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Tian H, Guo W, Zhou J, Wang X, Zhu Z. Bone graft versus non-bone graft for treatment of calcaneal fractures: A protocol for meta-analysis. Medicine (Baltimore) 2021; 100:e24261. [PMID: 33466211 PMCID: PMC7808454 DOI: 10.1097/md.0000000000024261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/07/2020] [Accepted: 12/13/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Calcaneal fractures are a prevalent form of injury caused by high-energy trauma. This study aimed at investigating whether bone graft and non-bone graft are essential for the internal fixation of calcaneal fractures. A meta-analysis of relevant clinical studies evaluated radiographic parameters, functional outcomes, and complications that offer practical recommendations on the suitability of bone grafts for the management of Calcaneal fractures. METHODS AND ANALYSIS This study performed a comprehensive search on PubMed, EMBASE, and Cochrane electronic to retrieve related clinical studies. The studies incorporated in our meta-analysis were identified after doing a preliminarily screening, reading of the full-text articles, and eliminating repeated studies. After quality assessment and data extraction, the standardized mean difference and risk ratio were selected as effect sizes. The data on Böhler angle, Gissane angle, calcaneal height, American Orthopaedic Foot and Ankle Society hindfoot scores, Maryland Foot Evaluation, and rate of wound infection were analyzed using Revman 5.3 software (Cochrane Collaboration). RESULTS AND CONCLUSIONS This study did not reveal any significant differences (P < .05) in both Böhler and Gissane angles, calcaneal height, American Orthopaedic Foot and Ankle Society hindfoot scores, Maryland foot evaluation, and rate of wound infection between the 2 groups. Due to the lack of a large sample of comparative studies, the use of bone grafting for the management of calcaneal fractures requires additional substantiation.
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Affiliation(s)
- Heng Tian
- Department of Hand Surgery, The Second Hospital of Jilin University
| | - Wenlai Guo
- Department of Hand Surgery, The Second Hospital of Jilin University
| | - Jinlan Zhou
- Center for Applied Statistical Research and College of Mathematics, Jilin University, Changchun, China
| | - Xiaoyue Wang
- Center for Applied Statistical Research and College of Mathematics, Jilin University, Changchun, China
| | - Zhe Zhu
- Department of Hand Surgery, The Second Hospital of Jilin University
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Zheng W, Xie L, Xie H, Chen C, Chen H, Cai L. With versus without bone grafts for operative treatment of displaced intra-articular calcaneal fractures: A meta-analysis. Int J Surg 2018; 59:36-47. [DOI: 10.1016/j.ijsu.2018.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/08/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
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Konya MN, Sargın S. Kalkaneus Kırıklarında Tedavi Yöntemi Klinik Sonuçları Etkiler Mi? Retrospektif Karşılaştırmalı Çalışma. ACTA MEDICA ALANYA 2017. [DOI: 10.30565/medalanya.313876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kapil Mani KC, Acharya P, Dirgha Raj RC, Pangeni BR, Sigdel A, Marahatta SB. A modified minimally invasive technique for intra-articular displaced calcaneal fractures fixed by transverse and axial screws. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:997-1004. [PMID: 28501960 DOI: 10.1007/s00590-017-1969-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/06/2017] [Indexed: 10/19/2022]
Abstract
The management of displaced, intra-articular calcaneal fracture represents a surgical challenge to even an experienced orthopedic surgeon. Plate osteosynthesis using an extended lateral approach is complicated by soft tissue problems, while those treated by closed reduction and percutaneous pinning cannot address all the intra-articular fragments sufficiently. The objective of our study is to evaluate restoration of subtalar joint and long-term functional outcomes in intra-articular displaced calcaneal fractures treated with transverse subcondral screws through a small incision on lateral aspect of calcaneus and percutaneously placed axial screws through the calcaneal tuberosity. Forty-five intra-articular calcaneal fractures were managed with this minimally invasive technique. Calcaneal height, width, length, Bohler's angle, and Gissane angle were measured preoperatively and last follow-up visit. Functional outcomes were assessed on the basis of American Orthopedic Foot and Ankle Society (AOFAS) ankle/hind foot score. Preoperative calcaneal length, height, width, Bohler's angle, and Gissane angle were improved from 68.62 ± 2.64 to 72.44 ± 2.63 mm, 39.28 ± 2.72 to 32.37 ± 2.65 mm, 47.04 ± 2.56 to 49.55 ± 2.45 mm, 12.66° ± 2.86° to 26.93° ± 2.57°, 123.91° ± 3.13° to 96.06° ± 3.92°, respectively, after surgery with P value <0.001. There were 21 (46.7%) excellent, 17 (37.8%) good, 4 (8.8%) fair, and 3 (6.7%) poor outcomes based on AOFAS ankle/hindfoot scores. Time to unite the fracture was 11.06 ± 1.82 weeks (range 8-16 weeks), and all fractures were united without major complications. Minimally invasive technique through a small incision on lateral aspect of calcaneus gives a moderately good exposure for anatomical restoration of Sander's type II and III calcaneal fractures fixed with both transverse and axial screws under fluoroscopic guidance.
