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Abstract Aims Which is the best extensile lateral (ELA) or sinus tarsi (STA) approach for osteosynthesis displaced intraarticular calcaneal fracture (DIACF) is still debatable. The current RCT’s primary objective was to compare the complications incidence after open reduction and internal fixation of DIACFs through STA vs. ELA. The secondary objectives were the differences in intraoperative radiation exposure, time to fracture union, functional and radiological outcomes. Methods Between August 2020 and February 2023, 157 patients with Sanders type II and III fractures were randomly assigned to either ELA (81 patients with 95 fractures) or STA (76 patients with 91 fractures). The primary outcome was the incidence of complications. The secondary outcomes were Böhler’s and Gissane angles angle, fracture union, and American Orthopaedic Foot and Ankle Society (AOFAS) score. Results No statistical differences between both groups regarding basic demographic data, injury characteristics, and fracture classification; however, patients in the STA group were operated upon significantly earlier (4.43 ± 7.37 vs. 7 ± 6.42 days, p = 0.001). STA’s operative time was significantly shorter (55.83 ± 7.35 vs. 89.66 ± 7.12 min, p

Abstract Background The surgical treatment and management of postoperative soft tissue complications in diabetic patients with displaced calcaneal fractures are still controversial. We aimed to evaluate the short-term efficacy of percutaneous minimally invasive screw fixation in treatment of diabetic patients with Sanders II and III calcaneal fractures under subtalar arthroscopy assisted by preoperative musculoskeletal ultrasonic locating lateral calcaneal branch (LCB) of the sural nerve and calcaneal-talar joint distraction device. Methods The clinical data of 52 diabetic patients diagnosed with Sanders II or III calcaneal fractures from March 2016 to August 2020 were followed up and analyzed. There were 23 patients of type II and 29 patients of type III, 34 males and 18 females, with a mean age of 61.7 ± 14.5 years (range: 45–72 years). Preoperative musculoskeletal ultrasonography was routinely examined to locate LCB of the sural nerve. During surgery, we performed arthroscopic percutaneous prying reduction screw fixation assisted by medial calcaneal-talar joint distraction. Incision healing, local skin paraesthesia and other conditions were observed regularly at 3 days, 6, 12 months, and the last follow-up after surgery. Also, we measured the length, width, height, Böhler angle, and Gissane angle of the calcaneus on lateral and axial x-rays. Visual analogue pain scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score and Maryland score were used to evaluate the efficacy. Results 52 patients were followed up for 23.7 ± 3.2 months (range: 20–28 months) without incision-related complications. Calcaneal radiographic parameters (length, width, height, Böhler/Gissane angle) were improved after surgery, and the differences were all statistically significant (P0.05). Postoperative VAS, AOFAS scores, and Maryland scores were significantly improved compared with those before surgery (P

Background: The surgical treatment and management of postoperative soft tissue complications in diabetic patients with displaced calcaneal fractures are still controversial. We aimed to evaluate the short-term efficacy of percutaneous minimally invasive screw fixation in treatment of diabetic patients with Sanders II and III calcaneal fractures under subtalar arthroscopy assisted by preoperative musculoskeletal ultrasonic locating lateral calcaneal branch (LCB) of the sural nerve and calcaneal-talar joint distraction device. Methods: The clinical data of 52 diabetic patients diagnosed with Sanders II or III calcaneal fractures from March 2016 to August 2020 were followed up and analyzed. There were 23 patients of type II and 29 patients of type III, 34 males and 18 females, with a mean age of 61.7 ± 14.5 years (range: 45–72 years). Preoperative musculoskeletal ultrasonography was routinely examined to locate LCB of the sural nerve. During surgery, we performed arthroscopic percutaneous prying reduction screw fixation assisted by medial calcaneal-talar joint distraction. Incision healing, local skin paraesthesia and other conditions were observed regularly at 3 days, 6, 12 months, and the last follow-up after surgery. Also, we measured the length, width, height, Böhler angle, and Gissane angle of the calcaneus on lateral and axial x-rays. Visual analogue pain scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score and Maryland score were used to evaluate the efficacy. Results: 52 patients were followed up for 23.7 ± 3.2 months (range: 20–28 months) without incision-related complications. Calcaneal radiographic parameters (length, width, height, Böhler/Gissane angle) were improved after surgery, and the differences were all statistically significant (P<0.05). There was no difference between calcaneal radiographic parameters at 6,12 months and the last follow-up compared with 3 days after surgery without significant loss in overall morphology (P>0.05). Postoperative VAS, AOFAS scores, and Maryland scores were significantly improved compared with those before surgery (P<0.05). Conclusions: Preoperative ultrasonic locating LCB of the sural nerve and arthroscopic percutaneous minimally invasive screw fixation of Sanders II and III calcaneal fractures with the assistance of calcaneal-talar joint distraction have good short-term efficacy and clinical feasibility in diabetic patients. [ABSTRACT FROM AUTHOR]

