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Le B, Gonzalez B, Weaver F, Sinnott B, Ray C, Chu E, Premji S, Raiford M, Mayur O, Carbone L. Malunions following lower extremity fractures in veterans with a spinal cord injury/disorder. J Spinal Cord Med 2024; 47:293-299. [PMID: 36977321 PMCID: PMC10885743 DOI: 10.1080/10790268.2023.2188391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Nearly 50% of all persons with a spinal cord injury/disorder (SCI/D) will sustain an osteoporotic fracture sometime in their life, with lower extremity fractures being the most common. There are a number of complications that can occur post fracture, including fracture malunion. To date, there have been no dedicated investigations of malunions among persons with SCI/D. OBJECTIVES The primary objective of this study was to identify risk factors associated with fracture malunion among fracture-related (type of fracture, fracture location, initial fracture treatment) and SCI/D-related factors. Secondary objectives were to describe treatment of fracture malunions and complications following these malunions. METHODS Veterans with SCI/D with an incident lower extremity fracture and subsequent malunion from Fiscal Year (FY) 2005-2015 were selected from the Veteran Health Administration (VHA) databases using International Classification of Diseases, 9th edition (ICD-9) codes for lower extremity fractures and malunion. These fracture malunion cases underwent electronic health record (EHR) review to abstract information on potential risk factors, treatments and complications for malunion. Twenty-nine cases were identified with a fracture malunion with 28 of them successfully matched with Veterans with a lower extremity fracture during FY2005-FY2014 without a malunion (matched 1:4) based on having an outpatient utilization date of care within 30 days of the fracture case. There was trend towards more nonsurgical treatment in the malunion group (n = 27, 96.43%) compared to the control group (n = 101, 90.18%) (P = 0.05), though fracture treatment proved not to be not associated with developing a malunion in univariate logistic regression analyses (OR = 0.30; 95% CI: 0.08-1.09). In multivariate analyses, Veterans with tetraplegia were significantly less likely (approximately 3-fold) to have a fracture malunion (OR = 0.38; 95% CI: 0.14-0.93) compared to those with paraplegia. Fracture malunion was significantly less likely to occur for fractures of the ankle (OR = 0.02; 95% CI: 0-0.13) or the hip (OR = 0.15; 95% CI: 0.03-0.56) compared to femur fractures. Fracture malunions were rarely treated. The most common complications following malunions were pressure injuries (56.3%) followed by osteomyelitis (25.0%). CONCLUSIONS Persons with tetraplegia as well as fractures of the ankle and hip (compared to the femur) were less likely to develop a fracture malunion. Attention to prevention of avoidable pressure injuries following a fracture malunion is important.
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Affiliation(s)
- Brian Le
- Division of Specialty Care, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Frances Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA
- Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Bridget Sinnott
- Department of Medicine, Division of Endocrinology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Elizabeth Chu
- Division of Specialty Care, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
| | - Sara Premji
- Division of Specialty Care, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
| | - Mattie Raiford
- Division of Specialty Care, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
| | - Omkar Mayur
- Department of Medicine, Division of Rheumatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Laura Carbone
- Division of Specialty Care, Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA
- Department of Medicine, Division of Rheumatology, J. Harold Harrison, MD, Distinguished University Chair in Rheumatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Wang B, Guan X, Hu Y, Jiang G, Lin Q, Ye J, Xiang D, Yu B. Multiple Reconstructive Osteotomy Treating Malunited Calcaneal Fractures Without Subtalar Joint Fusion. Orthop Surg 2023; 15:810-818. [PMID: 36718811 PMCID: PMC9977586 DOI: 10.1111/os.13506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Various surgical techniques have been reported in treating calcaneal malunions over the decades, while the operations on single plane were accompanied by respective limitations. The purpose of this study is to evaluate the efficacy of a novel multiple reconstructive osteotomy for treating malunited calcaneal fractures