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Affiliation(s)
| | | | | | | | - Arun Sigdel
- Civil Service Hospital, Minbhawan, Kathmandu, Nepal
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Sonmez MM, Armagan R, Ugurlar M, Eren T. Allografts versus Equine Xenografts in Calcaneal Fracture Repair. J Foot Ankle Surg 2017; 56:510-513. [PMID: 28242215 DOI: 10.1053/j.jfas.2017.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Indexed: 02/03/2023]
Abstract
Displaced intra-articular calcaneal fractures are difficult to treat. We determined the functional results and complications of using allografts or equine xenografts in treating these fractures. We reviewed patients seen at our center from May 2011 to December 2014 with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and an additional bone allograft or equine xenograft. A minimum of 1 year after surgery, a history of infection and functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society clinical rating system. Changes in the Gissane angle (GA) and Böhler angle were assessed from radiographs. Of the 91 eligible patients, 15 were lost to follow-up, leaving a sample of 76 patients (42 males): 45 received allografts (19 for type III and 26 for type IV fractures) and 31 received xenografts (20 for type III and 11 for type IV fractures). The mean age was about 40 years in both groups. After ≥1 year of follow-up, the proportion of patients in the American Orthopaedic Foot and Ankle Society scoring categories did not differ significantly between the 2 groups (mean ankle score, 86.5 in the allograft group and 85.1 in the xenograft group), and the American Orthopaedic Foot and Ankle Society functional outcomes were good or excellent in 69% and 68%, respectively (p = .986). The groups did not differ in the incidence of superficial or deep infection (p = 1.000). The Böhler angles were significantly decreased in the xenograft group. Xenografts might be preferred for repairing intra-articular calcaneal fractures because they can perform as well as allografts, avoid donor site morbidities, and are more available and less expensive than allografts.
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Affiliation(s)
- Mehmet Mesut Sonmez
- Doctor, Department of Orthopaedics, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Raffi Armagan
- Doctor, Department of Orthopaedics, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Meric Ugurlar
- Doctor, Department of Orthopaedics, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Tugrul Eren
- Associate Professor, Department of Orthopaedics, Hamidiye Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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Yeap EJ, Rao J, Pan CH, Soelar SA, Younger ASE. Is arthroscopic assisted percutaneous screw fixation as good as open reduction and internal fixation for the treatment of displaced intra-articular calcaneal fractures? Foot Ankle Surg 2016; 22:164-169. [PMID: 27502224 DOI: 10.1016/j.fas.2015.06.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/04/2015] [Accepted: 06/22/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study compares the outcomes of calcaneal fracture surgery after open reduction internal fixation and plating (ORIF) versus arthroscopic assisted percutaneous screw fixation (APSF). METHODS Group I (N=12) underwent ORIF. Group II (N=15) underwent APSF. Anthropometric data, pre and post-operative stay, complications and duration off work were recorded in this retrospective case cohort study. Radiographs were analyzed for Bohler's, Gissane's angle and Sanders' classification. AOFAS Hindfoot and SF 36 scores were collected at final follow-up. RESULTS Anthropometric data, Bohler's and Gissane's angles, AOFAS and SF 36 scores were not significantly different. Pre-operative duration was 12.3 days in ORIF and 6.9 days in APSF. Post-operative duration was 7.3 days vs 3.8 days. Duration off work was 6.2 months vs 2.9 months. CONCLUSION The APSF group was able to have surgery earlier, go home faster, and return to work earlier. This study was not powered to demonstrate a difference in wound complication rates.
