Explore the vast range of titles available.

BackgroundMinimally invasive reduction and fixation of intra-articular calcaneal fractures poses great challenges for orthopaedic surgeons. The aim of the present study was to report the technical points, evaluate the efficacy of minimally invasive reduction and internal fixation assisted by the temporary limb reconstruction system (LRS) external fixator for intra-articular calcaneal fractures, and propose the indications of our protocol.MethodsIn this retrospective study, a series of 34 consecutive closed and displaced intra-articular calcaneal fractures involving the articular surface were treated by this technology between June 2016 and April 2018. X-ray and computed tomography (CT) scans were performed before and after surgery to measure Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot. Postoperative complications were recorded. Imaging and clinical outcomes were comprehensively evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle scoring system. After testing the normality of the data, Bohler's angle and the length of calcaneus were compared using the Wilcoxon signed-rank test. The height, width of the calcaneus, and the mechanical axis of the hindfoot were compared using the Paired-Samples t-test.ResultsThirty-two fractures were followed up for an average of 20.66 months (from 12 to 32 months). All fractures achieved stable reduction and bony union. The articular surface was reduced and fixed with direct vision through the sinus tarsi incision. No failure of internal fixation or loss of reduction was detected during follow-up. There were no soft tissue complications. Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot improved significantly. The AOFAS scores averaged 84.12 points; seven cases were rated excellent, 20 good, four fair, and one poor.ConclusionsFor intra-articular calcaneal fractures, minimally invasive surgery assisted with temporary LRS external fixation can reconstruct the calcaneal shape and the sub-talar articular surface. This simple surgical modality with limited complications may be helpful in the surgical treatment of most type II and III calcaneal fractures except comminuted fractures of the calcaneal tuberosity.

Objective To assess the long‐term outcomes after percutaneous reduction (PR) and screw fixation versus plate fixation via the sinus tarsi approach (STA) for displaced intra‐articular calcaneal fractures (DIACF). Methods This retrospective study included a total of 150 patients (June 2008–August 2011), comprising 85 men and 65 women (mean age, 38.4 years), who were assigned to the PR group or the STA group. The inclusion criteria were DIACF (>2 mm) including Sanders type II and III, closed fracture, unilateral fracture, no history of smoking or no smoking during hospitalization and 3 months after surgery, and follow‐up time not less than 8 years. The exclusion criteria were clear surgical contraindications (severe cardiovascular and cerebrovascular diseases), local or systemic infection symptoms, diagnosis with diabetes or lower extremity vascular disease, and Sanders type IV or open fractures. Outcomes were assessed by means of the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scores, radiographic images, and postoperative complications. Results The mean follow‐up period was 8.7 years (range, 8.0–10.0 years). The AOFAS scores in the PR group during the follow‐up period were 54.2 ± 5.1, 85.8 ± 4.0, 88.1 ± 3.8, 87.9 ± 3.6, 87.8 ± 3.9, 86.9 ± 3.9, respectively, and in the STA group were 55.0 ± 5.6, 84.5 ± 5.2, 87.1 ± 3.8, 86.9 ± 3.8, 87.7 ± 3.3, and 87.6 ± 2.8, respectively. There was no significant difference in AOFAS scores, Bohler's angle, Gissane's angle, calcaneal length, and height between the two groups (P > 0.05). The good to excellent rate of the PR group (80.8%) was less than that of the STA group (91.7%) (P = 0.055). For Sanders III fractures, the good to excellent rate of the PR group (33.3%) was less than that of the STA group (76.9%) (P = 0.029). For calcaneal width recovery, the STA group performed better than the PR group (P < 0.05). The incidence of postoperative complications in the PR group (12.8%) was lower than that in the STA group (27.8%) (P = 0.026), of which the incidence of wound complications was 3.8% in the PR group and 13.9% in the STA group (P = 0.041). In addition, there was no significant difference in other postoperative complications such as sural nerve injury, peroneus longus and brevis muscle injury, calcaneal valgus symptoms, lateral impingement symptoms, and subtalar arthritis (P > 0.05). Conclusion From the 8–10‐year follow‐up results of PR and STA as surgical procedures for the treatment of DIACF, it was found that there was no significant difference in the overall efficacy between them. STA was found to be superior to the PR in terms of the recovery of calcaneal width, providing more stable fixation for Sanders III fractures. PR was found to be more effective in reducing wound complications.

