Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study

Abstract Background: Traditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan. Methods: We retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available. Results: Mean intraoperative fluoroscopy time was 3.95±1.78 h; IFAU in 16 patients (16 feet) was the same as the preoperative plan; mean surgery time was 28.16±10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2%±2.3%. AOFAS scores increased with time, with significant differences in the score at each time point. Conclusions: The newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.

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Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study

10.21203/rs.2.23611/v4 ◽

2020 ◽

Author(s):

Chenggong Wang ◽

Can Xu ◽

Mingqing Li ◽

Hui Li ◽

Han Xiao ◽

...

Keyword(s):

Internal Fixation ◽

Subtalar Joint ◽

Calcaneal Fracture ◽

Patient Specific ◽

Calcaneal Fractures ◽

Intraoperative Fluoroscopy ◽

Joint Width ◽

Preoperative Plan ◽

Overlap Ratio ◽

Minimally Invasive Internal Fixation

Abstract Background: Traditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan.Methods: We retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available.Results: Mean intraoperative fluoroscopy time was 3.95±1.78 h; IFAU in 16 patients (16 feet) was the same as the preoperative plan; mean surgery time was 28.16±10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2%±2.3%. AOFAS scores increased with time, with significant differences in the score at each time point.Conclusions: The newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.

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Patient-specific instrument assisted calcaneal fracture minimally invasive internal fixation is accurate and practical: a retrospective study

10.21203/rs.2.21684/v1 ◽

2020 ◽

Author(s):

Chenggong Wang ◽

Can Xu ◽

Mingqing Li ◽

Hui Li ◽

Han Xiao ◽

...

Keyword(s):

Minimally Invasive ◽

Internal Fixation ◽

Subtalar Joint ◽

Calcaneal Fracture ◽

Patient Specific ◽

Valgus Angle ◽

Intraoperative Fluoroscopy ◽

Joint Width ◽

Preoperative Plan ◽

Minimally Invasive Internal Fixation

Abstract Background: Almost all of the traditional calcaneal fracture minimally invasive internal fixation (MIIF) require a lot of intraoperative fluoroscopy, moreover, the fracture recovery of many patients are not considered ideal. Therefore, we designed a new surgical procedure through the digital surgical simulation and made patient-specific instrument (PSI) for calcaneal fracture patients before surgery, and then we manage the operation through the assistance of PSI during the whole process. The purpose of this study is to verify whether the PSI assisted calcaneal fracture minimally invasive internal fixation is accurate and practical. Methods: We retrospectively analyzed the Sanders type III or IV fresh calcaneal fracture patients who had been performed MIIF assisted by the PSI in our hospital during January 2016 to December 2018. We collected and analyzed perioperative data including intraoperative fluoroscopy times, whether the internal fixation actual usage (IFAU) same as preoperative plan, surgical time and situation of complication; and collected and analyzed the data of preoperative actual measurement, preoperative-plan and postoperative actual measurement from X-rays and CT, including Böhler angle, Gissane angle, subtalar joint width, calcaneus valgus angle and calcaneal volume overlapping ratio. All patients had been followed up and their AOFAS score had been recorded. Then we performed statistical analyses. Results: The intraoperative fluoroscopy times was 3.95±1.78, the condition of IFAU in 16 patients was the same as preoperative plan, the surgery time was 28.16±10.70 min, no patients developed complications. The preoperative plan Böhler angle, Gissane angle, subtalar joint width and calcaneus valgus angle were not significant different from the postoperative; the preoperative Böhler angle, Gissane angle, subtalar joint width and calcaneus valgus angle were all significant different from the postoperative. The calcaneal volume overlapping ratio with preoperative design was 91.2±2.3%. The AOFAS score of all patients gradually increased as time goes on, and difference of the AOFAS scores between all time-points were significant. Conclusions: The new PSI can indeed carry out the preoperative plan accurately and quickly, and the PSI assisted calcaneal fracture minimally invasive internal fixation is accurate and practical.

