Comparison of clinical effect and postopertaive incisions between No-touch technique and traditional retractor in treating calcaneal fracture / 中国骨伤

OBJECTIVE@#To compare clinical efficacy of No-touch technique and traditional retractor in treating calcaneal fracture.@*METHODS@#Clinical data of 74 calcaneal fracture patients with closed Sanders typeⅡ to Ⅳ were retrospectively analyzed from July 2019 to June 2021. According to different treatment methods, the patients were divided into No-touch group and conventional group, 37 patinets in each group. In No-touch group, there were 25 males and 12 females, aged from 19 to 70 years old with an average of (42.64±14.16) years old;17 patients were typeⅡ, 14 patinets with type Ⅲ, 6 patients with type Ⅳ according to Sanders fracture classification;three 2.0 mm Kirschner wires were implanted into the talus body, talus neck, and cuboid bone, and the flap was turned upward to expose the operation area. In conventional group, there were 30 males and 7 females, aged from 19 to 67 years old with an average of (41.56±11.38) years old;17 patients with typeⅡ, 12 patients with type Ⅲ, 8 patients with type Ⅳ according to Sanders fracture classification;the operation was completed by exposing the operation area with traditional retractor. Operation time, postoperative incision complications, postoperaive American Orthopedic Foot and Ankle Society (AOFAS) ankle hind foot score at 6 months between two groups were compared.@*RESULTS@#Seventy-four patients were followed up, and follow-up time in No-touch group ranged from 6 to 17 months with an average of(9.57±2.72) months, while in conventional group ranged from 6 to 16 months with an averge of(9.14±2.71) months, and no difference in follow-up between two groups (P>0.05). Operation time in No-touch group (55.67±7.94) min was shorter than that in conventional group (70.16±9.41) min (P<0.05);four patients in No-touch group occurred incision complications, while 8 patients in normal group, and had statistically difference(P<0.05). Daily activities and support, maximum walking distance (block), ground walking, limited degree of flexion, extension and valgus, foot alignment and total score of AOFAS scores in No-touch group was significantly higher than that of conventional group (P<0.05). There were no significant difference in pain degree, abnormal gait and ankle hind foot stability between two groups(P>0.05). According to AOFAS score, 19 patients got excellent result, 16 good and 2 poor in No-touch group;while 9 excellent, 24 good, and 4 poor in conventional group, and no difference between two groups (P>0.05).@*CONCLUSION@#Compared with traditional retractor in treating calcaneal fracture, No-touch technology could significantly shorten operation time, reduce incidence of postopertive complications, while two methods could improve excellent and good rate of ankle joint function recovery after operation.

Calcaneal fractures: a management dilemma-minimally invasive approach for intra and extra articular calcaneal fractures

Background: Calcaneal fractures which constitutes 2% of total fractures are frequent and very debilitating if not treated properly. Calcaneal fractures generally affect younger population leading to significant man-days loss(around 2-5 years3) and in-turn leading significant economic burden on the society. The goal of treatment for calcaneal fractures is elimination of pain and restoration of normal foot shape, biomechanics, and walking ability. Wound related complications are common with open surgeries. After open reduction internal fixation with perimeter plates for displaced calcaneal fractures, wound edge necrosis is commonly observed with the extended lateral approach. Because of such high incidence of wound complications in open reduction of calcaneum fractures, minimally invasive approach takes priority over open reduction of these fractures.Methods: The study aimed to evaluate the results of minimally invasive approach for calcaneal fractures. To reduce the operative complications, 30 patients were treated with minimally invasive methods in both extra articular and intra-articular calcaneal fractures and the results were evaluated. All patients were evaluated clinically , functionally and radiologically 3D- CT reconstruction images.Results: All cases were followed up for 2 years at specified intervals. The outcome measures were evaluated by AOFAS scores10 with excellent result in 13 cases and good to fair results in the rest. Operated patients had no wound infection, no skin necrosis, 5 patients had mild subtalar arthrosis and 3 patients complained slight difficulty in wearing shoes. None of them have any gait abnormalities.Conclusions: Our study suggests that the minimally invasive methods will reduce the operative complication rates. The minimally invasive surgical intervention in an expert hand can yield better results with less complication rates.