without subtalar joint fusion. METHODS From March 12, 2010, to August 17, 2017, 10 patients (10 feet) with malunited calcaneal fractures were treated with multiple reconstructive osteotomy with subtalar joint-preserving operations. All patients were treated with a corrective osteotomy, joint realignment, soft tissue balancing, and secondary internal fixation at a mean of 5.6 ± 2.41 months since the initial injury. With the utilization of the multiple reconstructive osteotomy, the posterior facet was restored to preserve the subtalar joint. All patients were evaluated clinically and radiographically at a mean follow-up of 3.04 ± 1.21 years. RESULTS All patients were subjectively satisfied with the treatment. The average time to union was 12.2 ± 1.11 weeks. The American Orthopedic Foot and Ankle (AOFAS) ankle and hind foot score was 86.3 ± 4.45 (t = 27.64, P < 0.0001, paired t-test), which was significantly higher than the preoperative assessment. Postoperative radiographic assessment revealed great improvement in Böhler's angle (from 25.4° to 86.3°), talocalcaneal height (65.15-72.68 mm) and Calcaneus-talus angle (from 34.46° to 39.7°). One patient had mild discomfort after a 1-h brisk walk. One patient was suspected to have early posttraumatic arthritis of the subtalar joint based upon radiographic evidence during the follow-up, but the patients could walk normally for a long time without pain. CONCLUSION Multiple reconstructive osteotomy is an effective way to restore the calcaneal morphology and preserve the subtalar joint for selected calcaneal malunion.
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Affiliation(s)
- Bowei Wang
- Division of Orthopaedic Trauma, Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina
| | - Xin Guan
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Yanjun Hu
- Division of Orthopaedic Trauma, Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina
| | - Guiyong Jiang
- Division of Orthopaedic Trauma, Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina
| | - Qingrong Lin
- Division of Orthopaedic Trauma, Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina
| | - Jing Ye
- Department of OrthopaedicsYunfu People’s HospitalYunfuChina
| | - Dayong Xiang
- Division of Orthopaedic Trauma, Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina
| | - Bin Yu
- Division of Orthopaedic Trauma, Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
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Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion: a retrospective study. J Orthop Surg Res 2022; 17:526. [PMID: 36476296 PMCID: PMC9730565 DOI: 10.1186/s13018-022-03413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This retrospective study aimed to introduce a novel method for simultaneous Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion and to evaluate the feasibility of this method. METHODS We retrospectively analysed the clinical and imaging data of 11 patients with calcaneus malunion treated using Y-shape osteotomy and subtalar arthrodesis who were admitted to our hospital from June 2018 to October 2020. The patients included 9 males and 2 females aged from 24 to 69 years old, with an average age of 42.18 years. The clinical and radiological results were assessed with the Visual Analogue Scale (VAS) pain score and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. In addition, functional recovery and general quality of life were evaluated using the 12-Item Short-Form Survey (SF-12). RESULTS All radiological parameters were significantly improved at the last follow-up, with increases of 14.37°, 9.18°, and 4.51 mm in the Böhler's angle, calcaneal pitch angle, and talocalcaneal height, respectively, and decreases of 6.39 mm and 6.18° in the calcaneal width and Hindfoot alignment angle (p < 0.05). The mean AOFAS and VAS scores at the last follow-up improved compared with those preoperatively, from 34.18 ± 9.53 to 84.18 ± 11.59 and from 6.90 ± 1.22 to 1.90 ± 1.13, respectively (p < 0.05). The SF-12 physical and mental health scores were 49.65 ± 6.84 and 52.68 ± 7.88, respectively. Furthermore, the early postoperative complications included skin necrosis in one and sural neuralgia in one patient, and the late postoperative complication included ankle pain in one patient. No other complications, such as implant discomforts, malunion, nonunion and re-fracture, were presented. CONCLUSION These results indicate that Y-shape osteotomy combined with subtalar arthrodesis is an effective new method for the treatment of calcaneal malunion. Advantages include improvement of the anatomic shape of the calcaneus and union rates for subtalar arthrodesis.