Background Calcaneal fractures are the most common type of tarsal fractures. The sustentaculum tali (ST) offers anatomical stability in calcaneal fractures, and recently, ST screws have been widely used in their treatment. This study aimed to investigate the clinical efficacy and value of ST screw fixation via a modified sinus tarsi approach (MSTA) for treating displaced intraarticular calcaneal fractures (DIACFs). Methods This study enrolled 64 patients (64 feet): 32 patients in the calcaneal locking plate combined with the ST screw group (CLP-STS Group) and 32 patients in the simple calcaneal locking plate internal fixation group (CLP Group). The minimum follow-up duration was 18 months. Ankle function was evaluated using VAS, AOFAS, and Short Form-36 scores. Imaging evaluation included the Böhler angle, Gissane angle, length, height, and width of the calcaneus, and the Böhler angle in both groups 1 year after surgery. Results Functional evaluation revealed that postoperative AOFAS and VAS scores in the CLP-STS Group were significantly better than those in the CLP Group. After surgery, the Böhler angle, Gissane angle, and length, height, and width of the calcaneus were significantly corrected compared to the preoperative values; however, the difference in these indicators between the two groups was not significant. Nevertheless, at the 1-year postoperative follow-up, the calcaneal Böhler angle loss in the CLP-STS Group was significantly better than that in the CLP Group. Conclusion Compared to simple calcaneal locking plate internal fixation, combining the plate with the additionally free ST screw can resolve the limited intraoperative exposure of MSTA, reduce postoperative foot pain in patients, and improve clinical efficacy.

Background Percutaneous reduction is a minimally invasive procedure for treating intra-articular calcaneal fractures that helps preserve the integrity of the soft tissues around the subtalar joint and reduces surgical complications. Auxiliary traction and temporary fixation are critical components in the process of percutaneous reduction. To overcome the limitations of current techniques for the percutaneous reduction of intra-articular calcaneal fractures, we introduced a technique in which wrist external fixators are used for assistance. This study aims to assess the effectiveness and safety of this approach through a retrospective case series. Methods From March 2015 to September 2018, patients with intra-articular calcaneal fractures who met the inclusion criteria underwent wrist external fixator-assisted percutaneous reduction at our hospital. Postoperatively, X-rays and CT scans were used to evaluate the degree of fracture reduction. The American Orthopedic Foot & Ankle Society (AOFAS) Ankle–Hindfoot score, along with the range of motion of the ankle and subtalar joints, was measured at the final follow-up. Results Among the 31 patients who completed the follow-up, 10 had Sanders type II fractures, and 21 had Sanders type III fractures. Postoperative imaging revealed significant improvements in calcaneal alignment, including the Böhler and Gissane angles. Excellent or good restoration of the subtalar joint surface was achieved in 83.8% of the patients, as confirmed by postoperative CT scans. The average AOFAS Ankle–Hindfoot score at the final follow-up was 93.84 ± 7.92. The mean range of motion for ankle flexion–extension was 64.35 ± 1.38 degrees, and for the internal–external motion of the subtalar joint, it was 29.27 ± 1.63 degrees, with no significant differences compared with the unaffected side. Only two patients developed subtalar osteoarthritis, and no cases of wound infection, skin necrosis, or sural nerve complications were reported. Conclusion The use of a wrist external fixator to assist in the percutaneous reduction of intra-articular calcaneal fractures appears to be an effective technique for restoring the calcaneal structure. This approach enhances postoperative subtalar joint mobility and overall ankle‒hindfoot function while significantly reducing surgery-related complications.

