Fractures of the sustentaculum tali

Dürr, C.; Zwipp, H.; Rammelt, Stefan

doi:10.1007/s00064-013-0247-2

Cited by 42 publications

(22 citation statements)

References 18 publications

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“…When the calcaneal fracture occurs, the calcaneus can be compressed and the posterior articular surface be comminuted because of the vertical pressure from the talus. However, as a result of the strong stabilized structures of the tendons and ligaments around the sustentaculum tali, the displacement of the sustentaculum tali rarely occurred in the calcaneal fractures [12]. Therefore, the sustentacular fragment is frequently the foundation for calcaneal fracture reduction because of its limited displacement [6, 7].…”

Section: Discussionmentioning

confidence: 99%

Sustentacular screw placement with guidance during ORIF of calcaneal fracture: an anatomical specimen study

Wang¹,

Huang²,

Ma³

et al. 2017

J Orthop Surg Res

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BackgroundThe sustentacular screw is essential to maintain the stability of the subtalar joint during ORIF (open reduction with internal fixation) of calcaneal fractures. Currently, the screw is still inserted based on surgeons’ anatomical experiences and nearly 40% of screws are misplaced from the sustentaculum. Previous studies demonstrated some methods of sustentacular screw placement through anatomical measurements or navigation system. The purposes of this study are to design an assistant guidance device that can effectively improve the accuracy of sustentacular screw placement and to compare the accuracy of this technique with traditional screw placement based on experience.MethodsA customized guidance device is designed, aiming to improve the accuracy of sustentacular screw placement. Twenty cadaveric specimens are used in the present study. Ten specimens are allocated into the guidance-assisted group, and others are included in the traditional screw insertion group. A total of 40 sustentacular screw placements are performed in each group. Fluoroscopic images are obtained after each screw placement. Only the screw that captures the sustentaculum both on the lateral and axial X-ray views was regarded as an accurate placement.ResultsThe accuracy rate in the guidance-assisted group is 87.5% (35 out of 40 times of insertions) while in the traditional screw insertion group, the accuracy rate is 65% (26 out of 40 times of insertions). A significant difference is found between the two groups (p = 0.018).ConclusionsThe guidance-assisted technique is a convenient approach that can effectively improve the accuracy of sustentacular screw placement during the ORIF of calcaneal fractures. This study provides a novel technique that significantly facilitates sustentacular screw insertion and improves its accuracy.

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Section: Discussionmentioning

confidence: 99%

Sustentacular screw placement with guidance during ORIF of calcaneal fracture: an anatomical specimen study

Wang¹,

Huang²,

Ma³

et al. 2017

J Orthop Surg Res

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“…A small medial approach directly over the sustentaculum tali is used in cases of isolated fractures of the sustentaculum tali or in addition to the extended lateral approach with fragmentation of the medial joint facet in more complex fracture patterns. 1 16 34 92 The incision of about 3 cm lies horizontally over the palpable sustentaculum. The nearby posterior tibial and flexor digitorum longus tendons are held away with vessel loops and the posterior tibial neurovascular bundle is usually not exposed.…”

Section: Choice Of Approachesmentioning

confidence: 99%

Calcaneal Fractures — Should We or Should We not Operate?

Rammelt

Sangeorzan

Swords

2018

IJOO

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The best treatment for displaced, intraarticular fractures of the calcaneum remains controversial. Surgical treatment of these injuries is challenging and have a considerable learning curve. Studies comparing operative with nonoperative treatment including randomized trials and meta-analyses are fraught with a considerable number of confounders including highly variable fracture patterns, soft-tissue conditions, patient characteristics, surgeon experience, limited sensitivity of outcome measures, and rehabilitation protocols. It has become apparent that there is no single treatment that is suitable for all calcaneal fractures. Treatment should be tailored to the individual fracture pathoanatomy, accompanying soft-tissue damage, associated injuries, functional demand, and comorbidities of the patient. If operative treatment is chosen, reconstruction of the overall shape of the calcaneum and joint surfaces are of utmost importance to obtain a good functional result. Despite meticulous reconstruction, primary cartilage damage due to the impact at the time of injury may lead to posttraumatic subtalar arthritis. Even if subtalar fusion becomes necessary, patients benefit from primary anatomical reconstruction of the hindfoot geometry because in situ fusion is easier to perform and associated with better results than corrective fusion for hindfoot deformities in malunited calcaneal fractures. To minimize wound healing problems and stiffness due to scar formation after open reduction and internal fixation (ORIF) through extensile approaches several percutaneous and less invasive procedures through a direct approach over the sinus tarsi have successfully lowered the rates of infections and wound complications while ensuring exact anatomic reduction. There is evidence from multiple studies that malunited displaced calcaneal fractures result in painful arthritis and disabling, three-dimensional foot deformities for the affected patients. The poorest treatment results are reported after open surgical treatment that failed to achieve anatomic reconstruction of the calcaneum and its joints, thus combining the disadvantages of operative and nonoperative treatment. The crucial question, therefore, is not only whether to operate or not but also when and how to operate on calcaneal fractures if surgery is decided.

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“…Contudo, a análise dos cortes coronais da TC revela frequentemente desvio articular e muitas vezes depressão da faceta medial 6 . Tal facto condiciona instabilidade e incongruência, que conduz a artrose póstraumática subtalar, rigidez do retropé, conflito com o tendão do músculo flexor longo do hallux, dor crónica, deformidade progressiva e a síndrome do túnel társico 7 .…”

Section: Discussionunclassified

A rara fratura do sustentaculum tali: dificuldades no diagnóstico e tratamento

Serrano¹,

Ribau²,

Barbosa³

et al. 2018

RCC-CBC

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As fraturas isoladas do sustentáculo do astrágalo são raras e frequentemente passam despercebidas na avaliação radiográfica inicial, exigindo um alto índice de suspeição e caracterização por tomografia computorizada. Este relato apresenta o diagnóstico, tratamento e seguimento de um caso clínico de uma fratura isolada do sustentáculo do astrágalo num desportista. Devido à sua função em relação ao astrágalo, pequenos desvios do sustentáculo podem levar a profundas alterações na biomecânica do pé. Uma reconstrução anatómica com um parafuso canulado 4,5mm, através de uma abordagem dire-ta medial, levou a um excelente resultado funcional. Descritores: Calcâneo. Tálus. Traumatologia. Medicina Esportiva. Fixação Interna de Fraturas.

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Fractures of the sustentaculum tali

Cited by 42 publications

References 18 publications

Sustentacular screw placement with guidance during ORIF of calcaneal fracture: an anatomical specimen study

Sustentacular screw placement with guidance during ORIF of calcaneal fracture: an anatomical specimen study

Calcaneal Fractures — Should We or Should We not Operate?

A rara fratura do sustentaculum tali: dificuldades no diagnóstico e tratamento

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