Purpose: Studies have reported conflicting findings on the relationship between smoking and surgical site infection (SSI) post fixation for ankle and calcaneal fractures. This meta-analysis explored the effect of smoking on SSI incidence following open reduction and internal fixation (ORIF) of these fractures. Methods: Full-text studies on smoking’s influence on post-ORIF SSI rates for closed ankle and calcaneal fractures were sourced from the PubMed, Embase, and Cochrane databases, with no consideration given to language or publication date. Study quality was appraised using the Newcastle–Ottawa Scale. Odds ratios (OR) and the corresponding 95% CIs were determined using random-effects models. This meta-analysis adhered to the PRISMA guidelines and was registered with PROSPERO (CRD42023429372). Results: The analysis incorporated data from 16 cohort and case–control studies, totaling 41 944 subjects, 9984 of whom were smokers, with 956 SSI cases. Results indicated smokers faced a higher SSI risk (OR: 1.62; 95% CI: 1.32–1.97, P < 0.0001) post ORIF, with low heterogeneity (I2 = 26%). Smoking was identified as a significant deep SSI risk factor (OR: 2.09; 95% CI: 1.42–3.09; P = 0.0002; I2 = 31%). However, the subgroup analysis revealed no association between smoking and superficial SSI (OR: 1.05; 95% CI: 0.82–1.33; P = 0.70; I2 = 0%). Conclusion: Smoking is associated with increased SSI risk after ORIF for closed ankle and calcaneus fractures. Although no clear link was found between superficial SSI and smoking, the data underscore the negative influence of smoking on deep SSI incidence.

Abstract Objective With the development of surgical technology, the level of digital medicine is constantly improving. The birth of new technologies has a certain impact on traditional methods. At present, robot-assisted technology has been applied to patients with calcaneal fractures, which poses a challenge to traditional surgery. We aimed to assess whether robot-assisted internal fixation confers certain surgical advantages through a literature review. Design The databases PubMed, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), and the Wanfang Data Knowledge Service Platform were systematically searched for both randomized and nonrandomized studies involving patients with calcaneal fractures. Main results Five studies were identified that compared clinical indexes. For the clinical indexes, robot-assisted surgery is generally feasible because of intraoperative fluoroscopy, complications, the Gissane angle, the calcaneal width, and the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score 3 and 6 months after the operation (P 0.05). Conclusions Based on the current evidence, the advantages of robot-assisted fixation over traditional fixation are clear. The long-term clinical effects of the two methods are also good, and the short-term effect of robot assistance is better. However, the quality of some studies is low, and more high-quality randomized controlled trials (RCTs) are needed for further verification.

The aim of the study was to compare the efficacy and safety of robot-assisted (RA) percutaneous hollow screw fixation with traditional open reduction internal fixation (ORIF) for the treatment of calcaneal fractures through a systematic review and meta-analysis. An extensive search was conducted in the following databases—PubMed, CNKI, Embase, and the Cochrane Library—to gather research on patients with calcaneal fractures published up to July 2024. This search focuses on studies comparing the effectiveness of robot-assisted percutaneous cannulated screw fixation versus ORIF. We will include studies published in both English and Chinese. Our screening process adhered strictly to predefined inclusion and exclusion criteria, emphasizing randomized controlled trials (RCTs) and cohort studies. The ROBINS-I tool was utilized to evaluate the risk of bias in non-randomized studies. Meta-analysis was conducted using Review Manager 5.4.1. The final analysis incorporated six retrospective cohort studies comprising 247 patients—122 treated with robotic-assisted percutaneous cannulated screw fixation and 125 with conventional open reduction and internal fixation. The findings indicated that patients undergoing robotic-assisted percutaneous cannulated screw fixation experienced advantages over those receiving conventional treatment in terms of reduced hospital stay, lower estimated blood loss, and higher AOFAS scores at both 3 and 6 months. No statistically significant differences were observed between the two methods concerning operative time, fracture healing duration, or the frequency of intraoperative fluoroscopies. Robotic-assisted percutaneous cannulated screw fixation is a safe and viable treatment approach for patients with calcaneal fractures. When compared to ORIF methods, this robotic-assisted technique demonstrated significant benefits, including reduced hospital stay, lower estimated blood loss, and improved AOFAS scores at both 3 and 6 months. [ABSTRACT FROM AUTHOR]

Objective: With the development of surgical technology, the level of digital medicine is constantly improving. The birth of new technologies has a certain impact on traditional methods. At present, robot-assisted technology has been applied to patients with calcaneal fractures, which poses a challenge to traditional surgery. We aimed to assess whether robot-assisted internal fixation confers certain surgical advantages through a literature review. Design: The databases PubMed, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), and the Wanfang Data Knowledge Service Platform were systematically searched for both randomized and nonrandomized studies involving patients with calcaneal fractures. Main results: Five studies were identified that compared clinical indexes. For the clinical indexes, robot-assisted surgery is generally feasible because of intraoperative fluoroscopy, complications, the Gissane angle, the calcaneal width, and the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score 3 and 6 months after the operation (P < 0.05). However, on the operation time, Böhler's angle at 3 and 6 months, Gissane angle and calcaneal width at 6 months after the operation did not show good efficacy compared with those of the traditional group (P > 0.05). Conclusions: Based on the current evidence, the advantages of robot-assisted fixation over traditional fixation are clear. The long-term clinical effects of the two methods are also good, and the short-term effect of robot assistance is better. However, the quality of some studies is low, and more high-quality randomized controlled trials (RCTs) are needed for further verification. [ABSTRACT FROM AUTHOR]