Purpose Several minimally invasive procedures were used to treat displaced intra-articular calcaneal fractures (DIACFs). No agreement among different authors about either the ideal fixation method or which technique is minimally invasive. The aim of this study was to compare functional and radiographic outcomes of two minimally invasive techniques in treatment of Sanders type II and III DIACFs by using K-wires or cannulated screws without bone grafts. Methods A prospective randomized controlled study was conducted on 28 patients (34 feet) with Sanders type II or III DIACFs, treated by closed reduction and fixation using cannulated screws or K-wires, at the Orthopedics Department of Sohag University Hospital, between April 2020 and February 2022. Functional assessment was done by American Orthopedic Foot and Ankle Society (AOFAS) score and VAS for pain. Radiographic assessment was done by measurement of three calcaneal angles (Gissane, Böhler’s, and posterior facet inclination angles) and three calcaneal distances (height, length, and width of the calcaneus). Results Mean ages of patients at the time of operation were 34.8 years for the cannulated screw group and 36.6 years for the K-wire group. A vast majority of patients were males (78.6%). Involvement of the right side in the cannulated screw group was 57.1% and that in the K-wire group was 47.9%. Mean operative time was significantly shorter among the K-wire group (42 min) compared to the cannulated screw group (57 min). Mean AOFAS score was higher among the cannulated screw group (85.9 points) compared to the K-wire group (75.8 points). Final VAS was significantly better among the cannulated screw group compared to the K-wire group. Mean time of radiographic union in the cannulated screw group was 8.9 weeks and that in the K-wire group was 10.1 weeks. Conclusion Both techniques avoided wound complications associated with ORIF with the advantage of a shorter hospital stay. Patients in the cannulated screw group had better functional and radiographic outcomes and a lower rate of subtalar arthritis than patients in the K-wire group. K-wires had advantages of reduced operative time, and easy removal as an outpatient procedure.

Background Following successful treatment, displaced intra-articular calcaneal fractures (DIACFs) necessitate an extensive rehabilitation regimen, significantly influencing functional and socio-economic outcomes. Apart from surgical intervention, the implementation of a comprehensive rehabilitation protocol is crucial to optimize foot stability and functional recovery. The objective of this study is to ascertain the optimal rehabilitation protocol for patients with surgically treated DIACFs, either permissive weight bearing (PWB) or Restricted Weight Bearing, focusing on functional outcomes, health-related quality of life (HRQoL), radiographic parameters, cost-effectiveness, and incidence of complications. Methods Study design: A prospective multicenter randomized controlled trial. Study population: Presence of surgically (extended lateral, sinus tarsi, or percutaneous approach) treated unilateral DIACFs (Sanders type II to IV), aged 18–67 years (labor force). Patients must be able to understand and follow weight bearing instructions. N = 115 patients with DIACFs will be included. Interventions: Patients with DIACFs will be randomly allocated to one of the rehabilitation protocols, either PWB or RWB. Primary outcome measure: Functional outcome, measured with the American Orthopaedic Foot & Ankle Society Score (AOFAS)). Secondary outcomes: Functional outcome (Maryland Foot Score, MFS), HRQoL (EuroQol-5D, EQ-5D), differences in radiographic parameters, cost-effectiveness, and complications. Nature and extent of burden: The PWB protocol is aimed to be non-inferior to the RWB protocol. Previous analysis of this protocol in other lower extremity fractures has shown a safe complication rate. Follow-up is standardized according to current trauma guidelines, namely at time points 2, 6, 12 weeks, and 6 months. The radiation exposure for both groups will differ from standard care (one extra CT scan of the foot will be made). Therefore, the burden for participants is considered minimal, with no significant health risks. Discussion This study will be the first study to define an optimal rehabilitation regime for surgically treated patients with DIACFs. The limitations of this study include the absence of patient blinding, as this is impossible in rehabilitation. Additionally, the primary outcome measure (AOFAS) has limited validity for DIACFs. However, it is the most commonly used questionnaire in the literature on DIACFs. There is an apparent need since current literature is lacking on this specific topic. Trial registration ClinicalTrials.gov NCT05721378, accepted on February 7, 2023.