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Xiao J, Xin Z, Fu X, Huang J, Zhang B, Yu H. Treatment of Fracture of the Calcaneus via Bone Axial X-Ray Image-Based Minimally Invasive Approach. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3012589. [PMID: 35813425 PMCID: PMC9270132 DOI: 10.1155/2022/3012589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022]
Abstract
To discuss the values of two bone axial X-ray image-based minimally invasive approach surgeries in the diagnosis and treatment of fracture of the calcaneus, 80 patients diagnosed with fracture of the calcaneus by bone axial X-ray examination were selected and divided equally into the minimally invasive longitudinal approach (MILA) group (40 cases) and the sinus tarsal approach (STA) group (40 cases). Besides, the duration of operation, the incidence of complications, the time-to-start weight training, and the American Orthopaedic Foot and Ankle Society (AOFAS) foot function scoring system between the patients in the two groups were compared. The results showed that the duration of operation and incidence of complications among the patients in the MILA group (42.87 ± 5.12 minutes, 20%) were both superior to those among the patients in the STA group (60.43 ± 7.31 minutes, 32.5%). The time-to-start weight training in the MILA group was 5.2 weeks, which was obviously shorter than that in the STA group (5.7 weeks). The difference in AOFAS scores between the two groups was not significant. The walking pavement score in the MILA group (4.2 ± 0.37 points) was slightly higher than that in the STA group (3.3 ± 0.45 points), and the differences demonstrated statistical meaning (P < 0.05). To sum up, the bone axial X-ray image is an essential examination method of diagnosing fracture of the calcaneus. The two minimally invasive methods both showed good clinical therapeutic effects. The operation of MILA was relatively shorter with fewer complications and is worthy of being promoted as an effective treatment method of fracture of the calcaneus.
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Affiliation(s)
- Jie Xiao
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Zengfeng Xin
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 311000 Zhejiang, China
| | - Xiaojun Fu
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Jiaqi Huang
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Bi Zhang
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Haiping Yu
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
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Staged Ilizarov distraction histogenesis and corrective reconstruction for severe malunited calcaneal fractures. Arch Orthop Trauma Surg 2022; 143:2845-2854. [PMID: 35513534 DOI: 10.1007/s00402-022-04449-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/10/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE Severe calcaneal malunion is a clinical conundrum for the difficulty of calcaneal reconstruction without soft tissue complications. The aim of this study is to introduce the treatment strategy and preliminary results of staged Illizarov distraction histogenesis and corrective reconstruction for severe malunion of calcaneal fractures. METHODS From June 2014 to May 2020, 14 patients with severe calcaneal malunion treated with the staged strategy were retrospectively analyzed. At the first stage, calcaneal osteotomy and external fixation with Ilizarov frame were performed. The restoration of the approximate configuration of calcaneus and the expansion of contractural soft tissue were achieved by gradual calcaneal distraction. At the second stage, corrective reconstruction was performed and autogenous iliac crest bone graft was used. Clinical and radiographic outcomes were evaluated at final follow-up. RESULTS The average time of Ilizarov distraction and total fixation was 21.4 days and 41.0 days at first-stage treatment. At a mean follow-up of 33.1 months, the average American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score increased significantly from 24.0 to 72.4 (p < 0.01). And the mean visual analogue scale (VAS) score had improved remarkably from 8.2 to 2.4 (p < 0.01). Radiographs showed that talocalcaneal height, calcaneal width, calcaneal tuberosity height, hindfoot alignment angle, and talar declination angle were improved to a great extent (p < 0.01). Only one patient had minor pin site infection at first-stage treatment and one got superficial wound infection after second-stage surgery. No wound dehiscence, skin necrosis, or deep infection occurred. CONCLUSION Staged Ilizarov distraction histogenesis and corrective reconstruction is a safe and effective treatment strategy for reducing soft tissue complications and improving reconstruction results in surgical correction of severe calcaneal malunion.