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Operative Versus Nonoperative Treatment of Displaced Intra-Articular Calcaneal Fractures: A Meta-Analysis of Randomized Controlled Trials. J Orthop Trauma 2016; 30:e75-81. [PMID: 26371619 DOI: 10.1097/bot.0000000000000446] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare the clinical outcomes of operative and nonoperative treatment for displaced intra-articular calcaneal fractures (DIACFs). DATA SOURCES PubMed, Embase, Cochrane library, and ClinicalTrial.gov. STUDY SELECTION Randomized controlled trials comparing operative and nonoperative treatment for DIACFs. DATA EXTRACTION Information on study methods and clinical outcomes. DATA SYNTHESIS We performed data synthesis on relevant clinical outcomes. Weighted mean differences with 95% confidence intervals were calculated for continuous data and relative risks with 95% confidence intervals were calculated for dichotomous data. A fixed-effect model or a random-effect model was used. RESULTS Seven randomized controlled trials involving 908 patients were included. Operative treatment for DIACFs reduced problems associated with shoe wear and increased walking ability but increased the risks of overall complications and infection. There were no significant differences between the groups in American Orthopaedic Foot and Ankle Society scores, The Short Form (36) Health Survey, return to work, rate of subsequent subtalar fusion, or the rate of reflex sympathetic dystrophy. CONCLUSIONS This meta-analysis documented that when surgery was performed correctly, better shoe wear and improved walking ability could be expected. These outcomes seemed to be based on the surgeon's ability to obtain an acceptable reduction. Benefits were tempered by the increase in wound complications associated with this intervention. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Alexandridis G, Gunning AC, Leenen LPH. Patient-reported health-related quality of life after a displaced intra-articular calcaneal fracture: a systematic review. World J Emerg Surg 2015; 10:62. [PMID: 26719760 PMCID: PMC4696241 DOI: 10.1186/s13017-015-0056-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/21/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A displaced intra-articular calcaneal fracture (DIACF) is known for having a negative influence on the daily activities of patients. A health-related quality of life (HRQoL) outcome instrument is used to quantify the impact of DIACF. It seems that these studies used restrictive inclusion criteria and observe specific patient groups; consequently, an increased risk of bias that results in incorrect estimation of the impact. Therefore, we will systematically review the current literature. MATERIALS AND METHODS A systematic search was performed in PubMed, Embase and Cochrane library. Inclusion criteria were studies reporting DIACF and HRQoL, measured with SF-36, SF-36v2, EQ-5D or EQ-6D. The identified articles were critically appraised for their relevance and validity. The overall risk of bias was determined. The studies with a low to medium risk of bias were used for data extraction. RESULTS 32 articles were available for the critical appraisal. 13 articles had a medium risk of bias. All studies reported the SF-36 and two studies also reported the EQ-5D. CONCLUSIONS This systematic review indicates that DIACF is a life-changing event for most patients. The HRQoL is substantially lower in comparison to the period before the trauma and to the general population, in particular the subdomains related to the physical domain are affected. In addition, this review reveals that the identified studies have a medium to high risk of bias. Consequently, it is challenging to make reliable and valid conclusions. Therefore, we provided recommendations to decrease the risk of bias in order to improve future research.
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Affiliation(s)
- G. Alexandridis
- Department of Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - A. C. Gunning
- Department of Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - L. P. H. Leenen
- Department of Surgery, University Medical Center Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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There is poor reliability of Böhler's angle and the crucial angle of Gissane in assessing displaced intra-articular calcaneal fractures. Foot Ankle Surg 2015; 21:277-81. [PMID: 26564731 DOI: 10.1016/j.fas.2015.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 03/01/2015] [Accepted: 03/03/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Two-dimensional measurements are used to describe displaced intra-articular calcaneal fractures (DIACF). Our study evaluates the performance of Böhler's angle (BA) and the crucial angle of Gissane (CAG) among orthopedic surgeons. METHODS Thirty-four pre- and post-operative lateral foot radiographs from patients with DIACF were shown to four orthopedic surgeons who measured BA and the CAG. The intra- and inter-observer reliability were calculated using the intra-class correlation coefficient (ICC). Additionally, we calculated frequency of consensus given an allowed discrepancy. We then determined the tolerance limit for each measurement. RESULTS The ICC for inter-observer reliability of BA was 0.83 in the first session and 0.77 in the second. The ICC for intra-observer reliability ranged from 0.83 to 0.98. For the CAG, the inter-observer ICC was 0.28 and 0.1 in the two sessions. Intra-observer ICC ranged from 0.16 to 0.67. With an allowed discrepancy of 20°, there was lack of consensus for BA in 37.5% and for the CAG in 59% of measurements on average. The 95% confidence interval for 90% agreement in BA involved a range of 76°. For CAG, the 95% confidence interval of tolerance for 90% agreement was 56°. CONCLUSIONS For BA and CAG, there is frequent disagreement among experienced observers, even given a wide tolerance range. We recommend use of caution when applying BA as currently measured in making treatment decisions for DIACF. LEVEL OF CLINICAL EVIDENCE Diagnostic, level III.