Objective This study aimed to investigate the clinical efficacy of arthroscopy-assisted absorbable screw combined with Kirschner wire internal fixation in the treatment of Sanders type III displaced intra-articular calcaneal fractures. Methods Eighty patients diagnosed with Sanders type III displaced intra-articular calcaneal fractures and treated at Dongguan Hospital of Guangzhou University of Chinese Medicine in China from December 2020 to June 2023 were enrolled in this study. According to treatment protocol, these patients were divided into the A group ( n  = 40), which underwent subtalar arthroscopic reduction combined with absorbable screw and Kirschner wire internal fixation, and the H group ( n  = 40), which received hollow screw internal fixation via a modified tarsal sinus incision. Intraoperative metrics, including intraoperative blood loss and operation time, were comparatively analysed. Postoperative functional improvement, including parameters such as fracture healing time, pre- and postoperative Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), Maryland Foot Score (MFS), Tegner scores and radiological parameters such as Böhler’s angle, Gissane’s angle and calcaneus height and width, was also evaluated. The incidence and nature of postoperative complications were analysed. Results (1) No significant differences in intraoperative blood loss, operation time and postoperative fracture healing time were observed between the two groups ( P  > 0.05). (2) Postoperative follow-ups revealed significant improvements in VAS scores, AOFAS ankle–hindfoot scores, MFS scores and Tegner scores in both groups ( P  < 0.05). Compared with the H group, the A group demonstrated significantly superior AOFAS ankle–hindfoot and MFS scores at 3 and 12 months post operation and Tegner scores at 12 months post operation and at the last follow-up ( P  < 0.05). No significant differences in postoperative VAS scores were found between the two groups ( P  > 0.05). (3) Significant postoperative improvements were noted in Böhler’s angle, Gissane’s angle and calcaneal dimensions ( P  < 0.05), with no significant intergroup differences during follow-up ( P  > 0.05). (4) The patients in the A group returned to sports activities earlier (7.23 ± 3.4 months) than those in the H group (9.28 ± 3.99 months). (5) The A group exhibited a lower incidence of postoperative complications, with one case of traumatic arthritis (2.5%, 1/40) compared with four cases of peroneal tendonitis (10%, 4/40) in the H group ( P  < 0.05). Conclusion Arthroscopy-assisted absorbable screw combined with Kirschner wire internal fixation provides effective and satisfactory outcomes in terms of internal fixation, foot function and radiological improvements for Sanders type III displaced intra-articular calcaneal fractures. This approach is associated with a low incidence of postoperative complications and a quick return to sports activities. It may potentially obviate the need for secondary surgery for implant removal. Clinical trial number Not applicable.

Sustentacular fragment displacement is not uncommon in calcaneal fractures. The factors that suggest a possible displacement of sustentacular fragment are still unclear. Displaced intra-articular calcaneal fractures with calcaneocuboid joint involvement are the most common type of calcaneal fracture. The purpose of this study is to investigate whether there is a correlation between calcaneocuboid joint involvement and sustentacular fragment displacement in displaced intra-articular calcaneal fractures. We collected basic data and CT scans of male patients with displaced intra-articular calcaneal fractures who were hospitalized in the north district of our hospital from July 2021 to June 2024. Three different logistic regression models were employed to analyze the relationship between calcaneocuboid joint involvement and sustentacular fragment displacement. Additionally, stratification analyses and their interactions were further carried out. 144 calcaneal fractures in 131 male patients were included in our study. 63 cases, accounting for 43.75%, exhibited sustentacular fragment displacement. In logistic regression analysis, a favorable association was noted between calcaneocuboid joint involvement and sustentacular fragment displacement (OR = 2.33, 95% CI: 1.18–4.59, P  < 0.05). In model 2, the association retained statistical significance after adjusting for confounding factor (OR = 2.27, 95% CI: 1.15–4.51, P  < 0.05). In model 3, further adjustment for all potential confounding factors also showed a statistically significant association (OR = 2.31, 95% CI: 1.14–4.68, P  < 0.05).Similar results were obtained in stratified analyses. Among male patients with displaced intra-articular calcaneal fractures, it was initially discovered that calcaneocuboid joint involvement can significantly increase the risk of sustentacular fragment displacement, particularly in Sanders type 3 and 4 fractures and when the proportion of the posterior facet in sustentacular fragment is less than 50%.

