Management of calcaneal fractures

Guerado, Enrique; Bertrand, Maria; Cano, Juan Ramón

doi:10.1016/j.injury.2012.05.011

Cited by 82 publications

(27 citation statements)

References 100 publications

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“…Selection of the optimal operative technique and modality has been controversial and remains a challenge. Open reduction and internal fixation (ORIF), which includes a plate fixation technique, is the recommended procedure for this fracture (Guerado et al, 2012;Rammelt, 2014). However, some prefer percutaneous reduction and fixation (PRF) with crossing screws, which is indicated for calcaneal fractures with minimal comminution (Abdelgaid, 2012;Hammond and Crist, 2013).…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…Fixed-angle locking compression plate osteosynthesis through the lateral approach is currently the gold standard procedure for the surgical management of calcaneal fractures [1][2][3]. The extensile lateral approach, however, is often associated with soft tissue complications [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the soft tissue advantages, the choice of optimal osteosynthesis of an intra-articular calcaneal fracture should be based on consideration of the technical feasibility, the ability to verify reduction results intra-operatively and the quality of retention [2]. The weight-bearing talotarsal joint is exposed to large biomechanical forces and requires stable subchondral support to enable functional treatment with early weight-bearing.…”

Section: Discussionmentioning

confidence: 99%

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A biomechanical comparison of fixed angle locking compression plate osteosynthesis and cement augmented screw osteosynthesis in the management of intra articular calcaneal fractures

Rausch

Klos²,

Wolf

et al. 2014

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to investigate whether cement-augmented screw osteosynthesis results in stability comparable to conventional fixed-angle locking plate osteosynthesis using cadaveric bones to model a Sanders type 2B fracture. Methods Seven pairs of fresh frozen human calcanei and the corresponding tali were used. The specimens were assigned pairwise to two study groups in a randomised manner. In order to determine the initial quasi-static stiffness of the boneimplant construct, testing commenced with quasi-static compression ramp loading; subsequently, sinusoidal cyclic compression loading at 2 Hz was performed until construct failure occurred. Initial dynamic stiffness (cycle 1), range of motion (ROM), cycles to failure and load to failure were determined from the machine data during the cyclic test. In addition, at 250-cycle intervals, Böhler's angle and the critical angle of Gissane were determined on mediolateral X-rays shot with a triggered C-arm; 5°angle flattening was arbitrarily defined as a failure criterion. Results Bone mineral density was normally distributed without significant differences between the groups. The augmented screw osteosynthesis resulted in higher stiffness values compared to the fixed-angle locking plate osteosynthesis. The fracture fragment motion in the locking plate group was significantly higher compared to the group with augmented screw osteosynthesis. Conclusions The results of this study indicate that in our selected test set-up augmented screw osteosynthesis was significantly superior to the conventional fixed-angle locking plate osteosynthesis with respect to primary stability and ROM during cyclic testing.

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“…Its normal value is 120°-145°. Böhler's and Gissane's angles are both clinically important radiographic landmarks on the lateral X-ray [9]. Böhler's angles, Gissane's angles, and calcaneal length and width are currently considered as the important reference to evaluate the severity of calcaneus fractures and the clinical efficacy of treatment of injuries.…”

Section: Introductionmentioning

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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Management of calcaneal fractures

Cited by 82 publications

References 100 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

A biomechanical comparison of fixed angle locking compression plate osteosynthesis and cement augmented screw osteosynthesis in the management of intra articular calcaneal fractures

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

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