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Patient-specific instrument assisted calcaneal fracture minimally invasive internal fixation is accurate and practical: a retrospective study

10.21203/rs.2.23611/v1 ◽

2020 ◽

Author(s):

Chenggong Wang ◽

Can Xu ◽

Mingqing Li ◽

Hui Li ◽

Han Xiao ◽

...

Keyword(s):

Minimally Invasive ◽

Internal Fixation ◽

Subtalar Joint ◽

Calcaneal Fracture ◽

Patient Specific ◽

Valgus Angle ◽

Intraoperative Fluoroscopy ◽

Joint Width ◽

Preoperative Plan ◽

Minimally Invasive Internal Fixation

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Patient-specific instrument assisted calcaneal fracture minimally invasive internal fixation can carry out preoperative plan accurately and quickly: a retrospective study

10.21203/rs.2.23611/v2 ◽

2020 ◽

Author(s):

Chenggong Wang ◽

Can Xu ◽

Mingqing Li ◽

Hui Li ◽

Han Xiao ◽

...

Keyword(s):

Minimally Invasive ◽

Internal Fixation ◽

Subtalar Joint ◽

Calcaneal Fracture ◽

Patient Specific ◽

Valgus Angle ◽

Intraoperative Fluoroscopy ◽

Joint Width ◽

Preoperative Plan ◽

Minimally Invasive Internal Fixation

Abstract Background: Almost all of the traditional calcaneal fracture minimally invasive internal fixations (MIIF) require a lot of intraoperative fluoroscopy, moreover, the fracture recovery of many patients is not considered ideal. Therefore, we designed a new surgical procedure through the digital surgical simulation and made patient-specific instrument (PSI) for calcaneal fracture patients before surgery, and then we manage the operation through the assistance of PSI during the whole process. The purpose of this study is to verify whether the PSI assisted calcaneal fracture minimally invasive internal fixation can carry out preoperative plan accurately and quickly. Methods: We retrospectively analyzed the Sanders type III or IV fresh calcaneal fracture patients who had been performed MIIF assisted by the PSI in our hospital during January 2016 to December 2018. We collected and analyzed perioperative data including intraoperative fluoroscopy times, whether the internal fixation actual usage (IFAU) same as preoperative plan, surgical time and situation of complication; and collected and analyzed the data of preoperative actual measurement, preoperative-plan and postoperative actual measurement from X-rays and CT, including Böhler angle, Gissane angle, subtalar joint width, calcaneus valgus angle and calcaneal volume overlapping ratio. All patients had been followed up and their AOFAS score had been recorded. Then we performed statistical analyses. Results: The intraoperative fluoroscopy times was 3.95±1.78, the condition of IFAU in 16 patients (16 feet) was the same as preoperative plan, the surgery time was 28.16±10.70 min, no patients developed complications. The preoperative plan Böhler angle, Gissane angle, subtalar joint width and calcaneus valgus angle were not significant different from the postoperative; the preoperative Böhler angle, Gissane angle, subtalar joint width and calcaneus valgus angle were all significant different from the postoperative. The calcaneal volume overlapping ratio with preoperative design was 91.2±2.3%. The AOFAS score of all patients gradually increased as time goes on, and difference of the AOFAS scores between all time-points were significant. Conclusions: The new patient-specific instrument assisted calcaneal fracture minimally invasive internal fixation can carry out the preoperative plan accurately and quickly.

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Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03439-3 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Chenggong Wang ◽

Can Xu ◽

Mingqing Li ◽

Hui Li ◽

Han Xiao ◽

...