Background and objective Percutaneous screw fixation (PSF) technique is widely used in treating displaced intra-articular calcaneal fractures (DIACFs), the optimal screw configuration remains controversial. In this study, a finite element analysis (FEA) was conducted to compare the biomechanical properties of five different screw configurations in the fixation of Sanders type ⅡB calcaneal fractures, aiming to provide a reference for clinical strategy selection. Methods In this study, models of five different screw configurations for the fixation of Sanders type IIB calcaneal fractures were constructed. After assigning material properties and applying stress, the maximum displacement and von Mises stress distribution of bone fragments and implants in each group were recorded and compared through FEA. Results After loading, the maximum displacement and von Mises stress of the bone fragments in the five models were recorded as follows: Model 1 (0.369 mm, 39.803 MPa), Model 2 (0.335 mm, 42.283 MPa), Model 3 (0.297 mm, 39.079 MPa), Model 4 (0.315 mm, 33.770 MPa), and Model 5 (0.415 mm, 41.095 MPa). The maximum displacement and stress of the screws were recorded as: Model 1 (0.286 mm, 34.439 MPa), Model 2 (0.277 mm, 35.489 MPa), Model 3 (0.233 mm, 60.152 MPa), Model 4 (0.247 mm, 38.725 MPa), and Model 5 (0.330 mm, 46.806 MPa), Model 3 exhibiting the best mechanical performance, while Model 5 showed the least favorable performance. Conclusions FEA results demonstrate that the use of multiple sustentaculum tali screws and a “kickstand” screw to enhance fixation of the posterior articular surface, along with longitudinal screws inserted superior to the Achilles tendon insertion contributed to stability. The longitudinal screws inserted from the calcaneal tuberosity provide relatively poor stability. Additionally, reinforcing the fixation of the medial column of the calcaneus enhances stability.

Background The treatment of calcaneal fractures is not uniform. This study aimed to compare the functional and imaging results of subtalar joint arthroscopic reduction combined with cannulated screw fixation (SJACF) and the extended lateral approach (ELA) for the treatment of Sanders type II and III displaced intra-articular calcaneal fractures (DIACFs). Methods From January 2020 to January 2023, 60 patients with calcaneal fractures were treated with SJACF or ELA for foot and ankle surgery at the Second Affiliated Hospital of Anhui Medical University. Changes in calcaneal Böhler’s angle, the Gissane angle, and calcaneal length, height, and width were recorded before, after, and at the 1-, 3-, 6-, 12-month, and last follow-up. The preoperative waiting time, operation time, length of hospital stay, and other data of each patient were analyzed. The visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores were used to evaluate clinical effects. Results All 60 patients were followed up for at least 12 months. There was no statistical difference in baseline data (age, sex, fracture side, mechanism of injury, and classification) between groups ( P  > 0.05). The preoperative waiting time, length of hospital stay, and intraoperative fluoroscopy times were shorter in the SJACF group than in the ELA group; however, the operative time was greater in the SJACF group ( P  < 0.05). There were no significant differences in Böhler’s angle, the Gissane angle, or calcaneal length, height, or width between the two groups at any time point ( P  > 0.05). These imaging values were significantly improved after surgery and at the last follow-up ( P  < 0.05). The VAS scores of the patients in the SJACF group were significantly different from those in the ELA group at the last follow-up ( P  < 0.05). The final AOFAS score and incidence of postoperative complications were better in the SJACF group; however, the difference was not significant ( P  > 0.05). Simultaneously, patients were able to return to work and achieve full weight-bearing earlier in the SJACF group ( P  < 0.05). Conclusion Both SJACF and ELA improved the clinical outcomes of patients with DIACFs. SJACF reduces surgical wounds and maintains effective reduction and strong internal fixation. It has the advantages of a reduced preoperative waiting time, shortened hospital stay, reduced intraoperative fluoroscopy time, alleviated postoperative pain, and accelerated patient recovery.