Background: Displaced intra-articular calcaneal fractures remain challenging to manage due to the complex anatomy, soft tissue envelope, and high risk of complications. This prospective study aimed to evaluate the functional and radiological outcomes of surgical treatment using open reduction and internal fixation with calcaneal locking plates. Methods: Twenty patients with displaced intra-articular calcaneal fractures underwent open reduction and internal fixation with calcaneal locking plates. Radiographic outcomes, including Böhler's angle, Gissane's angle, and calcaneal width, were assessed pre- and postoperatively. Functional outcomes were evaluated using the Maryland Foot Score (MFS). Postoperative complications and occupational rehabilitation were also recorded. Results: Radiographic outcomes showed significant improvements in Böhler's angle (from 1.7 ± 3.2° to 26.85 ± 4.1°, p < 0.001), Gissane's angle (from 158.55 ± 8.3° to 127.7 ± 6.2°, p < 0.001), and calcaneal width (from 7.58 ± 0.6 cm to 6.76 ± 0.4 cm, p < 0.001) following surgery. Functional outcomes were excellent or good in 90% of patients, with a mean MFS of 86.25 ± 8.4. Complications were observed in 20% of patients, with each of wound dehiscence, superficial skin necrosis, deep infection, and subtalar arthritis occurring in 5% of patients. Occupational rehabilitation was achieved in 80% of patients. Conclusion: Open reduction and internal fixation with calcaneal locking plates is an effective treatment for displaced intra-articular calcaneal fractures, resulting in significant improvements in radiographic parameters, good to excellent functional outcomes, and a high rate of occupational rehabilitation with minimal complications. [ABSTRACT FROM AUTHOR]

Purpose: Calcaneal fractures (CFs) are rare but potentially debilitating injuries. Apart from the open, far lateral or sinus tarsi approach, operative treatment can be performed minimally invasive and percutaneously with intramedullary nailing. In this study, we sought to investigate the functional outcome of severe CFs treated with the C-Nail® implant. Methods: Twenty-two CFs (9 × Sanders III and 8 × Sanders IV), operated between 2016 and 2019, were followed up with a mean duration of 36 (± 11) months. The AOFAS score, pre- and postoperative Böhler angles, wound healing disorders, and patient-reported outcome measures (PROMs) like pain levels and return to work/sport levels were assessed. Results: The mean AOFAS score was 72.0 (± 9.8). Four patients sustained wound healing disorders, yet no implant-associated surgical revision was required. Fifty percent of patients were pain-free within 1 year. Within 1 year, about 50% of the patients could return to sports, and about 80% of the patients could return to work. PROMs and functional results align with those from other implants reported in the literature. Conclusion: Intramedullary nailing of severe CFs with the C-Nail® implant can be considered a safe treatment alternative that yields acceptable results at mid-terms. [ABSTRACT FROM AUTHOR]

Purpose: Accurately classifying displaced intraarticular calcaneal fractures (DIACFs) is essential for orthopedic surgeons to choose optimal treatment methods and provide results evaluation and communication. Many authors studying used Sanders classification reported moderate intra- and interobserver reliability. Taking the software opportunity of 3D virtual exarticulation, Goldzak updated French tri-dimensional Utheza classification, providing an alternative framework for classifying DIACFs. The aim of this study was to compare the intra- and interobserver reliability of Sanders versus Goldzak classification systems. Methods: The CT scans of 30 patients with displaced intraarticular calcaneal fractures, treated in the same trauma center between 2014–2018, were analyzed by 16 medical doctors (specialists and residents in orthopedic surgery, specialists and residents in radiology), and classified according to Sanders and Goldzak classifications. The same images were sent on two separate sessions, in a randomized order. Interobserver reliability and intraobserver reproducibility were assessed using Kappa statistics and Gwet's AC1 coefficient. Results: Interobserver reliability using Gwet reported a value of 0.36 for Goldzak classification and 0.30 for Sanders classification (corresponding to "fair assessment" in both cases). In absence of subclasses, "substantial assessment" was reported for Goldzak classification (Gwet of 0.61) and "moderate assessment" for Sanders classification (Gwet of 0.46). Goldzak system had a greater interobserver reliability in the group of radiology residents. Intraobserver reliability coefficient was 0.60 for Goldzak classification and 0.69 for Sanders classification, indicating a substantial agreement for both classifications. Conclusion: Despite the better view of the fracture lines provided by 3D reconstructions, this study failed to prove the superiority of Goldzak classification compared to Sanders classification for DIACFs. [ABSTRACT FROM AUTHOR]