Clinical Experience of Close Reduction and Internal Fixation of Displaced Intra-articular Fractures of Calcaneum

Background: Displaced intra-articular fractures of calcaneum require conventional surgical treatment using open reductionand plate screw fixation which are technically demanding and result in several soft tissue complications and morbidity.Aims and Objectives: An attempt has been made to adopt close reduction and internal fixation without opening the fractureunder fluoroscopic control avoiding the complications of open reduction.Materials and Methods: A total of 30 patients presented with displaced calcaneum fractures of age varied from 19 years to60 years, of which 25 males and 5 females were operated between December 2013 and August 2015. Under spinal anesthesia,in prone position, K-wires were passed through calcaneum and talus for Joshi’s External Stabilisation System (JESS) distraction.Some patients required elevation of subtalar articular fragment by a small window from the lateral side. After restoring thearticular anatomy, three CHSs passed under fluoroscopic control. Then, distracters were removed. Some patients needed anadditional lateral-to-medial screw fixation for holding sustantaculamtali fragment. Conventional post-operative regimen wasfollowed with weight bearing after 3 months.Results: The patients were followed for 8 months to 1.5 yrs. The patients were studied using clinico-radiologicalparameters - wound status, Bohler’s angle, the American Orthopedic Foot and Ankle Society score, and Allmacher grade. Allpatients recovered satisfactory functions in longest follow-up.Conclusion: This method is technically easy, soft tissue friendly with least complications and may be advocated for the provisionof surgical treatment for displaced intra-articular calcaneum fractures.

Treatment of calcaneal fractures with plate via minimally invasive approach / 中国基层医药

Objective To evaluate the clinical effects of sinus tarsi approach and eight-shape approach in the treatment of calcaneal fractures.Methods Analyzed the outcomes of 23 patients(21 males and 2 females)with calcaneal fractures(25 feet)treated with plate via sinus tarsi approach and eight-shape approach.The mean age of patients was 38 years old(ranged from 24 to 55 years).According to Sanders classification:16 feet in type Ⅱ,9 feet in type Ⅲ.Results The average operation time was 85 min(ranged from 70 min to 100 min),and no wound compli-cations occurred.X-ray review showed that bony healing,and healing time was 3-6 months.The average duration of follow-up was 13 months(ranged from 12 to 18 months).The result was excellent in sixthteen cases,good in six cases and fair in one case according to Maryland score.The satisfactory rate was 95 .6%.Conclusion Open reduction and internal fixation via the sinus tarsi approach and eight -shape approach provides not only reliable fixation,but also less complications.

Application of arthroscopic surgery for patients with calcaneal fractures / 中国内镜杂志

Objective To study the clinical efficacy of bridge baton fixation with arthroscopic surgery in treatment of calcaneal fractures. Method From May 2013 to November 2014, 18 cases suffered from calcaneal fracture with arthroscopic surgical bridge baton fixation treatment in our hospital served as the object of the study. They were retrospectively analyzed during preoperative, postoperative the joint surface, the Bohler angle and Gissane angle , mean follow-up of 12 months, Maryland Foot Score were compared by the analysis. Results All cases were followed up for 12 months averagely. Joint surface flatness of 18 cases were significantly improved, Bohler angle, Gissane angle were also significant differences (P < 0.05). The excellent rate of Maryland score was 86.8%. Conclusion The bridge baton fixation with arthroscopic surgery for treatment of calcaneal fractures is certain effective and minimally invasive. Arthroscopy can restore the articular surface. The foot function recovery of the patients is satisfied.