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Gusic N, Fedel I, Darabos N, Lovric Z, Bukvic N, Bakota B, Lemac D. Operative treatment of intraarticular calcaneal fractures: Anatomical and functional outcome of three different operative techniques. Injury 2015; 46 Suppl 6:S130-3. [PMID: 26606987 DOI: 10.1016/j.injury.2015.10.061] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Management of the intraarticular calcaneal fracture is a challenge. The optimal method of treatment remains controversial. This study evaluates the anatomical and functional postoperative outcomes of displaced intraarticular calcaneal fractures that have been treated using three different techniques of ORIF. PATIENTS AND METHODS Between 2004 and 2011 we treated 143 patients with calcaneal fractures, 40 of these patients (28%) were treated conservatively. This is a retrospective study of the remaining 103 patients (72%) who were operated on consecutively, mainly by one surgeon (NG). Calcaneal fractures were classified according to the Sanders classification. Three types of osteosynthesis were used: standard anatomical plate (SP), locking anatomical plate (LCP) and standard anatomical plate with autologous bone graft (SP+ABG). Clinical outcome was assessed one year after the operation: anatomical reduction was evaluated according to the analysis of Bohler's angle at final follow-up, and functional assessment was conducted using the Maryland Foot Score (MFS). RESULTS The fractures were classified as follows: 35 (34%) Sanders type II, 47 (45.6%) Sanders type III and 21 (20.4%) Sanders type IV. The SP was used in 67 (65%) fractures, LCP in 16 (15.5%) and SP+ABH in 20 (19.4%). The correlation test showed a weak association between the Sanders fracture type and the operation technique (Pearson correlation coefficient r=0.26). The non-parametric tests showed that the fracture type did not significantly influence the postoperative Bohler's angle outcome (p=0.132), or the type of operation (p=0.664). Excellent or good reduction of the posterior calcaneal facet was achieved in all operated fractures. One year after the operation, the distribution of Bohler's angle was normal with a mean 31.9° (SD 4.84) in all three groups. There was no significant difference in the functional postoperative outcome in terms of MFS in the three groups (p=0.601), but the Sanders fracture type had significant influence on the functional postoperative outcome in terms of MFS (p=0.001). CONCLUSION In the representative sample of 103 operatively treated intraarticular calcaneal fractures, anatomical and functional postoperative efficacy outcomes appeared to be similar in all three treatment groups. High-grade displaced intraarticular calcaneal fractures (Sanders IV) had worse functional results irrespective of the type of operation. The optimal method for management of intraarticular calcaneal fracture is operative, using the standard anatomic calcaneal plate. Autologous bone grafting is not required. Large sample comparative studies are still needed.
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Affiliation(s)
- N Gusic
- Department for Traumatology and Orthopaedics, Pula County Hospital, Negrijeva 6, HR-52100 Pula, Croatia.
| | - I Fedel
- Department for Traumatology and Orthopaedics, Pula County Hospital, Negrijeva 6, HR-52100 Pula, Croatia.
| | - N Darabos
- University Clinic for Traumatology, Clinical Hospital Centre "Sisters of Charity", Draskoviceva ulica 19, HR-10000 Zagreb, Croatia.
| | - Z Lovric
- Department for Traumatology and Orthopaedics, University Hospital Dubrava, Av. Gojka Suska 6, HR-10040 Zagreb, Croatia.
| | - N Bukvic
- Department for Pediatric Trauma and Orthopaedics, Clinical Hospital Rijeka, Croatia, Istarska 43a, HR-51000 Rijeka, Croatia.
| | - B Bakota
- Department for Traumatology and Orthopaedics, Karlovac County Hospital, Karlovac, Croatia.
| | - D Lemac
- Department for Traumatology and Orthopaedics, University Hospital Dubrava, Av. Gojka Suska 6, HR-10040 Zagreb, Croatia.
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De Boer AS, Van Lieshout EMM, Den Hartog D, Weerts B, Verhofstad MHJ, Schepers T. Functional outcome and patient satisfaction after displaced intra-articular calcaneal fractures: a comparison among open, percutaneous, and nonoperative treatment. J Foot Ankle Surg 2014; 54:298-305. [PMID: 24891090 DOI: 10.1053/j.jfas.2014.04.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to compare the outcomes of patients with a displaced calcaneal fracture treated by open reduction and internal fixation (ORIF), percutaneous treatment, or nonoperative methods. A retrospective cohort study was conducted at a level I trauma center of patients with a displaced intra-articular calcaneal fracture treated from January 1, 2002 to December 31, 2011. The patient-reported outcome measures included the Foot Function Index, American Orthopaedic Foot and Ankle Society hindfoot scale, Short Form-36, the EQ-5D from the EuroQol Group, and a 10-point visual analog scale. Clinical data were collected from 169 patients, and questionnaires were obtained from 78 patients (18 nonoperatively, 27 ORIF, and 33 percutaneously). The late intervention rate was significantly greater in the percutaneous group (n = 18; 30%) than in the ORIF group (n = 6; 12%) or the nonoperative group (n = 8; 13%; p = .030). Significantly more disability was reported in the nonoperative group (median Foot Function Index score, 40 points) than in the ORIF group (median, 16 points; p = .010) or in the percutaneous group (median, 21 points; p = .034). In conclusion, the operatively treated patients (ORIF and percutaneous treatment) reported better functional outcome scores (Foot Function Index and American Orthopaedic Foot and Ankle Society hindfoot scale) than did the nonoperatively treated patients.