Background: The biomechanical outcomes of intra-articular calcaneal fracture treatment have not been fully explored. The purpose of this study was to analyze pedobarographic assessments of balance and body weight distribution over the lower limbs in patients following calcaneal fracture treatment with the Ilizarov method and to compare the results with those of a control group. Materials and Methods: The data for our retrospective study came from cases of intra-articular calcaneal fractures treated with the Polish modification of the Ilizarov method in the period between 2021 and 2022. The experimental group (21 patients; 7 women, 14 men) included Sanders classification calcaneal fractures type 2 (n = 3), type 3 (n = 5), and type 4 (n = 13). The control group comprised 21 sex-matched healthy volunteers, with no significant differences from the experimental group in terms of age or BMI. The examination included an assessment of balance and weight distribution over the lower limbs. The device used was a FreeMED MAXI pedobarographic platform (SensorMedica). Results: The mean displacement of the center of gravity in the experimental group was significantly higher at 1307.31 mm than in the control group (896.34 mm; p = 0.038). The mean area of the center of gravity was not significantly different between the groups. An analysis of weight distribution over the operated and uninjured limb in the experimental group and the non-dominant and dominant limb, respectively, in the control group revealed no significant differences. We observed no significant differences in the percentage of weight distribution over the lower limbs between the operated limb in the experimental group and the non-dominant limb in the control group, or between the uninjured limb in the experimental group and the dominant limb in the control group. Conclusions: The use of the Ilizarov method in calcaneal fracture treatment helps normalize the percentage weight distribution in the lower limbs, with the results comparable with those obtained in the healthy control group. The mean displacement of the center of gravity was worse in the experimental group than in controls; whereas the mean area of the center of gravity was comparable between the two groups. Treatment of calcaneal fractures with the Ilizarov method does not help achieve completely normal static parameters of lower-limb biomechanics. Patients treated for calcaneal fractures with the Ilizarov method require longer and more intense rehabilitation and follow-up. [ABSTRACT FROM AUTHOR]

Objective Heel fractures need extensive surgical incisions and are challenging to successfully reposition using traditional prying. The goal of this study is to evaluate the clinical effectiveness of using a Kirschner pin‐guided distractor to treat inversion shortening calcaneal fractures in the “out‐in” position. Methods A total of 40 data from 37 patients with inversion shortened calcaneal fractures from January 2018 to March 2020 were reviewed. Preoperative lateral and axial X‐rays and 3D CT were taken to assess the fracture type, and minimally invasive internal fixation was performed in the “out‐in” position with distractor repositioning, and intraoperative and postoperative images were taken to assess fracture repositioning and fixation. During the follow‐up period, the postoperative functional recovery status was assessed using the VAS score, AOFAS score, and FAOS score. Paired‐samples t‐test was used for all data comparisons. Results All cases received a mean follow‐up of 28.49 ± 3.25 months, and the mean fracture healing time was 7.84 ± 0.71 weeks. The postoperative images showed well‐fixed fracture repositioning, and calcaneal height, length, width, and inversion angles were significantly improved. At the final follow‐up, the calcaneal height, length, and width recovered from 39.35 ± 4.44mm, 79.35 ± 2.7mm, and 45.75 ± 2.87mm preoperatively to 50.93 ± 3.18mm, 82.23 ± 1.90mm, and 39.67 ± 1.58mm postoperatively (p

Abstract Background Treatment of displaced intra-articular calcaneal fractures (DIACFs) with percutaneous screw fixation remains defective in some aspects. A novel three-dimensional (3D) printed cast was devised to assist screw placement. This study assessed the radiological and functional outcomes of 3D-printed cast assisted screw fixation for patients with DIACFs. Methods Patients with unilateral Sanders type II or III DIACFs admitted to a single-centre hospital underwent either 3D-printed cast assisted screw fixation (3D group) or minimally invasive plate fixation (control group) from September 2020 to November 2022. All patients were assessed at one, two, three, and six months of follow-up. Comparison between groups was conducted in operative duration, fluoroscopic times, radiographic measurements of the calcaneus, and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. Results A total of 32 patients were enrolled (19 in the 3D group versus 13 in the control group). Significant differences were detected between the 3D group and control group in operative duration (53.63±8.95 min, 95.08±8.31 min, P 0.05). No wound-related complications occurred in either group. Conclusion The 3D-printed cast assisted screw fixation has shown superiority over minimally invasive plate fixation in the operative duration, fluoroscopic exposure, morphological restoration of the calcaneus, and functional outcomes in the treatment of DIACFs.

Objective: Heel fractures need extensive surgical incisions and are challenging to successfully reposition using traditional prying. The goal of this study is to evaluate the clinical effectiveness of using a Kirschner pin‐guided distractor to treat inversion shortening calcaneal fractures in the "out‐in" position. Methods: A total of 40 data from 37 patients with inversion shortened calcaneal fractures from January 2018 to March 2020 were reviewed. Preoperative lateral and axial X‐rays and 3D CT were taken to assess the fracture type, and minimally invasive internal fixation was performed in the "out‐in" position with distractor repositioning, and intraoperative and postoperative images were taken to assess fracture repositioning and fixation. During the follow‐up period, the postoperative functional recovery status was assessed using the VAS score, AOFAS score, and FAOS score. Paired‐samples t‐test was used for all data comparisons. Results: All cases received a mean follow‐up of 28.49 ± 3.25 months, and the mean fracture healing time was 7.84 ± 0.71 weeks. The postoperative images showed well‐fixed fracture repositioning, and calcaneal height, length, width, and inversion angles were significantly improved. At the final follow‐up, the calcaneal height, length, and width recovered from 39.35 ± 4.44mm, 79.35 ± 2.7mm, and 45.75 ± 2.87mm preoperatively to 50.93 ± 3.18mm, 82.23 ± 1.90mm, and 39.67 ± 1.58mm postoperatively (p < 0.001; p < 0.001; p < 0.001). The calcaneus inversion angle restored from 7.73° ± 2.26° to 3.80° ± 1.80° (p < 0.001). Böhler's angle and Gissane's angle improved from 13.13° ± 3.02° and 105.15° ± 8.94° to 27.95° ± 3.41° and 122.85° ± 5.54° (p < 0.001; p < 0.001). No non‐healing fractures, osteomyelitis, or traumatic arthritis were observed. Conclusion: Minimally invasive internal fixation with distractor repositioning in the "out‐in" position is effective in the treatment of inversion shortening calcaneal fractures while restoring the anatomy and protecting the soft tissue. [ABSTRACT FROM AUTHOR]