Application of arthroscopic surgery for patients with calcaneal fractures / 中国内镜杂志

Objective To study the clinical efficacy of bridge baton fixation with arthroscopic surgery in treatment of calcaneal fractures. Method From May 2013 to November 2014, 18 cases suffered from calcaneal fracture with arthroscopic surgical bridge baton fixation treatment in our hospital served as the object of the study. They were retrospectively analyzed during preoperative, postoperative the joint surface, the Bohler angle and Gissane angle , mean follow-up of 12 months, Maryland Foot Score were compared by the analysis. Results All cases were followed up for 12 months averagely. Joint surface flatness of 18 cases were significantly improved, Bohler angle, Gissane angle were also significant differences (P < 0.05). The excellent rate of Maryland score was 86.8%. Conclusion The bridge baton fixation with arthroscopic surgery for treatment of calcaneal fractures is certain effective and minimally invasive. Arthroscopy can restore the articular surface. The foot function recovery of the patients is satisfied.

Treatment of Displaced Intra-articular Calcaneal Fractures by Minimally Invasive Retractor Reduction and Fixation Through Sinus Tarsi Approach Together with External Application of Chinese Medicine / 广州中医药大学学报

Objective To evaluate the therapeutic effect of minimally invasive retractor reduction and fixation through sinus tarsi approach together with external application of Chinese medicine for displaced intra-articular calcaneal fractures. Methods From October of 2009 to June of 2013, 52 patients with displaced intra-articular calcaneal fractures (Sanders type Ⅱ, Ⅲ) were enrolled into the study. The patients received minimally invasive retractor reduction through sinus tarsi approach and fixation with small plate and cannulated screws, and after the operation were given external washing with Chinese herbal formula Shenxing Fang ( mainly composed of Herba Lycopodii, Herba Speranskiae Tuberculatae, Rhizoma Sparganii, Rhizoma Curcumae, Herba Asari, Radix Aconiti Preparata, Radix Aconiti Kusnezoffii Preparat). Follow-up was carried out for the evaluation of the therapeutic effect of displaced intra-articular calcaneal fractures ( Sanders type Ⅱ, Ⅲ). Results Forty cases (involving 44 feet) received the postoperative follow-up for 12-18 months (average being 14.2 months). The Maryland foot scores were 95 points for type Ⅱ displaced intra-articular calcaneal fractures, and 86 points for type Ⅲ fractures. Satisfactory results were achieved in the height, width and length of the calcaneus as well as the B?hler's and Gissane angle ( P<0.01). Conclusion Minimally invasive retracter reduction and fixation through sinus tarsi approach together with external application of Chinese medicine exert satisfying effect for the treatment of displaced intra-articular calcaneal fractures.

Application of Painless Nursing in Postoperative Pain at Night Patients after Calcaneal Fractures Surgery / 中国医学伦理学

Objective:To explore the effect of painless nursing in patients with calcaneal fractures postoperative pain at night.Methods:Total 60 cases of orthopaedic hospital patients were randomly divided into control group and experimental group, 30 cases in each group.The control group had routine nursing, the painless nursing was used in experimental group.By updating the paramedics painless concept, clear pain assessment method and pain nursing records, the implementation of procedural pain in health education, will be painless care effectively applied in postoperative patients with calcaneal fractures pain at night.Joint pain evaluation method is used and the night sleep stage method compare two groups of postoperative pain at night is happening.Results:After the painless nurs-ing, the patients pain at night to sleep affect significantly reduce, the incidence of pain at night fell, the experi-mental group effectiveness were significantly higher than that of control group, the difference was statistically signifi-cant ( P<0.05) .Conclusions:Painless nursing can effectively prevent or reduce the occurrence of calcaneal frac-tures patients postoperative pain at night, promote the body′s recovery, improve patient′s satisfaction, is helpful to improve the quality of nursing.

