Biomechanical analysis of minimally invasive crossing screw fixation for calcaneal fractures: Implications to early weight-bearing rehabilitation

2020 ◽  
Vol 80 ◽  
pp. 105143 ◽  
Author(s):  
Haowei Zhang ◽  
Miko Lin Lv ◽  
Yin Liu ◽  
Wanju Sun ◽  
Wenxin Niu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Biomechanical Analysis ◽  
Calcaneal Fractures ◽  
Early Weight Bearing

scholarly journals A Novel Minimally Invasive Reduction Technique by Balloon and Distractor for Intra-Articular Calcaneal Fractures: A Report of 2 Cases

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
M. Prod’homme ◽  
S. Pour Jafar ◽  
P. Zogakis ◽  
P. Stutz
Keyword(s):  
Soft Tissue ◽  
Minimally Invasive ◽  
Soft Tissues ◽  
Weight Bearing ◽  
Calcaneal Fracture ◽  
Invasive Technique ◽  
Calcaneal Fractures ◽  
Early Weight Bearing ◽  
Articular Fractures ◽  
Minimally Invasive Reduction

Treatment of displaced intra-articular fractures of the calcaneus remains a challenge for the orthopaedic surgeon. Conservative therapy is known to produce functional impairment. Surgical approach is plagued by soft-tissue complications and insufficient fracture reduction. We describe a minimally invasive technique that will hopefully improve these issues. We want to present our first experience through two cases. The first was a 46-year-old man who presented with a Sanders type IIBC calcaneal fracture, and the second was a 86-year-old woman with a type IIIBC calcaneal fracture. We introduced 2 Schanz screws in the talus and the calcaneus. After distraction, we introduced an inflatable balloon inside the calcaneus. By inflating the balloon, the articular surface was reduced by lifting it up. Then bone cement was injected in order to maintain the reduction. Additional screw fixation was used in the young patient. Postoperative imaging showed good congruence of the subtalar joint without leakage of cement, for the two cases. After 2 months, the patients had no pain and were without soft-tissue complications. We advocate this technique to perform a minimally invasive reduction and fixation of intra-articular calcaneal fractures because it preserves soft-tissues and provides good clinical results with early weight-bearing.

scholarly journals Mid-term outcomes of minimally invasive plate osteosynthesis for fresh and old calcaneal fractures with locked plate

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0022
Author(s):  
Tatsuji Fujiwara
Keyword(s):  
Minimally Invasive ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Calcaneal Fracture ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Calcaneal Fractures ◽  
Locked Plate ◽  
Early Weight Bearing ◽  
The Mean

Category: Trauma Introduction/Purpose: Since the mid-1990s, open reduction and internal fixation via an extended L-shaped lateral approach has been considered the gold standard for surgical treatment of displaced intraarticular calcaneal fractures. However, postoperative wound healing complications, including wound infection, skin edge necrosis, wound breakdown, and hematoma, remain a major concern. To minimize the incidence of and offer rigid stabilization of the calcaneal fracture fragments, we have performed minimally invasive plate osteosynthesis (MIPO) with locked plate for fresh and old calcaneal fractures. This study aims to assess the clinical and radiological mid-term outcomes in surgical treatment of the fresh and old calcaneal fractures using a minimally invasive technique and a locking plate to permit early weight bearing. Methods: A total of 29 fractures in 24 patients were found that met our inclusion criteria. 23 foots were fresh calcaneal fractures with an average age of 53.9 years (range, 17-80 years). We defined calcaneal fractures more than 6 weeks old as old calcaneal fracture. 6 foots were old calcaneal fractures with an average age of 43 years (range,35-52 years). Patients with fresh calcaneal fracture had been followed up for an average of 25.8 months (range, from 18-65 months). Patients with old calcaneal fracture had been followed up for an average of 29.4 months (range, from 24-48 months). The mean interval between injury and operation was 8.9 days (3-19 days) in fresh calcaneal fractures and 97 days (43-154 days) in old calcaneal fractures. There were 19 foots Sanders type II fractures, 9 foots Sanders type III and one Sanders type IV. Results: For fresh calcaneal fractures, the mean change in Böhler’s angle and width of the calcaneus from immediately after surgery to final follow-up were 0.5° and 0.7 mm, respectively. For old calcaneal fractures, the mean change in Böhler’s angle and width of the calcaneus from immediately after surgery to final follow-up were 3.4° and 1.7 mm, respectively. The reduction was graded as nearly anatomical (less than 2 mm residual articular displacement) in all fractures. One of the 22 foots had a blister. There were no events of osteomyelitis or infection or nonunion. Eight foots had revision surgery for symptomatic hardware removal. At final follow up the average American Foot and Ankle Society Score (AOFAS) were 82.8 for fresh calcaneal fractures and 83.2 for old calcaneal fractures. Conclusion: This study is first report to show that MIPO with locked plate and early weight bearing can be effectively treated for displaced intra-articular calcaneal fractures. Surgical preparation, reduction maneuvers, and fixation techniques can take time to master; however, with experience, all types of calcaneus fractures can be treated with this technique.