Abstract Background The extensile lateral approach (ELA) and sinus tarsi approach (STA) are commonly utilized for surgically treating calcaneal fractures. This study compared the outcomes of ELA and STA in the management of calcaneal fractures and assessed the influence of postoperative quality of reduction on functional and pain scores. Methods The study included 68 adults with Sanders type-II and type-III calcaneal fractures who underwent either ELA or STA surgery. Pre- and postoperative radiographs and computed tomography scans were analyzed, and functional and pain scores were evaluated using the Manchester Oxford Foot Questionnaire (MOXFQ), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and Visual Analogue Score (VAS) during follow-up visits. Results Out of the total patients, 50 underwent ELA surgery while 18 underwent STA surgery. The anatomic (excellent) reduction was achieved in 33 (48.5%) patients. There were no significant differences between the ELA and STA groups concerning functional scores, pain scores, the proportion of excellent reduction, and complications. Additionally, anatomic reduction, compared to near or non-anatomic (good, fair, or poor) reduction, demonstrated a decrease in MOXFQ (unstandardized β coefficient: -13.83, 95% CI: -25.47 to -2.19, p = 0.021), an increase in AOFAS (unstandardized β coefficient: 8.35, 95% CI: 0.31 to 16.38, p = 0.042), and a reduction in VAS pain (unstandardized β coefficient: -0.89, 95% CI: -1.93 to -0.16, p = 0.095) scores. Conclusion In conclusion, we found no significant differences regarding complications, excellent reduction, and functional scores between STA and ELA surgeries. Therefore, STA may be an effective alternative for the treatment of calcaneal fractures in Sanders type II and type III calcaneal fractures. Furthermore, the anatomic reduction of the posterior facet correlated with improved functional scores, emphasizing the importance of achieving it for restoring foot function regardless of surgery type or time between injury and surgery.

Abstract Background Calcaneal fractures are a common orthopedic disease, account for approximately 2% of all bone fractures, and represent 60% of fractures of tarsal bones. Tranexamic acid (TXA) is a synthetic antifibrinolytic drug that competitively blocks the lysine-binding sites of plasminogen, plasmin, and tissue plasminogen activator, delaying fibrinolysis and blood clot degradation. However, the effect of TXA on patients with calcaneal surgery remains controversial. Our objective was to evaluate the effectiveness of TXA in calcaneal fractures surgeries. Methods The electronic literature databases of Pubmed, Embase, and Cochrane library were searched in December 2022. The data on blood loss, the stay in the hospital, the duration of surgery, hemoglobin, hematocrit, platelet count, prothrombin time, activated partial thromboplastin time, and wound complication were extracted. The Stata 22.0 software was used for the meta-analysis. Results Four randomized controlled studies met our inclusion criteria. This meta-analysis showed that TXA significantly reduced postoperative blood loss during the first 24 h (p

Background: Treatment of displaced intra-articular calcaneal fractures (DIACFs) with percutaneous screw fixation remains defective in some aspects. A novel three-dimensional (3D) printed cast was devised to assist screw placement. This study assessed the radiological and functional outcomes of 3D-printed cast assisted screw fixation for patients with DIACFs. Methods: Patients with unilateral Sanders type II or III DIACFs admitted to a single-centre hospital underwent either 3D-printed cast assisted screw fixation (3D group) or minimally invasive plate fixation (control group) from September 2020 to November 2022. All patients were assessed at one, two, three, and six months of follow-up. Comparison between groups was conducted in operative duration, fluoroscopic times, radiographic measurements of the calcaneus, and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. Results: A total of 32 patients were enrolled (19 in the 3D group versus 13 in the control group). Significant differences were detected between the 3D group and control group in operative duration (53.63±8.95 min, 95.08±8.31 min, P <0.001), fluoroscopic times (7.37±1.21, 16.85±1.57, P <0.001). At a follow-up of six months, the 3D group showed better restoration than the control group in calcaneal width, height, Bohler angle, and AOFAS Ankle-Hindfoot scores (all P <0.001). No significant differences were shown in calcaneal length and Gissane angle (P >0.05). No wound-related complications occurred in either group. Conclusion: The 3D-printed cast assisted screw fixation has shown superiority over minimally invasive plate fixation in the operative duration, fluoroscopic exposure, morphological restoration of the calcaneus, and functional outcomes in the treatment of DIACFs. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to investigate the risk factors for incision infection after plate internal fixation for calcaneal fractures by a traditional lateral L-shaped approach. Methods The clinical data of 302 patients with calcaneal fractures who underwent surgical treatment in our hospital from January 2012 to June 2018 were retrospectively analysed, consisting of 177 males and 125 females. The enrolled patients were aged 21 to 75 years, with a mean age of 47.72 years. According to the Sanders classification, 108 patients were type II, 138 patients were type III, and 56 cases were type IV. A univariate analysis was conducted with sex, age, smoking history, history of diabetes, cause of injury, Sanders type, tension blisters, time from injury to surgery, preoperative haemoglobin, preoperative albumin, operation time, and bone grafting as possible risk factors. The factors with statistically significant differences were selected for multivariate binary logistic regression analysis. The clinical cut-off values of these risk factors were calculated using characteristic curves. Results The follow-up lasted for at least 1 year for all patients, with a mean follow-up time of 15.8 months. The results demonstrated 7.9% (24/302) infection rate after plate internal fixation of calcaneal fractures by the traditional lateral L-shaped approach. Univariate analysis showed that a history of diabetes, preoperative albumin, preoperative haemoglobin, time from injury to surgery, and operation time were correlated with incision infection (p