Application value of different minimally invasive approach in treatment of patients with intra-articular calcaneal fractures / 局解手术学杂志

Objective To compare the application value and the clinical curative effect of longitudinal incision and tarsal sinus minimal-ly invasive approach in treatment of patients with intra-articular calcaneal fractures. Methods A retrospective statistical analysis was made by collecting and comparing the clinical data of 67 patients with intra-articular calcaneal fractures from March 2008 to March 2012,and they were divided into the longitudinal incision minimally invasive approach group ( ZW group,36 patients,37 feet) and the tarsal sinus minimally invasive approach group ( FW group,31 patients,33 feet) . The Bohler angle, Gissane angle before and after operation,complications healing time,and AOFAS scores were compared. Results The healing time,Bohler angle,Gissane angle of ZW group and other indicators were better than those of the FW group,but there was no significant difference between the two groups (P>0. 05). The infection of incision and compli-cations in ZW group was obviously less than those of the FW group (P0. 05). Conclusion The two kinds of treatments are of no obvious difference,but the longitudinal small incision minimally invasive approach could receive better effect in terms of soft tissue damage,healing time,and postoperative complications.

Comparison of therapeutic effects of implant internal fixation for the treatment of Sanders Ⅱ calcaneal fractures after poking and open reduction / 中国组织工程研究

10.3969/j.issn.2095-4344.2013.26.023

Analysis of the effect of plastic titanic plates internal fixation in the treatment of intra-articular calcaneus fracture / 中国基层医药

Objective To explore the efficacy and safety of plastic titanic plates internal fixation in the treatment of intra-articular calcaneus fracture.Methods 42 patients with intra-articular calcaneus fracture were selected and taken lateral calcaneal improvement “L” shaped incision for the correction of calcaneal shortening and valgus deformity.Skidmore needle went through collapse of the articular surface below from calcaneal fractures after block nodules along with bone shaft,and restored Bohler angle,Gissane angle and bone length,height,and the lateral fracture piece was reset.The fixation was taken by plastic reconstruction titanic plates,and the fracture was inspected by Xray.Results In 42 patients,the fracture healing time was (11.4 ± 0.6) weeks.The fracture position was good on the line,and the articular surface of calcaneus and talus was smooth,and the Bohler angle,Gissane angle of calcaneus were returned to normal.The excellent rate was 90.5％ by Maryland score.No surgical causes of broken plate and screw breakage were found.Conclusion Internal fixation with open reduction and plastic titanic plates internal fixation for the treatment of intra-articular calcaneal fractures has a significant effect and safety,which is worthy of promotion.

Fractura bilateral de calcáneo: reporte de un caso / Bilateral calcaneus fracture: case report

Las fracturas del calcáneo representan aproximadamente 2% de todas las fracturas del cuerpo humano y 60% de las fracturas del tarso. Menos del 7% son bilaterales. Las fracturas intra-articulares desplazadas (Sanders Tipo IV) son el resultado de traumatismos de alta energía, usualmente debido a precipitaciones o accidentes automovilísticos. Es una lesión compleja que se asocia con elevados índices de incapacidad cuando no es tratada de forma correcta y oportuna. Se trata de paciente masculino, de 38 años de edad, quien presenta una fractura bilateral de calcáneo Sanders tipo IV, manejada quirúrgicamente, mediante reducción directa, reconstrucción anatómica del calcáneo, osteosíntesis con placa anatómica y artrodesis subtalar. Las fracturas del calcáneo siguen siendo un gran reto para el cirujano ortopedista y traumatólogo debido a la controversia en cuanto a su manejo. El diagnóstico preciso y precoz, basado en estudios imagenológicos, es necesario para una adecuada caracterización de la fractura, planificación preoperatoria y resolución quirúrgica(AU)