Keyword(s):

Retrospective Study ◽

Minimally Invasive ◽

Internal Fixation ◽

Calcaneal Fracture ◽

Patient Specific ◽

Specific Instrument ◽

Preoperative Plan ◽

Minimally Invasive Internal Fixation

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Minimally invasive internal fixation of calcaneal fractures or subtalar joint arthrodesis using the Calcanail®

Operative Orthopädie und Traumatologie ◽

10.1007/s00064-018-0576-2 ◽

2018 ◽

Vol 31 (2) ◽

pp. 149-164 ◽

Cited By ~ 3

Author(s):

M. Saß ◽

R. Rotter ◽

T. Mittlmeier

Keyword(s):

Minimally Invasive ◽

Internal Fixation ◽

Subtalar Joint ◽

Calcaneal Fractures ◽

Minimally Invasive Internal Fixation

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Functional outcome of operatively treated displaced intra-articular calcaneal fractures using two parallel contoured reconstruction plates

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i1.3215 ◽

1970 ◽

Vol 8 (1) ◽

pp. 12-17

Author(s):

S Lakhey ◽

RR Manandhar ◽

RL Pradhan ◽

BK Pandey ◽

S Sharma ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Scoring System ◽

Surgical Techniques ◽

Calcaneal Fracture ◽

Lateral Approach ◽

Complication Rates ◽

Calcaneal Fractures ◽

Articular Fractures ◽

Intraarticular Fractures

Introduction: The treatment of displaced intra-articular calcaneal fracture is controversial. Conventionally, they were treated non-operatively. However, some surgeons are now operatively treating these fractures because of continuing dissatisfaction with the outcome of conservative treatment of these fractures and improvements that have occurred in surgical techniques and complication rates. Objective: The aim of this study was to determine the functional outcome of operatively treated displaced intra-articular calcaneal fractures using two parallel contoured reconstruction plates. Materials and methods: 12 patients with 14 displaced intra-articular calcaneal fractures involving the subtalar joint were included in the study conducted between July 2005 and December 2008. The fracture site was exposed using extended lateral approach. Internal fixation was done by two nearly parallel 3.5mm reconstruction plates and screws contoured to form a gentle curve in all cases with the first plate fixed just below the articular surface. At the end of follow up, the patients' foot function was assessed by Calcaneal Fracture Scoring System of Kerr et al. Patients were also enquired about their satisfaction with their treatment outcome. Results: The patients were followed up for duration of 12 to 24 months (mean 15.64 months). The outcome score as measured by Calcaneal Fracture Scoring System ranged from 48 to 94 (mean 83.64). 11 of 12 patients (91.6 %) were satisfied with the treatment. Conclusion: Displaced intra-articular fractures treated by open reduction and internal fixation, using two nearly parallel, contoured reconstruction plates through an extensile lateral approach and following the principles of treatment of intraarticular fractures, have good functional results with high patient satisfaction rate. Key words: displaced intra-articular calcaneal fractures; operative treatment. DOI: 10.3126/kumj.v8i1.3215 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 12-17

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The Osteochondral Lesions of Talus in the Subtalar Joint following the Intra-articular Calcaneal Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000097 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Chayanin Angthong ◽

Suebsagul Nangnual

Keyword(s):

Subtalar Joint ◽

Preoperative Evaluation ◽

Osteochondral Lesion ◽

Calcaneal Fracture ◽

Osteochondral Lesions ◽

Fracture Type ◽

Calcaneal Fractures ◽

Type Iv ◽

Mapping System ◽

Post Traumatic

Category: Hindfoot, Trauma Introduction/Purpose: The cartilage delamination was frequently associated at the posterior articular facet of calcaneus following displaced intra-articular calcaneus fractures. However, little is known about the osteochondral lesion of the posterior facet of talus (OLPT) following an intraarticular calcaneal fracture. This study is to report the prevalence and characteristics of these lesions. Methods: This study retrospectively reviewed 34 patients who had the intraarticular calcaneal fractures. The CT scan was used to preoperatively evaluate the fracture type, the presence, area of lesion, and severity of OLPT following the intraarticular calcaneal fracture. These data were recorded in accordance with Akiyama mapping system, Sanders, and Ferkel classification. Results: The OLPT was found as 94.1% from a total of 34 patients. The most common area of OLPT was anterocentral part (26.5%) of posterior facet of talar surface in accordance with Akiyama mapping system. The most common fracture type was Sanders IV (44.1%). The most common severity of OLPT was Ferkel grade I (82.4%). The OLPT was predominantly associated in Sanders type IV fractures (46.9%; p = 0.412). Conclusion: This study demonstrated the high prevalence of OLPT following the intra-articular calcaneal fracture. Most lesions were mild severity; however, there was a tendency of the association of lesion occurrence with higher grade of fracture severity. The OLPT may play an important role in the formation of post-traumatic osteoarthritis of subtalar joint which can be found following the intraarticular calcaneal fracture. The preoperative evaluation of this lesion is recommended via CT. The lesion treatment may be encouraged to be performed during calcaneal fracture fixation for the reduction of post-traumatic osteoarthritis formation.