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Konovalchuk N, Sorokin E, Fomichev V, Chugaev D, Kochish A, Pashkova E, Mikhaylov K. Is There a Borderline Value in the Radiological Findings of Patients With Calcaneal Malunion That May Help to Select an Appropriate Treatment Option? Foot Ankle Int 2022; 43:42-48. [PMID: 34384274 DOI: 10.1177/10711007211027298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the constant evolution of technological support, operative techniques, and rehabilitation techniques after conservative treatment and operative treatment, a considerable number of patients with calcaneal fractures have constant pain, frequently resulting in loss of occupation. There are numerous options for the operative treatment of painful calcaneal malunion; however, very few publications suggest specific radiological measurements for pre- and postoperative planning-even fewer have statistically analyzed how these radiological measurements affect clinical outcomes. METHODS We performed a retrospective study of 100 patients after operative treatment of calcaneal malunion to determine the correlation between radiological measurements and clinical outcomes. Data were used to create an algorithm that would help to choose between in situ subtalar arthrodesis and complex reconstructive operations. The algorithm was then used to treat 27 prospective patients. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) were used for clinical assessment, whereas standard weightbearing anteroposterior (AP), lateral (LAT) ankle x-rays, and long axial hindfoot view were used for radiological assessment. RESULTS The talar declination angle was positively correlated with clinical outcome. Patients with talar declination angles less than 6.5 degrees showed worse results in AOFAS score than patients with a greater angle did (57.3 ± 15.3 and 81 ± 15.6, respectively). CONCLUSION The combination of subtalar arthrodesis with distraction bone block or calcaneal osteotomy in patients with calcaneal malunion and a talar declination angle less than 6.5 degrees showed better results than isolated in situ arthrodesis. LEVEL OF EVIDENCE Level III, retrospective cohort study, case series.
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Affiliation(s)
- Nikita Konovalchuk
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Evgenii Sorokin
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Viktor Fomichev
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Dmitrii Chugaev
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Alexander Kochish
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Ekaterina Pashkova
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Kirill Mikhaylov
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
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Kim HN, Park YU, Kim BS, Easley ME. Rotational Osteotomy and Subtalar Arthrodesis for Subtalar Arthritis With Calcaneal Malunion: A Technical Note. Foot Ankle Int 2021; 42:1340-1346. [PMID: 34024150 DOI: 10.1177/10711007211008512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Young Uk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Bom Soo Kim
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Republic of Korea
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Abstract
Treatment of calcaneal fractures has to be tailored to the individual pathoanatomy. If operative treatment is chosen, anatomic reconstruction of the calcaneal shape and joint surfaces is mandatory. For most of the displaced, intraarticular fractures, this can be achieved by less invasive reduction and fixation via a sinus tarsi approach, which may be extended along the "lateral utility" line for calcaneocuboid joint involvement or calcaneal fracture-dislocations. Purely percutaneous fixation is the treatment of choice for displaced extraarticular fractures and simple intraarticular fractures with adequate control of joint reduction. Specific approaches are used for rare calcaneal fracture variants.
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Affiliation(s)
- Stefan Rammelt
- University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, Dresden 01307, Germany.