Background: Calcaneal fractures are a common orthopedic disease, account for approximately 2% of all bone fractures, and represent 60% of fractures of tarsal bones. Tranexamic acid (TXA) is a synthetic antifibrinolytic drug that competitively blocks the lysine-binding sites of plasminogen, plasmin, and tissue plasminogen activator, delaying fibrinolysis and blood clot degradation. However, the effect of TXA on patients with calcaneal surgery remains controversial. Our objective was to evaluate the effectiveness of TXA in calcaneal fractures surgeries. Methods: The electronic literature databases of Pubmed, Embase, and Cochrane library were searched in December 2022. The data on blood loss, the stay in the hospital, the duration of surgery, hemoglobin, hematocrit, platelet count, prothrombin time, activated partial thromboplastin time, and wound complication were extracted. The Stata 22.0 software was used for the meta-analysis. Results: Four randomized controlled studies met our inclusion criteria. This meta-analysis showed that TXA significantly reduced postoperative blood loss during the first 24 h (p < 0.001), improved the level of hemoglobin (p < 0.001) and hematocrit (p = 0.03), and reduced the risk of wound complications (p = 0.04). There was no significant difference between the two groups regarding total and intraoperative blood loss, hospital stay, duration of surgery, platelet count, activated partial thromboplastin time, and prothrombin time. Conclusion: TXA significantly reduced blood loss during the first 24 h postoperatively, improved the level of hemoglobin and hematocrit, and reduced the risk of wound complications. Given the evidence, TXA can be used in patients with calcaneal fractures and had the potential benefit of blood reduction. Protocol registration: The protocol was registered in PROSPERO (registration No. CRD42023391211). Highlights: As we know, this is the first meta-analysis to focus on the safety and effectiveness of tranexamic acid (TXA) in the fields of calcaneal fracture surgeries which include percutaneous screw fixation, open reduction, and internal fixation. Our study was prospectively registered on the PROSPERO website. The search was conducted without any language restrictions and the results were reported according to the PRISMA checklist. The quality of evidence was assessed using the Grading Recommendations Assessment, Development, and Evaluation (GRADE) system. Thus, we yield a comprehensive group of eligible studies and dependable results for our conclusion. In this meta-analysis and systematic review, TXA significantly reduced blood loss during the first 24 h postoperatively, improved the levels of hemoglobin and hematocrit, and reduced the risk of wound complications. In view of the evidence, TXA can be safely used in patients with calcaneal fractures and had the potential benefit of blood reduction. [ABSTRACT FROM AUTHOR]

Introduction: A displaced fracture of calcaneum is serious and disabling injury. Treatment options have evolved from conservative to open surgical alternatives and include a variety of minimally invasive techniques also. We hypothesise that minimally invasive surgery of calcaneal fractures by using a distractor achieves a good clinical and functional outcome with minimum wound complications. Aims and objectives: The aim of our study was to assess the functional outcome of minimally invasive surgery in the management of calcaneal fractures and the subsequent complication rate in the management of displaced intra-articular fractures. Methods: Between April 2018 and March 2021, patients with unilateral or bilateral closed calcaneal fractures, treated operatively with minimally invasive technique using distractor were included in the study. 64 patients with 60 calcaneal fractures were included in the study. Pre operatively CT scan evaluation was done and fractures were classified as per Sander's classification. Only type II and type III were included in the study. Pre operatively both Bohler's and Gissane's angles were measured. Maryland foot and ankle score was used for evaluation and effectiveness of intervention. Results: The average operative time in our study was 45± 11.2 minutes. No major wound complications were reported in our study. Screw prominence was seen in three patients. Complex regional pain syndrome was seen in seven of our patients. Both Gissane and Bohlers angles were restored in 94% of our patients. Maryland foot and ankle score was excellent in 20 % (11) of patients, Good in 60% (33), Fair in 15% and Poor in 5%. Conclusion:We concluded that management of calcaneal fractures with the use of distractor helps to restore the articular congruity of subtalar joint with minimum soft tissue complications. [ABSTRACT FROM AUTHOR]

