Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (18): 2827-2832.doi: 10.3969/j.issn.2095-4344.3827

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Sanders type III calcaneal fractures: reliability of posterior facet screw fixation combined with lateral column screw fixation

Wu Kai, Lin Jian, Huang Yinjun, Wang Qiugen, Huang Jianhua, Weng Shiyang   

  1. Department of Orthopedic Trauma, South Branch of the First People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 201600, China
  • Received:2020-07-28 Revised:2020-07-29 Accepted:2020-08-29 Online:2021-06-28 Published:2021-01-12
  • Contact: Weng Shiyang, MD, Physician, Department of Orthopedic Trauma, South Branch of the First People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 201600, China
  • About author:Wu Kai, MD, Physician, Department of Orthopedic Trauma, South Branch of the First People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 201600, China

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Abstract: BACKGROUND: For Sanders type III calcaneal fractures, the classic “L-type” large incision often causes postoperative skin necrosis and other complications. Some scholars have shown that the use of mini plate through the tarsal sinus incision can significantly reduce the incision problems and achieve the same curative effect. However, there is still a lack of biomechanical verification.
OBJECTIVE: Biomechanical tests were carried out on Sanders III cadaveric model to verify the effectiveness and reliability of posterior facet screw fixation combined with lateral column screw fixation.
METHODS: Sanders III intra-articular calcaneal fracture models were established on five adult cadaveric lower limb specimens. The high flexible F3 plate system was used to fix the posterior articular surface, and two cannulated screws were used to support the inner and outer columns respectively. At the same time, the anterior calcaneal bone mass (block A), the medial posterior articular surface bone mass (bone block M), the lateral posterior articular surface bone mass (bone block L), and the posterior calcaneal bone block (bone block P) were labeled with rigid body. The relative distances between the bone fragments were marked as AM, AL, AP, ML, MP, LP. Then, 800 N cyclic load test and 2 000 N ultimate load test were carried out on the biomechanical test platform. Simultaneously, the displacement between the rigid bodies of each bone block was tracked by using the Qualisys motion capture system, and the data were recorded and analyzed by using the software of Qualisys track manager.
RESULTS AND CONCLUSION: (1) In 800 N cyclic load test, the median displacements of AM, AL, AP, ML, MP and LP were 1.60, 1.68, 2.45, 2.20, 1.20 and 2.00 mm, and the average values were 1.99, 2.05, 2.05, 2.48, 1.17 and 1.97 mm. (2) Under the limit load of 2 000 N, the median displacements of AM, AL, AP, ML, MP and LP were 2.10, 1.85, 2.40, 2.10, 1.50 and 1.70 mm, and the average values were 2.09, 1.88, 2.44, 2.10, 1.59 and 1.69 mm. (3) The internal fixation system of all specimens withstood the load and maintained its integrity and reliability in both tests. There was no broken nail, no screw withdrawal or plate bending. Only one hollow nail was slightly bent in one case. (4) The internal fixation effect and biomechanical strength of the posterior facet screw fixation combined with lateral column screw fixation meet the design expectations. It is a reliable and effective method to treat sanders III calcaneal fractures with minimally invasive treatment.

Key words: calcaneal fracture, sanders III, biomechanics, cyclic loading, ultimate loading

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