| | - Michael P Swords
- Michigan Orthopedic Center, Sparrow Hospital, 2815 S. Pennsylvania Avenue, Suite 204 Lansing, MI 48910, USA
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Schulze S, Rothe R, Neuber C, Hauser S, Ullrich M, Pietzsch J, Rammelt S. Men who stare at bone: multimodal monitoring of bone healing. Biol Chem 2021; 402:1397-1413. [PMID: 34313084 DOI: 10.1515/hsz-2021-0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/12/2021] [Indexed: 12/19/2022]
Abstract
Knowledge of the physiological and pathological processes, taking place in bone during fracture healing or defect regeneration, is essential in order to develop strategies to enhance bone healing under normal and critical conditions. Preclinical testing allows a wide range of imaging modalities that may be applied both simultaneously and longitudinally, which will in turn lower the number of animals needed to allow a comprehensive assessment of the healing process. This work provides an up-to-date review on morphological, functional, optical, biochemical, and biophysical imaging techniques including their advantages, disadvantages and potential for combining them in a multimodal and multiscale manner. The focus lies on preclinical testing of biomaterials modified with artificial extracellular matrices in various animal models to enhance bone remodeling and regeneration.
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Affiliation(s)
- Sabine Schulze
- University Center of Orthopaedics, Trauma and Plastic Surgery (OUPC), University Hospital Carl Gustav Carus, D-01307Dresden, Germany.,Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, D-01307Dresden, Germany
| | - Rebecca Rothe
- Department of Radiopharmaceutical and Chemical Biology, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), D-01328Dresden, Germany.,Faculty of Chemistry and Food Chemistry, School of Science, Technische Universität Dresden, D-01062Dresden, Germany
| | - Christin Neuber
- Department of Radiopharmaceutical and Chemical Biology, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), D-01328Dresden, Germany
| | - Sandra Hauser
- Department of Radiopharmaceutical and Chemical Biology, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), D-01328Dresden, Germany
| | - Martin Ullrich
- Department of Radiopharmaceutical and Chemical Biology, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), D-01328Dresden, Germany
| | - Jens Pietzsch
- Department of Radiopharmaceutical and Chemical Biology, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), D-01328Dresden, Germany.,Faculty of Chemistry and Food Chemistry, School of Science, Technische Universität Dresden, D-01062Dresden, Germany
| | - Stefan Rammelt
- University Center of Orthopaedics, Trauma and Plastic Surgery (OUPC), University Hospital Carl Gustav Carus, D-01307Dresden, Germany.,Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, D-01307Dresden, Germany.,Center for Regenerative Therapies Dresden (CRTD), D-01307Dresden, Germany
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Guan X, Xiang D, Hu Y, Jiang G, Yu B, Wang B. Malunited calcaneal fracture: the role and technique of osteotomy-a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2663-2678. [PMID: 34240235 DOI: 10.1007/s00264-021-05130-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The research is aimed to introduce various corrective osteotomies utilized in treating calcaneal malunions in published papers, to further analyze the results, and to summarize recommended indications. METHODS The relevant research screening was conducted on the following search engines: the Cochrane Library, Web of Science, PubMed, Embase, Medline, and Academic Search Premier. Key words input included "calcaneal/calcaneus", "malunion," and "malunited fracture(s)" with Boolean operators "AND" and "OR." The inclusion criteria were researches containing surgical procedures treating calcaneal malunion with corrective osteotomy and published in the English language. For included research article, such information was extracted and analyzed: the type of calcaneal malunion, the time from initial injury to corrective surgery, the method of osteotomy, outcomes of each osteotomy (score systems, Bohler angle, talocalcaneal height and width of calcaneus, etc.), the function of the affected limb, post-operative complications, and patients' satisfaction. For included review, descriptive, commentary, or indicative sentences about corrective osteotomy were highlighted, analyzed, and summarized. RESULTS Ten research articles (170 patients with 184 feet) and nine reviews were included in this review, presenting seven types of corrective osteotomies (lateral wall exostectomy, Dwyer osteotomy, lateral wedge opening osteotomy, Romash osteotomy, tongue osteotomy, sagittal resection osteotomy, and modified Dwyer osteotomy). CONCLUSION A different corrective osteotomy with/without arthrodesis is recommended to be utilized based on the classification of the malunion and the condition of the cartilage in treating malunited calcaneal fractures. With adequate postoperative care and rehabilitation, the results of treatment could be associated with patients' satisfaction and good function.