Background: Calcaneal fractures are serious injuries that mainly affect young, active people. As a result, these fractures may cause long-term impairment and have a major socioeconomic impact. The current updated systematic review and meta-analysis were conducted to evaluate the functional outcomes, re-operative risk, and complications associated with the treatment of displaced intra-articular calcaneal. Methodology: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this meta-analysis. The literature search was carried out using PubMed, Cochrane, MEDLINE, Google Scholar, and the EMBASE databases with the appropriate keywords. Results: A total of 13 studies were included in this review. The follow-up months were diverse, ranging between 12 and 65 months in sinus tarsi approach (STA) and 12 to 76 months in extended lateral approach (ELA) methods. Time to surgery was shorter for the STA when compared to ELA (MD: 3.48; 95% CI 2.43 to 4.53; p < 0.00001). No significant difference was observed in functional outcomes between STA and ELA (MD: 0.34; 95% CI: −0.37 to 1.04; p = 0.35 > 0.05; I2 = 88%). In comparison to the ELA, the STA has significantly less wound healing complications (RR: 0.20; 95% CI 0.11 to 0.36; p 0.00001; I2 = 0%). Conclusion: In conclusion, the STA technique in treating calcaneal fractures was significantly safer and more effective when compared to the ELA methods. The STA method of treatment was found to have a lower risk of complications and an infection rate, as well as a shorter operating and recovery time. [ABSTRACT FROM AUTHOR]

Background: The optimal surgical treatment of intra-articular calcaneal fractures (IACF) is still under debate. In the literature, results are based on clinical or radiographical findings. Few studies have evaluated the effect of patient expectations on patient-reported outcomes after surgery and little is known about outcomes directly reported by the patient who experienced it. Patient reported outcome measures (PROMs) may represent a viable and useful tool for evaluating the efficacy of the procedure and can be considered as an indicators of health-care quality. The aim of this study is to evaluate PROMs after minimally invasive reduction and percutaneous Kirschner-wires fixation for IACF, and to compare PROMs to pre-operative and last follow-up radiographic findings. Methods: 33 consecutive patients with IACF treated with minimally invasive reduction and percutaneous K-wires fixation were included. Data collection included demographics, pre-operative and last available Böhler and Gissane angle X-rays, foot function index (FFI), and foot and ankle outcome score (FAOS). Results: At a mean follow up of 36.7 months, the mean FFI score was 24.3 ± 19.9 and the mean FAOS score was 68 ± 24.8. Patients with better Gissane angle showed better activity limitations FFI subscores. Moreover, worse pre-operative Gissane and Böhler angle were significantly associated with a worse total FAOS score and subscores. Conclusions: Minimally invasive reduction and percutaneous K-wires fixation provided satisfactory PROMs. Despite these results, prospective randomized studies are required to confirm the validity and reliability of PROMs in evaluating different treatments. [ABSTRACT FROM AUTHOR]

Category: Hindfoot; Trauma Introduction/Purpose: Fractures of the calcaneus are the most frequent form of fractures among the tarsal bones. The treatment plan depends on various fracture characteristics, particularly the extension of the fracture line into the subtalar joint surfaces. While X-rays are the primary diagnostic tool, Computed Tomography (CT) scans are often necessary as they provide a more detailed description of these fractures, especially if the articular surfaces are involved. Although informative, CT scans expose patients to higher doses of ionizing radiation, and they might not be readily available in certain settings. This study aims to develop a deep learning model that will first detect calcaneal fractures and then classify the type of fracture based on its extension into the subtalar joint surfaces. Methods: A retrospective case-control study was conducted. Patients aged >18 years who sustained a calcaneal fracture were included in the case group, along with the same number of healthy adults for the control group. Various X-ray views of the foot including anterior, posterior, lateral, along with the axial and lateral calcaneal views were obtained. Two experienced orthopaedic researchers screened the dataset and confirmed the type of fracture. Two models were developed using an Inception V3 architecture and a split ratio of 60:20:20 for training, validation, and testing purposes. The first model was designed for fracture detection, and the second one was designed for detecting intra-articular fracture extension, if present. Conventional model metrics including sensitivity, specificity, Youden index, area under the receiver operating characteristic curve (AUC), and F1 score were reported for each model. A p-value below 0.05 was statistically significant. Baseline values are presented in median and interquartile ranges (IQR). Results: A total of 1102 individuals (n=551 for each group) with a female-to-male ratio of 1.6:1 were included. Baseline comparisons showed a significant difference in the age of the groups [cases: 55 (IQR 42, 67) years; controls: 62 (IQR 51, 72 years), p-value < 0.001]. The first model for fracture detection demonstrated a high performance with an AUC of 0.99 and a Youden index of 0.96. The intra-articular fracture detection model showed a slightly lower performance with an AUC of 0.97 and a Youden index of 0.88 (Table 1, Figure 1). Conclusion: Our study showed promising results with the utility of deep learning methods for detecting calcaneal fractures and classifying intra- vs extra-articular fractures. This algorithm may help facilitate the diagnosis and treatment of patients with suspected calcaneal fractures, serving as a decision-support tool in settings where CT scanning is not available. [ABSTRACT FROM AUTHOR]

