Biomechanical Stability of Intramedullary Technique for Fixation of Joint Depressed Calcaneus Fracture

Nelson, Joshua D.; McIff, Terence E.; Moodie, Patrick G.; J, Iverson; Horton, Greg A.

doi:10.3113/fai.2010.0229

Cited by 33 publications

(16 citation statements)

References 17 publications

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“…In this study, the construct stability of LPF was greater than that of the two crossing screws; it had the smallest displacements at the fracture gaps. Other studies (Nelson et al, 2010;Smerek et al, 2008) found similar results, where LPF of calcaneal fractures provided better fracture reduction than fixation with percutaneous screws. However, this high rigidity promoted a higher concentration of stress on the implant, which, in this situation, could result in hardware failure.…”

Section: Discussionmentioning

confidence: 56%

Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures

Wong

Mei

et al. 2016

Sci. China Life Sci.

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The locking plate and percutaneous crossing metallic screws and crossing absorbable screws have been used clinically to treat intra-articular calcaneal fractures, but little is known about the biomechanical differences between them. This study compared the biomechanical stability of calcaneal fractures fixed using a locking plate and crossing screws. Three-dimensional finite-element models of intact and fractured calcanei were developed based on the CT images of a cadaveric sample. Surgeries were simulated on models of Sanders type III calcaneal fractures to produce accurate postoperative models fixed by the three implants. A vertical force was applied to the superior surface of the subtalar joint to simulate the stance phase of a walking gait. This model was validated by an in vitro experiment using the same calcaneal sample. The intact calcaneus showed greater stiffness than the fixation models. Of the three fixations, the locking plate produced the greatest stiffness and the highest von Mises stress peak. The micromotion of the fracture fixated with the locking plate was similar to that of the fracture fixated with the metallic screws but smaller than that fixated with the absorbable screws. Fixation with both plate and crossing screws can be used to treat intra-articular calcaneal fractures. In general, fixation with crossing metallic screws is preferable because it provides sufficient stability with less stress shielding.

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Section: Discussionmentioning

confidence: 56%

Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures

Wong

Mei

et al. 2016

Sci. China Life Sci.

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“…22,28 To enhance stability, additional lateral plate fixation, contoured along the posterior facet, was used in the present study. 18 The significant improvement in Bohler's angle in the present study indicated that percutaneous reduction via the sinus tarsi approach allowed for adequate restoration of calcaneal height.…”

Section: Discussionmentioning

confidence: 99%

“…Depending on the specific fracture type, one or two more screws were directed cranially toward the posteromedial and posterolateral fragments, fixing these to the tuberosity fragment and serving as additional support for the posterior facet ( Figure 3B and 3C). 22 No bone graft was used in any patient. In the case of a comminuted anterior process fracture, fixation with an additional small plate or screws was considered.…”

Section: Operative Proceduresmentioning

confidence: 99%

Mini-Open Sinus Tarsi Approach with Percutaneous Screw Fixation of Displaced Calcaneal Fractures: A Prospective Computed Tomography–Based Study

et al. 2012

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“…However, the fixation using plates has the disadvantages of greater soft tissue injury than the percutaneous method and weak fixation strength due to the use of small plates and 2.7-mm screws. According to a recent biomechanical study, two cannulated screws to the medullary cavity shows same to better biomechanical strength than plates 34. In the present study, Steinmann pins were used to fix anterior and posterior bone fragments in the first eight cases and we have experienced collapse of Böhler's angle in some cases.…”

Section: Discussionmentioning

confidence: 70%

“…Fixation using Steinmann pins is simple surgically, but the fixation strength achieved is weak and their use is accompanied by the risk of pin site infection. Cannulated screws of diameter of 6.5 or 7 mm are more commonly used and have been reported to have satisfactory fixation strength 34. Recently, the fixation using plates has prodeuced better results with the development of low-profile plates 18.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Sanders Type 2 Calcaneal Fractures Using a Sinus Tarsi Approach

Park

Lee

2017

IJOO

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Background:Calcaneum is the most commonly fractured tarsal bone. The optimal treatment for displaced calcaneus fractures involving the posterior facet is surgical. The extensile lateral approach is commonly preferred because it provides sufficient exposure of the subtalar facet. However, this technique has the risk of complications such as wound necrosis and sural nerve injury. Various minimally invasive approaches, such as sinus tarsi approach, limited posterior approach, and percutaneous approach, have been introduced to reduce possible complications. This study was prospectively performed to evaluate the results of the sinus tarsi approach for Sanders Type 2 calcaneal fractures using postoperative computed tomography (CT).Materials and Methods:Between October 2012 and December 2013, 20 Sanders Type 2 calcaneal fractures were consecutively treated using a sinus tarsi approach and checked using CT preoperatively, immediately postoperatively, and at 12 months after surgery. Clinical evaluations were performed using the visual analog scale (VAS) and the ankle-hindfoot score developed by the American Orthopaedic Foot and Ankle Society (AOFAS). Radiographic evaluations were performed using calcaneus lateral and axial radiographs, hindfoot alignment radiograph, and CT. Changes in Böhler's angles and calcaneal widths were evaluated both preoperatively and at last followup. Reduction of the posterior facet was graded according to articular step, defect, and angulation of the posterior facet in CT.Results:VAS and AOFAS scores were significantly improved at 1 year after surgery but did not improve further. Böhler's angles and calcaneal widths were significantly improved after surgery. Böhler's angle was significantly smaller at the last followup than immediately after surgery, whereas calcaneal width was maintained. Reduction of the posterior facet was graded excellent in five feet (25%), good in ten (50%), and fair in five (25%) on immediately postoperative CT. Two feet (10%) had transient sural nerve injury which resolved within 3 months. Five feet (20%) had subfibular pain due to a prominent screw heads.Conclusion:Surgical management using a sinus tarsi approach produced good clinical and radiographic results and low wound complications for Sanders type 2 calcaneal fractures. It is important to have stable fixation and to achieve sufficient reduction of calcaneal width for the prevention of loss of reduction and lateral subfibular impingement.

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Biomechanical Stability of Intramedullary Technique for Fixation of Joint Depressed Calcaneus Fracture

Abstract: This fixation technique provides a biomechanically stable construct with the potential for a minimally invasive approach and improved post-operative soft tissue healing.

Cited by 33 publications

References 17 publications

Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures

Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures

Mini-Open Sinus Tarsi Approach with Percutaneous Screw Fixation of Displaced Calcaneal Fractures: A Prospective Computed Tomography–Based Study

Surgical Treatment of Sanders Type 2 Calcaneal Fractures Using a Sinus Tarsi Approach

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