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Affiliation(s)
- Xin Guan
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Dayong Xiang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yanjun Hu
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Guiyong Jiang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Bin Yu
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China. .,Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Bowei Wang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Abstract
BACKGROUND Calcaneal fracture-dislocations are rare but potentially disabling injuries that are regularly overlooked at first presentation. To date, only about 50 cases have been reported in the literature. METHODS Over a period of 8 years, 10 patients (average age 61.7 years) with acute fracture-dislocations of the calcaneus were treated at 2 level 1 trauma centers. The calcaneocuboid joint was involved in 9 patients. There was a concomitant fracture of the lateral talar process and of the tip of the distal fibula in 7 patients each. Open reduction and internal fixation was performed in 9 of 10 patients via an oblique lateral dislocation approach. One patient underwent primary subtalar fusion. All patients were seen for clinical and radiographic follow-up at an average of 3 years using patient-reported outcome scores. RESULTS Anatomic fixation was achieved in all patients as judged by postoperative computed tomographic imaging. In the 9 patients treated with internal fixation, the Foot Function Index averaged 12.8, the EuroQol 5D score averaged 0.89 and the visual analog scale score for patient satisfaction averaged 79.3 at final follow-up. Signs of mild subtalar arthritis were seen in 6 patients. No secondary subtalar fusions were needed. CONCLUSION When recognized and treated early, prognosis of calcaneal fracture-dislocation was favorable. A dislocation approach starting over the distal fibula, continuing over the sinus tarsi, and extending toward the calcaneocuboid joint allowed for adequate visualization of the subtalar joint and treatment of all components of the injury. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Stefan Rammelt
- University Center of Orthopaedics and Trauma Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christine Marx
- University Center of Orthopaedics and Trauma Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Grace Swords
- Michigan Orthopedic Center, Sparrow Hospital, Lansing, MI, USA
| | - Michael Swords
- Michigan Orthopedic Center, Sparrow Hospital, Lansing, MI, USA
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12
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Khezami K, Bassalah E, Bennour MA. Endoscopic lateral decompression of calcaneo-fibular impingement: Case Report and literature Review. Int J Surg Case Rep 2021; 80:105649. [PMID: 33621725 PMCID: PMC7907803 DOI: 10.1016/j.ijscr.2021.105649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE The calcaneo-fibular impingement syndrome is frequent after calcaneal fracture. The impinging lesion could be in bone and/or in soft tissue. The operative treatment aims to remove the impinging lesions either by open or endoscopic surgery. CASE PRESENTATION We report a case of a 33-year female patient with calcaneo-fibular impingement syndrome. The condition was managed using endoscopic bone resection, soft tissue debridement and peroneal tendons release. CLINICAL DISCUSSION Endoscopic treatment of calcalneo-fibular impingement syndrome has gradually been broadened as a safe, minimally invasive, and effective procedure. This endoscopic approach could reduce the wound complications associated with the open procedure and ensure early return to activity, better cosmetic and better patient satisfaction. The lateral approach could reduce nervous and tendinous complications associated with posterior approach. CONCLUSION The endoscopic surgery using lateral approach is a reliable and a minimally invasive technique to address calcaneo-fibular impinging. However, this procedure is less useful for advanced cases of calcaneal malunion (Stephens and Sanders II and III).
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Affiliation(s)
- Karim Khezami
- Faculty of Medicine of Tunis, University Tunis El Manar, Department of Orthopedic Surgery, Habib Bougatfa Hospital, Bizerte, Tunisia.
| | - Emir Bassalah
- Faculty of Medicine of Tunis, University Tunis El Manar, Department of Orthopedic Surgery, Habib Bougatfa Hospital, Bizerte, Tunisia.
| | - Mohamed Amine Bennour
- Faculty of Medicine of Tunis, University Tunis El Manar, Department of Orthopedic Surgery, Habib Bougatfa Hospital, Bizerte, Tunisia.
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