scholarly journals Assessment of First Metatarsal Head Bone Density for Optimal Screw Placement in Minimally-Invasive Hallux Valgus Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0003
Author(s):  
Katherine M. Dederer ◽  
Patrick J. Maloney ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
Rebecca A. Cerrato
Keyword(s):  
Bone Density ◽  
Minimally Invasive ◽  
Hallux Valgus ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Metatarsal Head ◽  
Screw Placement ◽  
Cannulated Screws ◽  
First Metatarsal ◽  
History Of

Category: Bunion; Basic Sciences/Biologics Introduction/Purpose: Minimally-invasive surgery (MIS) for hallux valgus correction has become increasingly common. This technique involves an osteotomy of the first metatarsal, followed by fixation with two cannulated screws. Since screws are typically not bicortical, they rely upon bone quality within the metatarsal head for fixation strength. However, bone mineral density (BMD) within different regions of the metatarsal head is unknown. Measuring the BMD in the target region may predict the strength of the bone-screw fixation. Similar to previous work which determined the optimal position for lag screw placement in the femoral head during hip fracture fixation, this study aimed to determine average BMD within four quadrants of the metatarsal head using CT and thus predict the optimal trajectories for cannulated screws during the MIS bunion procedure. Methods: All patients between 18-75 years of age scheduled to undergo MIS hallux valgus correction by one of two surgeons experienced in the MIS technique were eligible to participate. Patients were excluded if they had a prior first metatarsal surgery, pre-existing hardware, previous first metatarsal fracture, or a history of osteoporosis treatment. Patients were enrolled prospectively, and a weight-bearing CT scan of the affected foot was obtained pre-operatively. Demographic factors including age, sex, laterality, body mass index (BMI), comorbidities, and smoking status as well as standard three-view weight-bearing radiographs were collected for all patients.Using the coronal CT slice at maximal metatarsal head diameter, each head was divided into equal quadrants. Hounsfield units (HU) within each quadrant were measured independently by three study investigators using our hospital’s radiology viewing software (Merge PACS; IBM Corporation, Armonk, NY), and these density measurements were averaged. Statistical analysis was conducted using ANOVA and Student’s t-test. Results: Fifteen patients were included for preliminary analysis. All patients were female. The average age was 45.7 years. 9 of the 15 included feet were right feet. Average BMI was 28.0. One patient reported active smoking prior to surgery. Comorbidities included obesity in three patients; none were diabetic. One had a history of diplegic cerebral palsy. The average HVA on a weight- bearing AP foot x-ray was 28.2°, and the average IMA was 12.6°. The BMD within the metatarsal head varied by quadrant, with the two combined dorsal quadrants having higher average BMD than the two combined plantar quadrants (122 vs 85 HU; p<0.001). The dorsal lateral quadrant had the highest average BMD of any quadrant (132 HU, p<0.001; Table 1). Conclusion: The density of the metatarsal head did vary by region within the head. The highest BMD was found in the dorsal lateral quadrant, and the lowest in the plantar lateral and plantar medial quadrants, which did not differ significantly from each other. Because strength of screw fixation is predicated upon screw design as well as bone density, these results suggest that surgeons may wish to direct screws toward the dorsolateral region of the metatarsal head in order to achieve optimal fixation. Further work is needed to determine whether this varies with patient age, gender, or hallux valgus angle. [Table: see text]

scholarly journals Radiologic and Clinical Outcomes of Ollier Approach with Screw Fixation for Displaced Intra-Articular Calcaneal Fractures – Comparative Study with Extensile Lateral Approach with Lateral Plating

