An experimental study on the digital precision of internal fixation via the sinus tarsi approach for calcaneal fractures

Abstract

Objective: To investigate the effectiveness and accuracy of internal fixation of calcaneal fractures with a three-dimensional (3-D) printing navigation module via the sinus approach. Methods: Eleven lateral lower extremity specimens were used in the experiment and divided into the digital design (DD) group (n = 11) and the real surgery (RS) group (n = 11). For the DD group, thin-section computed tomography (CT) scans, virtual fracture modeling, virtual bone plate fixation, sinus occlusal module design, and navigation module design were performed for the cadaver specimens. A 3-D navigation module was printed using a 3-D printer. For the RS group, the sinus approach incision was made, and the navigation module was used to assist the placement of screw fixation and anatomically locked bone plate fixation. Thin-layer CT scans, 3-D reconstructions, and reconstruction of the nail paths were performed in the RS group and 3-D registered with the DD group. 3-D coordinate values for the screw entry and exit points in the RS and DD groups were recorded, and the corresponding offset values of the screw points were calculated. The number of qualified nails at different accuracy levels was counted. The χ 2 test was used to compare the data for the DD and RS groups to obtain the accuracy level for both groups when p > 0.05, which is the critical value for experimental accuracy. Results: A total of 11 bone plates were placed and 120 screws were locked. None of them protruded from the inferior articular surface. The screw entry and exit point offsets were 1.71 ± 0.11 mm and 3.10 ± 0.19 mm, respectively. When the accuracy requirement for the entry point was 3.8 mm, there was no statistically significant difference between the two groups (p > 0.05). Similarly, the accuracy of the exit point of the screw could only reach 6.6 mm. Conclusion: Internal fixation of calcaneal fractures via the sinus tarsi approach with an anatomical locking plate based on the 3-D printing navigation module can achieve accurate screw placement and good overall internal fixation.

Biomechanical testing of three coracoclavicular ligament reconstruction techniques with a 3D printing navigation template for clavicle-coracoid drilling

“…The scan results were saved as data imaging and communications in medicine (DICOM) format files. Then, the navigation template was designed via the MedCAD/cylinder order in Geomagic Studio 2017 (Geomagic, Inc., Cary, North Carolina, USA) and Mimics 21.0 (Materialise, Belgium), following previously reported methods (18,26,27). Firstly, CT data were imported, and the threshold was set to 226-1,688 HU.…”

Comparison of the modified sinus tarsi approach versus the extensile lateral approach for displaced intra-articular calcaneal fractures

“…The primary goal of ORIF in the treatment of DIACFs is to restore the congruence of the subtalar joint. This fixation not only requires the anatomical reduction of the calcaneus, subtalar articular surface, and heel tubercle, but also stable and firm internal fixator support to facilitate early rehabilitative exercise (5).…”

Comparison of Two Surgical Approaches for Displaced Intra-Articular Calcaneal Fractures: The Modified Sinus Tarsi Approach Versus The Extensile Lateral Approach

“…The primary goal of ORIF for DIACF is to restore the congruence of the subtalar joint. This xation requires not only the anatomical reduction of the calcaneus, subtalar articular surface, and heel tubercle but also stable and rm internal xator support to facilitate early rehabilitation exercise 5 .…”