Calcaneal fractures represent approximately 2% of all fractures of the body and 60% of fractures of the tarsus. Less than 7% are bilateral. The displaced intra-articular fractures (Sanders type IV) are the result of high energy trauma, usually because of rainfall or auto accidents. It is a complex injury that is associated with high rates of disability when not treated properly and timely. The case of male 38-year-old man presented with bilateral calcaneal fractures Sanders type IV, which were managed surgically by direct reduction of the calcaneus and anatomical reconstruction píate fixation and anatomic subtalar arthrodesis. Calcaneal fractures remain a major challenge for orthopedic surgeons and trauma due to controversy regarding their management. The early and accurate diagnosis based on imaging studies, it is necessary for proper characterization of the fracture, preoperative planning and surgical resolution(AU)

Effect of Internal Fixation of Plates on Displaced Intra-articular Fracture of Calcaneus / 中国康复理论与实践

@#Objective To investigate the effect of internal fixation of plates on displaced intra-articular fracture of the calcaneus. Methods 27 patients with calcaneal fracture and treated surgically with open reduction and internal fixation were analyzed retrospectively. Results All the cases are closed fracture. According to the Sanders classification, 18 cases were type 2 calcaneal fractures, and 9 were type 3. 6 cases (22.2%) showed wound-healing problems. The average Bohler's angle before and after surgery was 7.5° and 27.54° respectively. 20 patients were followed up for average 16.8 months, and all showed excellent walking ability and normal gait, and no shoe wear complaints. Conclusion Open reduction and internal fixation can guarantee the anatomic reduction of displaced calcaneal fractures, and the outcomes are satisfied.

Conservative Management of Calcaneal Fractures. A Retrospective Review of Treatment Outcome

Int roduction: Treatment of calcaneal fracture is still controversial and indication for surgery is not well established. We are reporting the mid term outcome of calcanel fractures treated conservatively. Material and Methods: Patients admitted with calcaneal fractures from 1st November 2002 till 31st December 2004 and were treated conservatively were included in this study. The fractures were grouped according to Essex-Lopresti classification and their outcomes were assessed with the Maryland foot score. We also looked at time to weight bearing and returning to occupational activity. Results: Forty-four patients were included for evaluation. Patients with extraarticular calcaneal fractures had significantly higher rating scores compared to those with intraarticular fractures (98.2 and 88.8 respectively, with a p value = 0.0001). Generally, both group of patients had a good clinical outcome. 18 of the 44 patients (41%) started partial weight bearing before or at 6 weeks and 31 patients (72%) were able to start full weight bearing by 12 weeks. 31 patients (72%) were back to work 12 weeks after the injury. Conclusion: Conservative management for calcaneal fractures is an acceptable mode of treatment with satisfactory functional outcome.

Operative treatment of intra-articuIar fractures of calcaneus / 重庆医科大学学报

Objective: To investigate the effect of plastic calcaneus plate in the treatment of intra-articuIar fractures of calcaneus.Methods: 16 cases with intra-articuIar fractures of calcaneus were treated with open reduction and internal fixation with plastic calcaneus plate,all of which underwent Allogeneic bone grafting. Results: 16 cases were followed up for 10～25 months.According to Maryland foot score system,the results were excellent in 11 cases,good in 4 and fair 1 in. Conclusions:It can provide rigid fixation and less complication,which is beneficial for early functional exercises in the treatment of intra-articuIar fractures of calcaneus with plastic calcaneus plate.

Effective comparison between nonoperative and operative treatment in calcaneal fractures / 中国矫形外科杂志

