Total arthroscopy-assisted reduction and internal fixation with cannulated screws for Sanders II and III calcaneal fractures

doi:10.3969/j.issn.2095-4344.2852

Abstract

Abstract:

BACKGROUND: In recent years, arthroscopy has been widely used in the treatment of calcaneal fractures, but it is often used to treat Sanders type I and II fractures, or as an auxiliary means of complex calcaneal fracture reduction and intraarticular injury exploration and cleaning.

OBJECTIVE: To explore the effect of total arthroscopy-assisted reduction and internal fixation with cannulated screws for treatment of Sanders II and III calcaneal fractures.

METHODS: From December 2016 to November 2018, 42 patients (42 feet) of Sanders II and III calcaneal fractures treated in Foshan Hospital of Traditional Chinese Medicine as the research subjects were divided into two groups according to the surgical plan. Patients in the total arthroscopy group (n=21) received total arthroscopy-assisted reduction and internal fixation with cannulated screws. Patients in the tarsal sinus approach group (n=21) received internal fixation of calcaneus anatomical plate through tarsal sinus approach. At 12 months after surgery, adverse reactions were recorded. X-ray films were reexamined. Böhler angle and Gissane angle were examined, and Maryland score and AOFAS ankle/hindfoot score were evaluated. This study was approved by the Ethics Committee of Foshan Hospital of Traditional Chinese Medicine.

RESULTS AND CONCLUSION: (1) Preoperative preparation time and average hospital stay were longer in the tarsal sinus approach group than in the total arthroscopy group (P < 0.05). There was no injury of posterior tibial vessels, tibial nerve or sural nerve, and no infection of soft tissue in the incision in the total arthroscopy group. In the tarsal sinus approach group, there were three feet with superficial skin infection, one foot with gastrocnemial nerve injury, and no deep incision infection or necrosis. (2) At 12 months after operation, Böhler and Gissane angles in both groups were better than before surgery (P < 0.05), but there was no significant difference between the two groups (P > 0.05). (3) Perimeter of the ankle was significantly reduced after surgery than before surgery in both groups (P < 0.05), and motion range of ankle flexion and extension was significantly increased after surgery than before surgery in both groups (P < 0.05). The perimeter of the ankle was smaller in the total arthroscopy group than in the tarsal sinus approach group at 1 month after surgery (P < 0.05). Motion range of ankle flexion and extension was not significantly different at postoperative 1 year in both groups (P > 0.05). (4) At postoperative 12 months, Maryland scores and AOFAS ankle/hindfoot scores were not significantly different between the two groups (P > 0.05). (5) Compared with internal fixation of calcaneus anatomical plate through tarsal sinus approach, total arthroscopy-assisted reduction and internal fixation with cannulated screws for the treatment of Sanders II and III calcaneal fractures can promote the recovery of the patient’s foot function and reduce postoperative complications.

Key words: bone, steel plate, internal fixation, calcaneal fracture, arthroscopy, foot function

CLC Number:

Shen Guodong, Zou Yunxuan, Zhang Hongning, Li Xue, Yang Kangyong, Lai Zhibin, Zhu Yongzhan. Total arthroscopy-assisted reduction and internal fixation with cannulated screws for Sanders II and III calcaneal fractures[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(33): 5343-5348.

Figures/Tables 11

References

[1] MOLLOY AP, LIPSCOMBE SJ. Hindfoot arthrodesis for management of bone loss following calcaneus fractures and nonunions.Foot Ankle Clin.2011;16(1):165-179.

[2] 方永刚,邱小魁,张雁儒.关节镜辅助下有限切口内固定治疗SandersII-III型跟骨关节内骨折[J].中国矫形外科杂志, 2019, 27(12):1141-1143.

[3] ZHANG T, SUN Y, CHEN W, et al. Displaced intra-articular calcaneal fractures treated in a minimally invasive fashion: longitudinal approach versus sinus tarsi approach.Bone Joint Surg Am.2014;96(4):302-309.

[4] GAVLIK JM, RAMMELT S, ZWIPP H. Percutaneous, arthroscopically-assisted osteosynthesis of calcaneus fractures.Arch Orthop Trauma Surg.2002;122:424-428.

[5] PASTIDES PS, MILNES L. Percutaneous Arthroscopic Calcaneal Osteosynthesis: A Minimally Invasive Technique for Displaced Intra-Articular Calcaneal Fractures.J Foot Ankle Surg. 2015;54(5):798-804.

[6] MITCHELL MJ, MCKINLEY JC. The epidemiology of calcaneal fractures.Foot (Edinburgh, Scotland).2009;19(4): 197-200.

[7] BARRICK B, JOYCE DA, WERNER FW, et al. Effect of Calcaneus Fracture Gap Without Step-Off on Stress Distribution Across the Subtalar Joint.Foot Ankle Int. 2017; 38(3):298-303.

[8] 伍凯,林健,黄建华,等.扩大Ｌ型切口治疗闭合性跟骨骨折伤口并发症的相关因素分析[J].上海交通大学学报(医学版),2014, 34(7):1043-1048.

[9] WEBER M, LEHMANN O, SAGESSER D, et al. Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum.Bone Joint Surg Br. 2008;90(12): 1608-1616.

[10] 吴旻昊,孙文超,蔡林,等.经微创跗骨窦切口入路与传统外侧L形切口入路比较治疗跟骨骨折的Meta分析[J].中国骨伤,2017, 30(12):1118-1126.

[11] JANZEN DL, CONNELL DG, MUNK PL, et al. Intraarticular fractures of the calcaneus: value of CT findings in determining prognosis.Am J Roentgenol.1992;158(6):1271-1274.

[12] DEWALL M, HENDERSON CE, MCKINLEY TO, et al. Percutaneous reduction and fixation of displaced intra-articular calcaneus fractures.J Orthop Trauma.2010;24: 466-472.

[13] MEHTA CR, AN VVG, PHAN K, et al. Extensile lateral versus sinus tarsi approach for displaced, intra-articular calcaneal fractures: a meta-analysis.J orthop Surg Res.2018;13(1):243.

[14] VELTM AN ES, DOOM BERG JN, STUFKENS SA, et al. Long-term outcomes of 1730 calcaneal fractures: system atic review ofthe literature.J Foot Ankle Surg. 2013;52(4): 486-490．

[15] 郝巍琳,周家悦.关节镜辅助下复位空心螺钉内固定治疗跟骨骨折的临床效果[J].临床医学研究与实践,2019,4(13):96-97.

[16] LI S.Wound and Sural Nerve Complications of the Sinus Tarsi Approach for Calcaneus Fractures.Foot Ankle Int. 2018;39(9): 1106-1112.