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The epidemiology and trends in the surgical management of calcaneal fractures in England between 2000 and 2017

The Bone & Joint Journal ◽

10.1302/0301-620x.101b2.bjj-2018-0289.r3 ◽

2019 ◽

Vol 101-B (2) ◽

pp. 140-146 ◽

Cited By ~ 9

Author(s):

J. A. Humphrey ◽

A. Woods ◽

A. H. N. Robinson

Keyword(s):

Surgical Treatment ◽

Internal Fixation ◽

Calcaneal Fracture ◽

Recent Change ◽

Calcaneal Fractures ◽

Female Ratio ◽

The United Kingdom ◽

The Mean ◽

The Uk ◽

Male To Female

Aims This paper documents the epidemiology of adults (aged more than 18 years) with a calcaneal fracture who have been admitted to hospital in England since 2000. Secondary aims were to document whether publication of the United Kingdom Heel Fracture Trial (UK HeFT) influenced the proportion of patients admitted to hospital with a calcaneal fracture who underwent surgical treatment, and to determine whether there has been any recent change in the surgical technique used for these injuries. Patients and Methods In England, the Hospital Episode Statistics (HES) data are recorded annually. Between 2000/01 and 2016/17, the number of adults admitted to an English NHS hospital with a calcaneal fracture and whether they underwent surgical treatment was determined. Results During this 17-year period, 62 858 patients were admitted to hospital with a calcaneal fracture. The male-to-female ratio was 2.66:1. The mean annual incidence was 10.5/100 000 for men and 3.8/100 000 for women. The results of the UK HeFT were published in July 2014. The percentage of patients admitted with a calcaneal fracture undergoing internal fixation was 7.31% (3792/51 859) before and 7.38% (534/7229) after its publication. This difference was not statistically significant (p = 0.94). Since 2015, there has been a significant increase in the percentage of calcaneal fractures treated by closed reduction and internal fixation, as opposed to open reduction and internal fixation, from 7.7% (292/3792) to 13.29% (71/534) (p < 0.001). Conclusion This study documents the epidemiology and trends in surgical treatment of calcaneal fractures in England. We established that surgeons did not change their practice in terms of offering surgery to these patients in response to the results of the UK HeFT. There has been a significant (p < 0.001) increase in the number of calcaneal fractures being treated surgically using less invasive procedures.

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Fractures of the Calcaneus Part II: Treatment

Foot & Ankle International ◽

10.1177/107110079601700612 ◽

1996 ◽

Vol 17 (6) ◽

pp. 360-366 ◽

Cited By ~ 33

Author(s):

Robert B.W. Lowery ◽

Jason H. Calhoun

Keyword(s):

Internal Fixation ◽

Classification System ◽

Open Reduction ◽

Subtalar Joint ◽

Calcaneal Fractures ◽

Articular Fracture ◽

Articular Fractures ◽

Anatomic Reduction ◽

Fracture Management

Extra-articular fracture management of the calcaneus is well accepted. Despite advancements, there is still no consensus on the treatment of intra-articular calcaneal fractures. Although the results of open reduction and internal fixation appear promising, evaluation is difficult because there is no universally accepted classification system. We believe that a consensus is developing for the evaluation, staging, and treatment of the acute calcaneus fracture and its chronic problems. Advancements in the understanding of the anatomy, injury mechanism, and classification of calcaneal fractures were presented in Parti ( Foot & Ankle International, 17(4):230–235, 1996). Treatment of displaced intra-articular fractures gives superior results when anatomic reduction of the subtalar joint is achieved.

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