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Affiliation(s)
- A Siebe De Boer
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bas Weerts
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tim Schepers
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Veltman ES, Doornberg JN, Stufkens SAS, Luitse JSK, van den Bekerom MPJ. Long-term outcomes of 1,730 calcaneal fractures: systematic review of the literature. J Foot Ankle Surg 2013; 52:486-90. [PMID: 23663876 DOI: 10.1053/j.jfas.2013.04.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Indexed: 02/03/2023]
Abstract
The objective of the present study was to review the current data on the long-term outcomes of calcaneal fractures, with special emphasis on the role of the type of treatment, surgical approach, and reduction and internal fixation. The search was limited to skeletally mature patients. Major databases were searched from 1978 to 2011 to identify studies relating to functional outcome, subjective outcome, and radiographic evaluation at least 2 years after either surgical or conservative treatment of calcaneal fractures. Of 59 initially relevant studies, 25 met our inclusion criteria. A total of 1,730 fractures were identified in 1,557 patients. The mean sample size-weighted follow-up period was 4.6 years. The findings from the present review support current clinical practice that displaced calcaneal fractures are treated surgically from 1 level I evidence study, 1 level II, and multiple studies with less than level II evidence, with open reduction and internal fixation as the method of choice. If the fracture is less complex, percutaneous treatment can be a good alternative according to current level 3 and 4 retrospective data.
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Affiliation(s)
- Ewout S Veltman
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
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Ventham NT, Phadnis J, Sujenthiran A, Trompeter AJ, Ramesh P. Isolated transcalcaneal talonavicular dislocation: a severe injury related to a low-energy mechanism. J Foot Ankle Surg 2013; 52:367-9. [PMID: 23376005 DOI: 10.1053/j.jfas.2012.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Indexed: 02/03/2023]
Abstract
Transcalcaneal talonavicular dislocation is a rare injury, with very few reported cases. Of these, most have been the result of high-energy mechanisms such as road traffic collisions or falls from a height. The management of this injury is challenging, and treatment is fraught with a high rate of disability, infection, and amputation. We describe the successful management of the first reported case of a low-energy transcalcaneal talonavicular dislocation in a 71-year-old female. Combined external and internal fixation was used to reduce and maintain the injury, with a resultant good functional and complication-free outcome at 1 year after the injury. Our experience highlights the prevalence of these devastating injuries caused by relatively benign mechanisms in an increasingly older population with osteoporotic bone. It also indicates that operative stabilization of a low-energy injury can be more successful than that with the traditional high-velocity trauma.
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Yang Y, Zhao H, Zhou J, Yu G. Treatment of displaced intraarticular calcaneal fractures with or without bone grafts: A systematic review of the literature. Indian J Orthop 2012; 46:130-7. [PMID: 22448049 PMCID: PMC3308652 DOI: 10.4103/0019-5413.93672] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The necessity of bone grafts in the treatment of intraarticular calcaneal fractures continues to be one of the most debated topics in foot and ankle surgery. The purpose of this study was to determine whether there are sufficient objective cumulative data in the literature to compare the two methods and if the bone graft was needed in surgical treatment of intraarticular calcaneal fractures. MATERIALS AND METHODS A comprehensive search of all relevant articles from 1990 to 2010 was conducted. Two reviewers evaluated each study to determine its suitability for inclusion and collected the data of interest. Meta-analytic pooling of group results across studies was performed for the two treatment methods. RESULTS The systematic review identified 32 primary studies with 1281 fractures, which contained 4 comparative studies, 13 with bone grafts, and 15 without bone grafts in treatment methods. The infection rate in bone graft group was higher through statistically insignificant than in non-graft group (8.3% vs. 6.3%) No significant difference was found between good reduction rate, postoperative osteoarthritis rate, and subtalar fusion rate. The average full weight-bearing time in bone graft group was significantly lower (5.4 months) than in non-graft group (10.5 months). The mean postoperative Böhler's angle was significantly higher in bone graft group (lose due to collapse was significancy less). For the efficacy outcomes, the bone graft group had a lower American Orthopaedic Foot and Ankle Society Score (AOFAS) (71.4 points vs. 80.5 points) but a higher Creighton score (89.9 points vs. 81.0 points) compared with non-graft group. Pooled mean results showed 35% of the patients in bone graft group had an excellent result, 40% had a good result, 21% had a fair result, and 4% had a poor result. In the non-graft group, the corresponding values were 34, 42, 14, and 10%, respectively. CONCLUSIONS The operative treatment of intraarticular calcaneal fractures with bone grafts could restore the Böhler's angle better and the patients could return to full weight bearing earlier. However, the functional and efficacy outcomes appear to be similar between the two treatment groups. There were more joint depression and comminuted fractures in the bone graft group, and the mean followup time was shorter. Large sample comparative studies are still needed.