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004 ◽  
Author(s):  
Seunghun Woo ◽  
Su-Young Bae ◽  
Hyung Jin Chung ◽  
Tae Sik Goh
Keyword(s):  
Soft Tissue ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Lateral Approach ◽  
Functional Score ◽  
Calcaneal Fractures ◽  
Pain Scores ◽  
Extensile Lateral Approach ◽  
Lateral Plating

Category: Trauma Introduction/Purpose: This study aims to assess the detailed radiologic outcomes which used uninjured side weight-bearing radiograph as a template as well as clinical results to compare the Ollier approach with screw fixation and the extensile lateral approach with lateral plating. Methods: We performed a retrospective review of intra-articular calcaneal fractures treated operatively in our hospital from January 2009 to November 2014. Radiologic outcomes were assessed using radiologic parameters such as Böhler angle, calcaneal height, and talar sagittal angles represent calcaneal deformation by the comparison of the final follow-up bilateral weight-bearing lateral radiograph. Functional outcome was assessed through the American Orthopaedic Foot and Ankle Society (AOFAS) scores and Visual Analog Scale (VAS) pain scores. Postoperative complications were investigated. Results: Ninety-seven unilateral fractures were appeared to match our inclusion criteria: forty-six fractures were treated by using the extensile lateral approach with lateral plating (the ELP group), and fifty-one fractures were treated with the Ollier approach and screw fixation (the OS group). The operation time was significantly shorter in the OA group (p<0.05). There were no significant difference of the final follow-up radiologic parameters between two groups. The mean AOFAS scores were significantly higher in the OS group (p = 0.020) and both groups showed similarity in the VAS pain scores (p = 0.175). Overall soft-tissue complications were 28.3% in the ELP group and 9.8% in the OS group (p = 0.034). Conclusion: No difference could be shown in the postoperative and final follow-up radiological outcomes between the Ollier approach and the extensile lateral approach, but the Ollier approach had better functional score and lower soft tissue complication rate with shorter operative time.

scholarly journals Cement-augmented screw fixation for calcaneal fracture treatment: a biomechanical study comparing two injectable bone substitutes

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Konrad F. Fuchs ◽  
Philipp Heilig ◽  
Miriam McDonogh ◽  
Sebastian Boelch ◽  
Uwe Gbureck ◽  
...  
Keyword(s):  
Bone Cement ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Calcaneal Fracture ◽  
Fracture Treatment ◽  
Peak Displacement ◽  
Early Weight Bearing ◽  
Screw Osteosynthesis ◽  
Total Displacement ◽  
With Screws

Abstract Background The role of cement-augmented screw fixation for calcaneal fracture treatment remains unclear. Therefore, this study was performed to biomechanically analyze screw osteosynthesis by reinforcement with either a calcium phosphate (CP)-based or polymethylmethacrylate (PMMA)-based injectable bone cement. Methods A calcaneal fracture (Sanders type IIA) including a central cancellous bone defect was generated in 27 synthetic bones, and the specimens were assigned to 3 groups. The first group was fixed with four screws (3.5 mm and 6.5 mm), the second group with screws and CP-based cement (Graftys® QuickSet; Graftys, Aix-en-Provence, France), and the third group with screws and PMMA-based cement (Traumacem™ V+; DePuy Synthes, Warsaw, IN, USA). Biomechanical testing was conducted to analyze peak-to-peak displacement, total displacement, and stiffness in following a standardized protocol. Results The peak-to-peak displacement under a 200-N load was not significantly different among the groups; however, peak-to-peak displacement under a 600- and 1000-N load as well as total displacement exhibited better stability in PMMA-augmented screw osteosynthesis compared to screw fixation without augmentation. The stiffness of the construct was increased by both CP- and PMMA-based cements. Conclusion Addition of an injectable bone cement to screw osteosynthesis is able to increase fixation strength in a biomechanical calcaneal fracture model with synthetic bones. In such cases, PMMA-based cements are more effective than CP-based cements because of their inherently higher compressive strength. However, whether this high strength is required in the clinical setting for early weight-bearing remains controversial, and the non-degradable properties of PMMA might cause difficulties during subsequent interventions in younger patients.

