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Pang J, Hussain A, Yan M, Kapur K, Solomou G, Brassett C, Pasapula C, Norrish AR. The cadaveric research model for calcaneus fractures: A scoping review of biomechanical, anatomical, radiographic and fracture fixation studies. Foot (Edinb) 2024; 59:102085. [PMID: 38493665 DOI: 10.1016/j.foot.2024.102085] [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: 07/11/2022] [Accepted: 03/10/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Calcaneal fractures remain a big challenge in orthopaedic surgery and lead to long lasting disabilities. Cadaveric research plays an important role in determining optimal fracture treatment. This scoping review aims to provide insight into cadaveric research that has been conducted on calcaneal fractures, including biomechanics, fixation, approaches and radiographic studies. METHODOLOGY A search strategy was created and implemented as per PRISMA guidance. 3 databases, Medline, Embase and Scopus, were used when conducting this review. RESULTS 484 individual studies were retrieved across the 3 databases, of which 186 duplicates were excluded. Study abstracts were individually reviewed, of which 208 studies were excluded in accordance with study criteria. 90 papers were sought for retrieval, of which 83 full text papers were successfully retrieved. Of the full papers retrieved, 22 did not meet our inclusion criteria, and 19 papers related only to talus fractures. In the end, 43 cadaveric studies pertaining to this scoping review were included and reviewed. DISCUSSION Studies were grouped into biomechanical, anatomical, fixation and radiographic studies for review. CONCLUSION Evaluation of current cadaveric studies pertaining to calcaneal fractures has allowed greater insight into the myriad challenges in the management of these injuries. Effects of intra-articular fractures on calcaneal biomechanics assist in establishing surgical goals. Whilst fixation studies showing good stability of nail fixations could encourage further development in minimally invasive techniques. Avoiding pitfalls seen in the extensile lateral approach. Recommendations of areas for further research include use of external fixators, fixation in non-Sanders Type 2 fractures, and comparison of intraoperative CT/3D fluoroscopy with o conventional fluoroscopy.
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Affiliation(s)
- Joe Pang
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Department of Orthopaedic Surgery, Gayton Road, King's Lynn PE30 4ET, United Kingdom
| | - Ali Hussain
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
| | - Mathhew Yan
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
| | - Karan Kapur
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
| | - Georgios Solomou
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Department of Orthopaedic Surgery, Gayton Road, King's Lynn PE30 4ET, United Kingdom; School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, United Kingdom.
| | - Cecilia Brassett
- Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge CB2 3DY, United Kingdom
| | - Chandra Pasapula
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Department of Orthopaedic Surgery, Gayton Road, King's Lynn PE30 4ET, United Kingdom
| | - Alan R Norrish
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Department of Orthopaedic Surgery, Gayton Road, King's Lynn PE30 4ET, United Kingdom; Academic Unit of Injury, Recovery and Inflammation Sciences, Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
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Silhanek AD, Ramdass R, Lombardi CM. The effect of primary fracture line location on the pattern and severity of intraarticular calcaneal fractures: a retrospective radiographic study. J Foot Ankle Surg 2006; 45:211-9. [PMID: 16818147 DOI: 10.1053/j.jfas.2006.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This retrospective radiographic study sought to evaluate how primary fracture line location relates to the pattern and severity of intraarticular calcaneal fractures. Preoperative lateral radiographs and semicoronal computed tomography scans of 100 displaced intraarticular calcaneal fractures (89 patients) were evaluated for Bohler's angle, Sanders classification, and calcaneocuboid, anterior, or middle subtalar articular involvement. Primary fracture line location was measured on semicoronal computed tomography views as a ratio of the width of the posterior facet. There were 60 Sanders type II (29 IIA, 29 IIB, 2 IIC), 35 type III (10 IIIAB, 9 IIIAC, 16 IIIBC) and 5 type IV fractures. The mean Bohler's angle was 10.1+/-15.6 degrees. The mean primary fracture line location was calculated to be found at 45.7+/-18.2% of the width of the posterior facet, as measured from lateral to medial. Statistical analysis found a significant association between primary fracture line location and Sanders class (r=.636; P<.001) and Bohler's angle (r=-.287; P=.005); as the fracture line moved medially, comminution increased and Bohler's angle decreased. Forty-eight percent of the fractures involved the calcaneocuboid joint; 39% involved the anterior (n=28) or middle (n=11) subtalar facets, or both. A medial primary fracture line correlated to greater involvement of the calcaneocuboid joint (r=.247; P=.015) and the anterior (r=.241; P<.001) and middle (r=.344; P=.003) facets. These results suggest that intraarticular calcaneal fractures exhibiting a medial primary fracture line are associated with a more severe fracture pattern and an increased incidence of anterior articular extension.
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Affiliation(s)
- Alison D Silhanek
- Podiatric Medical Residency Program, Wyckoff Heights Medical Center, Brooklyn, NY, USA.
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Abstract
Displaced fractures of the calcaneous are relatively common injuries that remain a treatment enigma. Virtually all aspects of the management of calcaneal fractures are a source of debate. Contemporary imaging, reduction, and fixation techniques attempt to improve the long term results of these injuries. The complex fracture fragments displace in predictable patterns. Meticulous surgical technique, restoration of extra- and intra-articular anatomy, and obtaining rigid fracture fixation are critical to obtaining satisfactory operative results. This article extensively reviews the controversies and summarizes the current opinions in the management of displaced calcaneal fractures.
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Affiliation(s)
- David P Barei
- Department of Orthopedic Surgery, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104-2499, USA
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