Limb Reconstruction System Assisted Reduction and Internal Fixation for Intra‐Articular Calcaneal Fractures: A New Application

Autor: Guiyong Jiang, Jie Li, Xiaolong Zhang, Shan Shu, Yunfei Ma, Ping Zhang, Gang Wang, Hua Liao, Jijie Hu
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Orthopaedic Surgery, Vol 15, Iss 10, Pp 2540-2548 (2023)
Druh dokumentu: article
ISSN: 1757-7861
1757-7853
DOI: 10.1111/os.13828
Popis: Background Minimally invasive reduction and fixation of intra‐articular calcaneal fractures poses great challenges for orthopaedic surgeons. The aim of the present study was to report the technical points, evaluate the efficacy of minimally invasive reduction and internal fixation assisted by the temporary limb reconstruction system (LRS) external fixator for intra‐articular calcaneal fractures, and propose the indications of our protocol. Methods In this retrospective study, a series of 34 consecutive closed and displaced intra‐articular calcaneal fractures involving the articular surface were treated by this technology between June 2016 and April 2018. X‐ray and computed tomography (CT) scans were performed before and after surgery to measure Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot. Postoperative complications were recorded. Imaging and clinical outcomes were comprehensively evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot‐ankle scoring system. After testing the normality of the data, Bohler's angle and the length of calcaneus were compared using the Wilcoxon signed‐rank test. The height, width of the calcaneus, and the mechanical axis of the hindfoot were compared using the Paired‐Samples t‐test. Results Thirty‐two fractures were followed up for an average of 20.66 months (from 12 to 32 months). All fractures achieved stable reduction and bony union. The articular surface was reduced and fixed with direct vision through the sinus tarsi incision. No failure of internal fixation or loss of reduction was detected during follow‐up. There were no soft tissue complications. Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot improved significantly. The AOFAS scores averaged 84.12 points; seven cases were rated excellent, 20 good, four fair, and one poor. Conclusions For intra‐articular calcaneal fractures, minimally invasive surgery assisted with temporary LRS external fixation can reconstruct the calcaneal shape and the sub‐talar articular surface. This simple surgical modality with limited complications may be helpful in the surgical treatment of most type II and III calcaneal fractures except comminuted fractures of the calcaneal tuberosity.
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