were amenable to fixation. MAIN OUTCOME MEASURES Data regarding demographics, injury characteristics, time to fixation, interventions, and treatment complications were documented. The complication rate, time to bony union, and additional procedures were determined. RESULTS There were four OTA 73B and 10 OTA 73C injuries with open Type II or Type IIIA wounds on the medial side. All patients had débridement, irrigation, and percutaneous fixation within 8 hours of presentation. Definitive fixation was carried out on average 18 days after initial presentation with 10 patients only requiring the initial débridement and stabilization procedure followed by definitive fixation All 14 patients underwent definitive fixation through an extensile lateral approach. A superficial infection developed in one patient and a deep infection in one patient. All patients went on to union at an average follow up of 19 months. CONCLUSION Open Type II and IIA wounds associated with displaced OTA Type 73 B or C calcaneal fractures represent high-energy injuries with potential increased risk for wound complications. In our series, a staged treatment strategy consisting of urgent débridement, provisional internal stabilization, and late definitive reconstruction offers a protocol that may reduce infections associated with open calcaneal fractures.
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Besch L, Waldschmidt JS, Daniels-Wredenhagen M, Varoga D, Mueller M, Hilgert RE, Mathiak G, Oestern S, Lippross S, Seekamp A. The treatment of intra-articular calcaneus fractures with severe soft tissue damage with a hinged external fixator or internal stabilization: long-term results. J Foot Ankle Surg 2010; 49:8-15. [PMID: 20123280 DOI: 10.1053/j.jfas.2009.07.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Indexed: 02/03/2023]
Abstract
We developed a hinged external fixator for the treatment of dislocated intra-articular calcaneus fractures with severe soft tissue damage. The external fixation was performed with a known external fixator system. The screw insertion points were biomechanically tested by defining a virtual rotation axis through the center of the talus to allow early active motion in the ankle joint. Long-term follow-up was performed after an average of 7.3 years. Results were graded with the American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographs were reviewed according to Sanders classification. Four open fractures and 33 cases with extremely swollen soft tissue, blisters, or compartment syndromes were treated. In 24 cases (64.9%), the hinged fixator was the final method of treatment (group I). A change to open reduction with internal fixation was performed in 13 fractures (35.1%) when soft tissue problems were minimal (group II). There were no late amputations, osteomyelitis, or malunions. According to Sanders classification, group I consisted of 14 type II, 8 type III, and 2 type IV fractures. Pin loosening or pin infection was seen in 4 cases, but there was no redislocation. The Böhler's angle improved in 43%, gaps in the posterior facet were closed in 41%, and any shortening or deviation of the axis was corrected in 82% of the cases. The AOFAS score for the group averaged 66.5. According to Sanders classification, group II consisted of 8 type II and 5 type III fractures. The Böhler's angle improved in 88%, and gaps in the posterior facet were closed in 87%. Any shortening or deviation of the axis was corrected in 95%, and the AOFAS score averaged 61.3. Significant differences in patient outcome scores between open reduction with internal fixation and hinged fixator were not found. P value was > .05. The hinged external fixator frame can be used in all calcaneus fracture types without soft tissue limitation. The hinged fixator allows early movement in the ankle joint, the risk of infection is minimized, and secondary plate fixation remains possible.
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Affiliation(s)
- Lutz Besch
- Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Uygur M, Atamaz F, Celik S, Pinar Y. The types of talar articular facets and morphometric measurements of the human calcaneus bone on Turkish race. Arch Orthop Trauma Surg 2009; 129:909-14. [PMID: 18810474 DOI: 10.1007/s00402-008-0729-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There are three facets over upper side of talocalcaneal joint: anterior talar facet, middle and posterior. Three types of calcaneus that have distinct talar facets were defined as types A, B and C. MATERIALS AND METHODS A total of 221 calcanei (98 right, 123 left), with unknown gender, were dried and evaluated. RESULTS In our study type B calcaneus (58%) was defined as the most common type, and type A calcaneus (39.3%) as the second most common type. By using facet joint differences and bone measurement, we tried to define calcaneus bone. DISCUSSION In many diseases of foot, such as the talocalcaneal artritis and coalition, intraarticular fractures and congenital dysmorphology, flatfood, valgus deformities, the size and shape of the bones, the relationships of the talus and calcaneus with each other and other bones of the foot must be considered for the internal and external fixation and surgical procedures. Type B calcaneus was defined as the most comman type in Turkish race and these results correlate with the ones which were performed on bones of American, Indian and African people, and it was uncorrelated with the results of the researches performed in Europe.
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Affiliation(s)
- Mujde Uygur
- Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey
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