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Affiliation(s)
- Yunfeng Yang
- Department of Orthopaedic Surgery, Tongji Hospital of Tongji University, Shanghai, China
| | - Hongmou Zhao
- Department of Orthopaedic Surgery, Tongji Hospital of Tongji University, Shanghai, China
| | - Jiaqian Zhou
- Department of Orthopaedic Surgery, Tongji Hospital of Tongji University, Shanghai, China
| | - Guangrong Yu
- Department of Orthopaedic Surgery, Tongji Hospital of Tongji University, Shanghai, China,Address for correspondence: Dr. Guangrong Yu, Department of Orthopaedic Surgery, 389 Xincun Road, Shanghai - 200 065, China. E-mail:
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Rubino R, Valderrabano V, Sutter PM, Regazzoni P. Prognostic value of four classifications of calcaneal fractures. Foot Ankle Int 2009; 30:229-38. [PMID: 19321100 DOI: 10.3113/fai.2009.0229] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The purpose of this study was to assist surgeons treating calcaneal fractures in choosing the most predictive fracture classification and clinical outcome tool. MATERIALS AND METHODS For 152 patients (189 calcaneal fractures; average followup, 9.9 years), all fractures were classified in accordance with the Essex-Lopresti, OTA, Regazzoni, and Sanders classifications and matched with the following scores: AOFAS score, CNHF, FOA, MFS, Rowe, MFA, SF-36, and VAS. RESULTS The Essex-Lopresti classification showed no statistically significant relation with any of the clinical scores (p > 0.05). The OTA classification related statistically significant with the MFS (p = 0.006), AOFAS score (p = 0.013), FOA (p = 0.019), Rowe (p = 0.0027), and MFA score (p = 0.03). The Regazzoni classification correlated with the AOFAS score (p = 0.003), MFS (p = 0.002), Rowe (p = 0.002), CNHF (p = 0.0001), FOA (p = 0.003), MFA score (p = 0.002), and VAS (p = 0.005). The Sanders classification corrrelated with the AOFAS score (p = 0.007), MFS (p = 0.001), Rowe (p = 0.001), CNHF (p = 0.024), FOA (p = 0.021), MFA score (p = 0.036), and VAS (p = 0.014). CONCLUSION Compared to radiological based classifications, the CT based classifications, especially the Regazzoni and Sanders classifications, exhibited higher prognostic value compared to ultimate outcome scores.
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Affiliation(s)
- Raffaele Rubino
- Orthopedic Traumatologic Department, University Hospital of Basel, 4031 Basel, Switzerland
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Weber M, Lehmann O, Sägesser D, Krause F. Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. ACTA ACUST UNITED AC 2008; 90:1608-16. [DOI: 10.1302/0301-620x.90b12.20638] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The extended lateral L-shaped approach for the treatment of displaced intra-articular fractures of the calcaneum may be complicated by wound infection, haematoma, dehiscence and injury to the sural nerve. In an effort to reduce the risk of problems with wound healing a technique was developed that combined open reduction and fixation of the joint fragments and of the anterior process with percutaneous reduction and screw fixation of the tuberosity. A group of 24 patients with unilateral isolated closed Sanders type II and III fractures was treated using this technique and compared to a similar group of 26 patients managed by the extended approach and lateral plating. The operation was significantly shorter (p < 0.001) in the first group, but more minor secondary procedures and removal of heel screws were necessary. There were no wound complications in this group, whereas four minor complications occurred in the second group. The accuracy and maintenance of reduction, and ultimate function were equivalent.