[Objective]To evaluate the effect of nonoperative and operative treatment in calcaneal fractures.[Method]Operative effect of 38 cases of calcaneal fracture of all kinds(42 foots)were analyzed.Accordind Essex-Loprestis classification,6 foots suffered type I tongue fracture,28 foots suffered compressed fracture(type Ⅱ),8 foots suffered serious comminuted fracture(type Ⅲ).All patients underwent open reduction interal fixation by Buttress plate(AO calcaneal fracture plate or simulated AO calcaneal fracture plate made domestically) from the extended "L" lateral approach.Postoperatively,no patient needed plaster fixation.All patients started non-weight-bearing fuctional exercise at 2-3days,gradual weight-bearing walking at 6-8 weeks.The result of operated group was compared with nonoperative treatment group.The follow-up period was from 10 months to 36 months,with an average of 17monthes.[Result]Assessed the effect by Maryland foot score,the base line included every foot.Total excellent and good rate in operative group was 93%,it was 100% in type I fracture group,96% in type Ⅱ fracture group,75% in type Ⅲ fracture group.The result of nonoperative treatment group was:total excellent and good rate was 67%,it was 92% in type I fracture group,77% in type Ⅱ fracture group,there was not excellent and good patients in type Ⅲ fracture group.[Conclusion]It is important to regain the flatness of subtalar joint and calcaneocuboid joint,maintain the normal shape of foot.The authors recommend that type Ⅱ and type Ⅲ fractures of calcaneus according Essex-Loprestis classification were treated with open reduction and interal fixation by Buttress plate.By selecting the appropriate approach,proper reducting and postoperative treating rightly,it is an ideal measure to treat calcaneal fracture by selection of treatment method acciding to patient's individual status and fracture type.

Classification and treatment progress of caleaneus fracture / 中国矫形外科杂志

Fractures of the calcaneus are most common of tarsal bone fractures and usually the result of a fall from a great height.Controversies are about the appropriate classification system,treatment options,indication for surgery,surgical approaches and post operative management.The calcaneal fractures are divided into extra-articular fractures and intra-articular fractures.Sanders classification is of great importance to the treatment options and the outcome assessments.The treatment of the calcaneal fractures is challenging,but the ideal treatment for the calcaneal fractures has not been found so that further research is needed.Nonoperative treatment continues to be the preferred method for non-displaced fractures.Displaced and comminuted fractures can be treated with operation.Complications after calcaneal fractures include blisters,compartment syndrome,wound dehiscence,wound infection,pain,subtalar arthritis and so on.This article reviews the classification,score,treatment and complication of the calcaneal fractures.

Entrapment of Sural Nerve in Essex-Lopresti Axial Fixation for Calcaneal Fracture: A Case Report / 대한족부족관절학회지

Injuries to sural nerve through surgical incision or open wound in calcaneal fractures were reported as complications causing lateral hindfoot pain. But sural nerve entrapment by adhesive fibrous tissue after Essex-Lopresti axial fixation has not been reported. We report a case of sural nerve entrapment after Essex-Lopresti axial fixation which was successfully treated by nerve decompression.

Intraarticular calcaneal fractures Operative management / 中华创伤骨科杂志

Evidence is lacking from these trials concerning the optimal procedure for treatment of displaced intraarticular calcaneal fractures. Clinical trials comparing different treatment , especially as they relate to potential risk fractors such as fracture classification, should be explored.

Biologic Changes of Xenograft ( LUBBOC ) in the Surgical Treatment of Calcaneal Fractures / 대한정형외과학회잡지

PURPOSE: To evaluate the biologic changes of xenograft (Lubboc, Transphyto S. A., Clermont-Ferrand, France) applied in the surgical treatment of calcaneal fractures. MATERIALS AND METHODS: Xenograft were used in twenty-five calcaneal fractures, as bone substitutes for mechanical support of the articular surface from March 1994 to December 1996. Twenty-four cases had obtained clinical and radiological bony union without complications. We performed biopsy at the xenograft area in eight cases when the hardware was removed. And then we took a magnetic resonance imaging of the calcaneus after the biopsy in three cases. RESULTS: The pathologic findings of the xenografts showed dead bony trabeculae with inflammed fibrous tissue. There was no osteoblastic activity but some osteoclastic activity was seen in the graft-host junctional area. MRI findings showed that there was well-circumscribed, low-signal intensity in the xenograft area contrast to the normal bony signal intensity. Its lesion was equal to the sclerotic finding in the calcaneal radiograph. CONCLUSIONS: Xenograft (LUBBOC'), which is used in the mechanical support of the articular surface, apparently lacks osteogenic capacity.