scholarly journals Early Weight Bearing on Weber C Fractures with Retained Syndesmotic Screws

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Cristian Ortiz ◽  
Andres Keller Díaz ◽  
Pablo Mococain ◽  
Pablo Wagner ◽  
Ruben Radkievich ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
X Rays ◽  
Aofas Score ◽  
Early Weight Bearing ◽  
Clear Space ◽  
Screw Breakage ◽  
The Mean

Category: Ankle, Sports, Trauma Introduction/Purpose: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged, or the clinical result depending on the screw status, which can be intact, broken or loose. Our objective was to evaluate the radiographic and clinical parameters of patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Our hypothesis was that no difference would be observed on syndesmotic reduction or clinical function depending on the screw status. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). Radiologically we measured medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS), talar shift (TS) and screw condition (intact, broken, loose). Clinical function was measured with the AOFAS score and stratified by the screw condition. Statistical analysis was performed with the SPSS software and a non-inferiority confidence interval for the mean was calculated. Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p>0,05). Relative to clinical function, the mean AOFAS score was 95 points. No difference was found between the clinical scores of patients stratified by the screw condition (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographic or clinical consequences regarding ankle joint function. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We suggest that routine removal of syndesmotic screws is not necessary in these group of patients.

scholarly journals Outcome of the patients who underwent minimally invasive screw fixation for calcaneal fracture: an institutional study

2019 ◽  
Vol 5 (6) ◽  
pp. 1136
Author(s):  
Vivek Amritbhai Patel ◽  
Pathik Vala
Keyword(s):  
Minimally Invasive ◽  
Functional Outcome ◽  
Screw Fixation ◽  
Calcaneal Fracture ◽  
Deep Infection ◽  
Radiographic Evaluation ◽  
Calcaneal Fractures ◽  
Superficial Wound ◽  
Pedal Edema ◽  
Minimally Invasive Fixation

<p class="abstract"><strong>Background:</strong> Calcaneal fractures account for 2% of all fractures with approximately 65-75% intra-articular. The aim of the present study is to determine the outcome of the patients who underwent minimally invasive screw fixation for calcaneal fracture in our institute.</p><p class="abstract"><strong>Methods:</strong> The present study was performed in 31 patients who underwent closed reduction and fixations with screw in this institute for the duration of 2 years were included in this study. Present study was conducted to determine the functional outcome of patients with calcaneal fractures treated with minimally invasive fixation of fractures with cancellous screws after indirect reduction with JESS or manual reduction or with Steinmen pin.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average age of the patients was 44.14 years, ranging from 16 to 74 years, 28 patients were males and 3 were female. The AOFAS score at last follow up was 78.05 this improvement was also significant statistically (p&lt;0.05). The mean Bohler angle at the last radiographic evaluation was 32.87°. The complications noted were proud implant with superficial wound infection in one, deep infection in 2 patients and delay in wound healing in 2 patients, persistent pedal edema in 2 patients.</p><p><strong>Conclusions:</strong> ORIF of calcaneal fractures is associated with high skin complications and comorbidities. Percutaneous screw fixation has fewer skin complications and can have satisfactory functional outcome. JESS or similar external fixator can be used intraoperatively for achieving reduction through ligamentotaxis.</p>

scholarly journals A minimally invasive sinus tarsi approach with percutaneous plate and screw fixation for intra-articular calcaneal fractures

2013 ◽  
Vol 11 (10) ◽  
pp. 1087-1091 ◽  
Author(s):  
Shengli Xia ◽  
Xiuhui Wang ◽  
Yaogang Lu ◽  
Huizhong Wang ◽  
Zuming Wu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Screw Fixation ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach

Early Weight Bearing of Calcaneal Fractures Fixated With Locked Plates

2010 ◽  
Vol 3 (6) ◽  
pp. 320-323 ◽  
Author(s):  
Christopher F. Hyer ◽  
Said Atway ◽  
Gregory C. Berlet ◽  
Thomas H. Lee
Keyword(s):  
Weight Bearing ◽  
Calcaneal Fractures ◽  
Early Weight Bearing
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