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Affiliation(s)
- M. Weber
- Department of Orthopaedic Surgery University of Bern, Inselspital, CH-3010 Bern, Switzerland
| | - O. Lehmann
- Department of Orthopaedic Surgery University of Bern, Inselspital, CH-3010 Bern, Switzerland
| | - D. Sägesser
- Department of Orthopaedic Surgery University of Bern, Inselspital, CH-3010 Bern, Switzerland
| | - F. Krause
- Department of Orthopaedic Surgery University of Bern, Inselspital, CH-3010 Bern, Switzerland
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Schepers T, Ginai AZ, Mulder PGH, Patka P. Radiographic evaluation of calcaneal fractures: to measure or not to measure. Skeletal Radiol 2007; 36:847-52. [PMID: 17554537 DOI: 10.1007/s00256-007-0330-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2006] [Revised: 01/06/2007] [Accepted: 03/05/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to correlate the functional outcome after treatment for displaced intra-articular calcaneal fracture with plain radiography. DESIGN The design was a prognostic study of a retrospective cohort with concurrent follow-up. PATIENTS A total of 33 patients with a unilateral calcaneal fracture and a minimum follow-up of 13 months participated. Patients filled in three disease-specific questionnaires, graded their satisfaction and the indication for an arthrodesis was noted. Standardised radiographs were made of the previously injured side and the normal (control) side. Different angles and distances were measured on these radiographs and compared with values described in the literature. The differences in values in angles and distances between the injured and uninjured (control) foot were correlated with the outcome of the questionnaires, and the indication for an arthrodesis. RESULTS None of the angles correlated with the disease-specific outcome scores. Of the angles only the tibiotalar angle correlated with the VAS (r = 0.35, p = 0.045) and only the absolute foot height correlated with the indication for an arthrodesis (odds = 0.70, CI = 0.50-0.99). CONCLUSION In this study the radiographic evaluation correlated poorly with the final outcome. Measurements on plain radiographs seem not to be useful in determining outcome after intra-articular calcaneal fractures.
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Affiliation(s)
- T Schepers
- Department of General Surgery-Traumatology, Erasmus MC, University Medical Centre Rotterdam, Room H-974, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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Ibrahim T, Rowsell M, Rennie W, Brown AR, Taylor GJS, Gregg PJ. Displaced intra-articular calcaneal fractures: 15-year follow-up of a randomised controlled trial of conservative versus operative treatment. Injury 2007; 38:848-55. [PMID: 17445815 DOI: 10.1016/j.injury.2007.01.003] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 11/27/2006] [Accepted: 01/03/2007] [Indexed: 02/02/2023]
Abstract
AIM To report the 15-year follow-up of displaced intra-articular calcaneal fractures from a randomised controlled trial of conservative versus operative treatment published in 1993. PATIENTS AND METHODS Of the initial study, 46 patients (82%) were still alive at a mean of 15 years post injury and 26 patients (57%) agreed to review. The patients had been randomly allocated to either conservative or operative treatment in the original study. Clinical [American orthopaedic foot and ankle society hindfoot scale (AOFAS), foot function index (FFI) and calcaneal fracture score] and radiological (Böhler's angle and calcaneum height) outcome measures were used. The grade of osteoarthritis was also assessed at long-term follow-up. RESULTS At long-term follow-up, the clinical outcomes were not different between conservative versus operative treatment. AOFAS hindfoot scale: conservative=78.5 and operative=70, p=0.11; FFI: conservative=24.4 and operative=26.9, p=0.66; calcaneal fracture score: conservative=70.1 and operative=63.5, p=0.41. The radiological outcomes were also not different between both groups. Böhler's angle: conservative=10.4 degrees and operative 16.9 degrees , p=0.07; height of calcaneum: conservative=37.2mm and operative=38.2mm, p=0.57; grade of osteoarthritis of the sub-talar joint: p=0.54. There was no correlation between Böhler's angle and the outcome measures in either group. CONCLUSION The results of this 15-year follow-up of displaced intra-articular calcaneal fracture randomised controlled trial were equivalent between conservative and operative treatment and demonstrate similar findings to those at one year follow-up.
