Functional outcome of displaced intra-articular calcaneal fractures

Wu, Zhiyong; Su, Yanling; Chen, Wei; Zhang, Qi; Liu, Yueju; Li, Ming; Wang, Haili; Zhang, Yingze

doi:10.1097/ta.0b013e318253b5f1

Cited by 62 publications

(53 citation statements)

References 43 publications

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“…As a minimal incision technique, whether a sinus tarsi approach (STA) can aid to expose the fracture enough to achieve the adequate reconstruction of DIACF and meanwhile minimize the incidence of wound complications remains uncertain. Some RCTs [21, 22] and cohort studies (CSs) [23–27] were developed trying to answer this question, but the conclusions were not completely consistent. Based on the current evidence, we performed this meta-analysis to compare the STA with ELA for the management of DIACF and expected to draw a certain and meaningful conclusion for this question.…”

Section: Introductionmentioning

confidence: 99%

Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base

Yao

Tang

et al. 2017

J Orthop Surg Res

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BackgroundThe extensile lateral approach (ELA) has been widely performed for displaced intra-articular calcaneal fractures (DIACFs), and wound complications remain a significant problem. As a minimal incision technique, the sinus tarsi approach (STA) was designed to overcome this disadvantage. There were already many reports about this approach but the conclusions were not completely consistent. Based on the current evidence, we performed this meta-analysis to compare the STA with ELA in the management of DIACF and expected to draw a certain and meaningful conclusion.MethodsAll potentially relevant randomized controlled trials (RCTs) and cohort studies (CSs) were searched in the databases of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrial.gov. The desirable outcomes including wound complications, excellent and good rate, secondary surgery rate and Böhler’s angle were extracted. RCT studies were assessed using the Risk of Bias Tool recommended by the Cochrane Collaboration, and cohort studies were evaluated using the Newcastle–Ottawa Scale. The data of RCTs and cohorts were pooled respectively using the fixed-effect model or random-effect model. Mean differences with 95% confidence intervals (CIs) were calculated for continuous data, and relative risks (RRs) with 95% CIs were calculated for dichotomous data. Statistical heterogeneity was assessed with the Q test and I 2. Sensitivity analysis was developed to assess the reliability of pooled results.ResultsSeven studies including two RCTs and five CSs were eligible for the meta-analysis. No matter RCTs or CSs, the pooled data all showed that STA group had a lower incidence of wound complications than that in the ELA group and no significant difference was found in excellent and good rate and the recovery of Böhler’s angle between the two groups. The CSs also showed that the STA group had a lower incidence of secondary surgeries than that in the ELA group.ConclusionsThrough a STA, we not only can reduce the problems in wound healing but also achieve nearly the same adequate restoration of DIACF along with the similar functional outcomes compared with through an ELA.

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Section: Introductionmentioning

confidence: 99%

Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base

Yao

Tang

et al. 2017

J Orthop Surg Res

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“…The minimally invasive surgical technique does not provide direct visualization of the articular facets, and can not guarantee acurate reduction of the posterior articular facet. However, this technique can achieve clinical outcome as good as, if not better than the traditional open techniques in treating displaced intra-articular calcaneal fractures [23]. The relatively bulky size of the nuts may result in potential nerve injury, skin irritation or flexor hallucis longus tendeon restriction, although no such complications were reported in the current study.…”

Section: Discussionmentioning

confidence: 68%

“…During 20–200 N cyclic axial loading, the anatomical plate and compression bolts showed significantly lower irreversible deformation and a higher level of fixation failure than those of the conventional plate and cancellous screws. This minimally invasive technique was applied to treat displaced intra-articular calcaneal fractures, which was demonstrated to be an effective alternative treatment, offering the combination of fewer soft tissue complications and good reduction [22,23]. In contrast to previous studies, the current study only recruited the most severe portion of Sanders type IV fractures without the inclusion of Sanders type II and type III fractures and the less severe type IV fractures.…”

Section: Discussionmentioning

confidence: 99%

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Bony destructive injuries of the calcaneus: long-term results of a minimally invasive procedure followed by early functional exercise: a retrospective study

Chen

Zhou

et al. 2014

BMC Surg

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BackgroundBony destructive injury of the calcaneus (BDIC) represents one of the most severe comminuted fractures of the calcaneus in which soft tissue coverage remains intact. The features of this injury include a collapsed articular surface, significant widening, severe loss of height and an unrecognisable outline of the calcaneus. This study aims to present the long-term outcomes of BDIC treated in a minimally invasive fashion followed by supervised early exercise.MethodsTwelve patients with unilateral BDICs were treated at our institution. The main surgical procedures included percutaneous traction and leverage reduction and internal compression fixation with anatomic plates and compression bolts. Early functional exercise was encouraged to mould the subtalar joint. The height, length and width of the calcaneus; Böhler’s and Gissane’s angles; reduction of the articular surfaces; and functional recovery of the affected feet were assessed.ResultsThe height, length and width of the calcaneus were substantially restored. The mean Böhler’s and Gissane’s angles of the affected calcaneus were 24.5 and 122.8 degrees, respectively. Five patients regained anatomical or nearly anatomical reduction of their posterior facets. Residual articular displacement of more than 3 mm was noted in three patients. Patients were followed for a mean of 93.9 months. The mean American Orthopaedic Foot and Ankle Society score was 83.8. Nine patients showed excellent or good results. Radiographic evidence of post-traumatic subtalar arthritis was observed in four cases. However, no subtalar arthrodesis was required.ConclusionsBDICs can be treated effectively with percutaneous reduction and internal compression fixation followed by early active exercise. This protocol resulted in satisfactory radiological and functional outcomes.

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“…Böhler's and Gissane's angles are clinically important references for evaluating the severity of calcaneus fractures, the clinical efficacy of treatments to such injuries, and the prognosis of these injuries [4,5,11,18]. Böhler's and Gissane's angles are both clinically important radiographic landmarks on lateral X-rays [9].…”

Section: Discussionmentioning

confidence: 99%

Calcaneal varus angle change in normal calcaneus: a three-dimensional finite element analysis

Zhang

et al. 2016

Med Biol Eng Comput

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The objective of the study was to investigate the stress changes in the posterior articular surface of the calcaneus following alternation of the calcaneal varus angle in normal calcaneus and discuss the clinical significance of the calcaneal varus angle. Axial view radiographs of 165 volunteers were obtained to measure the calcaneal varus angle of normal calcaneus. A calcaneal model with different varus angle changes (including +2°, +4°, +6°, -2°, -4°, and -6°) was established using Creo 2.0 software. Stress changes at different calcaneal varus angles in the posterior articular surface of the calcaneus under a load of 100 N were measured. Stressed areas in posterior articular facets were slightly fewer following +2°, +4°, and +6° changes in varus angle than in normal varus angles with stress concentering regions moving to the anteromedial aspect of the posterior calcaneal facet. However, stress concentering areas in posterior calcaneal facets following -4° and -6° changes in varus angle obviously moved to the anterior and posterior medial side of posterior calcaneal facets. Stress distribution in the posterior articular surface of the calcaneus varies with the calcaneal varus angle. The decrease in calcaneal varus angle following operative treatment of calcaneal fractures should be controlled within 2°.

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Functional outcome of displaced intra-articular calcaneal fractures

Abstract: Therapeutic study, level IV.

Cited by 62 publications

References 43 publications

Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base

Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base

Bony destructive injuries of the calcaneus: long-term results of a minimally invasive procedure followed by early functional exercise: a retrospective study

Calcaneal varus angle change in normal calcaneus: a three-dimensional finite element analysis

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