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Affiliation(s)
- T Ibrahim
- Department of Orthopaedic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
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Schepers T, Schipper IB, Vogels LMM, Ginai AZ, Mulder PGH, Heetveld MJ, Patka P. Percutaneous treatment of displaced intra-articular calcaneal fractures. J Orthop Sci 2007; 12:22-7. [PMID: 17260113 PMCID: PMC2778659 DOI: 10.1007/s00776-006-1076-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Accepted: 09/22/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND The outcome after displaced intra-articular calcaneal fractures is influenced by the condition of the surrounding soft tissues. To avoid secondary soft tissue complications after surgical treatment, several less-invasive procedures for reduction and fixation have been introduced. The percutaneous technique according to Forgon and Zadravecz is suitable for all types of displaced intra-articular calcaneal fractures and was therefore introduced in our clinic. The aim of this study was to evaluate the long-term outcome of percutaneous treatment according to Forgon and Zadravecz in patients with displaced intra-articular calcaneal fractures. METHODS A cohort of patients with displaced intra-articular calcaneal fractures treated with percutaneous surgery was retrospectively defined. Clinical outcome was evaluated by standardized physical examination, radiographs, three published outcome scores, and a visual analogue scale of patient satisfaction. RESULTS Fifty patients with 61 calcaneal fractures were included. After a mean follow-up period of 35 months, the mean values of the Maryland foot score, the Creighton-Nebraska score, and the American Orthopaedic Foot and Ankle Society score were 79, 76, and 83 points out of 100, respectively. The average visual analogue scale was 7.2 points out of 10. The average range of motion of the ankle joint was 90% of normal and subtalar joint movements were almost 70% compared with the healthy side or normal values. Superficial wound complications occurred in seven cases (11%) and deep infections in two (3%). A secondary arthrodesis of the subtalar joint was performed in five patients and was scheduled in four patients (15%). CONCLUSIONS Compared with the outcome of historic controls from randomized trials and meta-analyses, this study indicates favorable results for the percutaneous technique compared with the open technique. Despite similar rates of postoperative infection and secondary arthrodesis, the total outcome scores and preserved subtalar motion are overall good to excellent.
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Affiliation(s)
- Tim Schepers
- Department of Surgery, Traumatology, Erasmus MC University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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Paula SSD, Biondo-Simões MDLP, Luzzi R. Evolução das fraturas intra-articulares desviadas do calcâneo com tratamento cirúrgico. ACTA ORTOPEDICA BRASILEIRA 2006. [DOI: 10.1590/s1413-78522006000100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Fraturas do calcâneo correspondem a 2% do total de fraturas do corpo humano. Apresentam acentuada importância social e grande impacto econômico, pois ocorrem em indivíduos economicamente ativos. Para reconhecer a evolução das fraturas intra-articulares desviadas do calcâneo, um estudo retrospectivo é apresentado. A amostra constituiu-se de 71 doentes com fratura de calcâneo intra-articular desviada, 63 homens (88,73%) e 8 mulheres (11,27%). A idade esteve entre 14 e 74 anos. Conforme a escala de ESSEX-LOPRESTI, 55 delas eram do tipo depressão articular (77,46%) e 16 do tipo em língua (22,54%). A incisão mais usada foi a lateral em L (91,55%). Sessenta e uma das fraturas foram fixadas com placa "duplo H" (85,92%), 9 necessitaram apenas de parafusos (12,68%) e uma delas foi fixada com fios de Kirschner. Sete fraturas necessitaram de enxerto ósseo (9,86%). O tempo médio de seguimento foi de 11,59 ± 6,72 meses. Complicações precoces estiveram presentes em 33,82% dos doentes sendo mais comum a infecção e a necrose de pele. Complicações tardias foram identificadas em 63,38% dos doentes, principalmente edema residual e artrose. A incidência de complicações tardias não esteve relacionada ao tipo de fratura. As fraturas do tipo depressão articular contribuíram para a maior limitação das atividades (p=0,0315). O ângulo de Böhler, medido no pós-operatório, apresentou relação direta com o resultado final e ângulos menores do que 20 graus determinam maior incidência de maus resultados (p=0,0111). Observando a escala AOFAS, 59,26% de todos os doentes, evoluíram com bons e excelentes resultados.
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Voigt C, Prescher W, Lill H. [A bilaterally dislocated intraarticular calcaneus fracture in a 13-year old boy]. Unfallchirurg 2005; 108:601-3. [PMID: 15756526 DOI: 10.1007/s00113-005-0917-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Bilaterally dislocated intraarticular calcaneus fractures in childhood are rare. This case report shows that adequate preoperative tissue management, open anatomical reduction, and lateral plate osteosynthesis by an experienced surgeon according to the principles of adult surgery achieve a good functional result.
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Affiliation(s)
- C Voigt
- Klinik für Unfall- und Wiederherstellungschirurgie, Ev. Diakoniewerk Friederikenstift Hannover
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Kelly AJ. An outcome assessment of intra-articular calcaneal fractures, using patient and physician's assessment profiles. Injury 2005; 36:1383. [PMID: 16191428 DOI: 10.1016/j.injury.2004.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Accepted: 11/23/2004] [Indexed: 02/02/2023]
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23
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Khan M, Waseem M, Barnes K. Re: An outcome assessment of intra-articular calcaneal fractures, using patient and physician's assessment profiles. Injury 2005; 36:234-5. [PMID: 15589959 DOI: 10.1016/j.injury.2004.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2004] [Indexed: 02/02/2023]
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