Category: Hindfoot; Trauma Introduction/Purpose: Calcaneal fractures, commonly caused by high-energy trauma, present significant challenges for orthopedic surgeons. Open reduction internal fixation (ORIF) is a widely used surgical technique for managing these fractures; it can lead to subtalar joint arthritis and pain, requiring subtalar fusion when conservative treatments prove ineffective. Understanding the risk factors associated with subtalar fusion (STF) after calcaneal ORIF is crucial for optimizing patient outcomes and treatment strategies. In this study, we aimed to comprehensively evaluate these risk factors, including patient demographics, medical comorbidities, same day and 90-day reimbursement data. Methods: A retrospective analysis was performed using the PearlDiver Mariner 157 national claims database from January 1st, 2010 to October 31st, 2021. Patients who underwent calcaneal ORIF, identified using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9, ICD-10) codes, were queried for 5-year rates of STF and reimbursement data. Patient demographics and comorbidities were recorded, and multivariate logistic regression was employed to determine the association of risk factors with STF. A p-value of less than 0.001 was considered significant after performing a Bonferroni correction. Results: Patients with STF had a higher proportion of alcohol abuse (21.3% vs. 16.2%), depression (58.1% vs. 43.1%), drug abuse (29.1% vs. 19.7%), obesity (40.3% vs. 28%) and tobacco use (62.2% vs. 50.3%), all exhibiting a p-value of less than 0.001. Those with depression (OR: 1.54; 99% CI:1.29-1.84; p< 0.001) and obesity (OR:1.58; 99% CI: 1.32-1.88; p< 0.001) as comorbidities had a higher odds ratio of association ith STF within 5 years following calcaneal ORIF. Conclusion: Our study demonstrates that patients who ultimately required STF within 5 years of calcaneal ORIF had higher rates of alcohol abuse, tobacco use, drug use, obesity, and depression prior to ORIF. In addition, there was no significant difference observed between those with and without STF in average same-day and 90-day reimbursements and demographics. Future patients with a calcaneal fracture along with multiple risk factors listed above should be in consideration for primary surgical fusion over calcaneal ORIF, with additional studies needed to aid orthopaedic surgeons in this decision making. [ABSTRACT FROM AUTHOR]

Category: Hindfoot; Trauma Introduction/Purpose: Calcaneal fractures are a common work-related injury that can be treated both operatively and nonoperatively. Operative management typically consists of open reduction with internal fixation via either an extensile lateral or sinus tarsi approach. Conservative treatment employs a combination of immobilization, rest, and elevation. Given that return to work is a critical milestone for many of these patients, it is crucial that the best management option is chosen. While there have been studies that compared operative versus conservative treatment, there has been no summative review on this topic. Thus, the goal of this study was to conduct a systematic review and meta-analysis on the impact of operative versus nonoperative management on return to work outcomes. Methods: MEDLINE (PubMed), Embase (Elsevier), and Cochrane Library were searched for the concepts of calcaneal fracture and return to work. Inclusion criteria consisted of studies that reported on operative or nonoperative treatment of calcaneal fractures and outcomes relating to timing of return to work. Abstract only studies, biomechanical studies, cadaveric studies, case reports, studies involving pediatric patients, and non-English texts were excluded. Factors that were extracted included fracture type, pre-injury workload, mechanism of injury, treatment, return to work, functional outcomes, and complications. Revman 5.3 software was used for meta-analysis. Studies that did not qualify for meta-analyses were described qualitatively. Results: 2462 studies were identified on initial search. 52 texts met inclusion and exclusion criteria. A total of 3338 patients were included. Operative management had significantly improved return to work outcomes compared to nonoperative treatment, with an overall mean difference of 40.79 days [95% Confidence Interval (CI), -69.55 to -12.03, p < 0.05]. Operative treatment was also associated with significantly lower pain scores [Mean difference: -1.14; 95% CI, -2.24 to -0.04, p < 0.05] and higher SF-36 scores [Mean difference: 13.89; 95% CI, 7.69 to 20.10, p < 0.0001]. Operative treatment did have expectedly higher risk of all complications compared to the nonoperative group [Risk Ratio: 1.80; 95% CI, 1.22 to 2.66, p < 0.05]. Conclusion: While operative management was associated with higher risk of complications, patients had improved return to work, pain, and functional outcomes compared to nonoperative treatment. Careful consideration should be taken when determining treatment options for calcaneal fracture patients. Further research is needed to better elucidate differences between operative treatment options. [ABSTRACT FROM AUTHOR]

For displaced intra-articular calcaneal fractures (DIACFs), the less invasive surgical techniques vary widely. Herein, the study is to introduce a novel, reliable and reproducible protocol of three-step closed reduction (distracting, elevating, and clamping) and percutaneous screw fixation for DIACFs. This retrospective study included 32 patients with 33 DIACFs treated by the abovementioned surgical procedures with an average follow-up of 17.7 months. Postoperative outcomes were evaluated by complications, radiographs, and functional scores. There were no incision complications. Postoperative Böhler's angle, height, and width were significantly recovered with p < 0.001. Especially, mean postoperative subtalar incongruity was 0.5 ± 0.5 mm. The average values of Maryland Foot Score (MFS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score were 93.6 ± 5.9, 91.7 ± 6.7, respectively. The average scores of short form-36 (SF-36) and visual analog scale (VAS) were 89.9 ± 10.4 and 3.1 ± 1.6, respectively. Further subgroup analysis showed that the functional scores were comparable among different fracture types according to either Sanders or Essex-Lopresti classification. We consider the three-step reduction (distracting, elevating and clamping) and percutaneous screw fixation to be a reliable and reproducible protocol for the treatment of DIACFs. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the risk factors for incision infection after plate internal fixation for calcaneal fractures by a traditional lateral L-shaped approach. Methods: The clinical data of 302 patients with calcaneal fractures who underwent surgical treatment in our hospital from January 2012 to June 2018 were retrospectively analysed, consisting of 177 males and 125 females. The enrolled patients were aged 21 to 75 years, with a mean age of 47.72 years. According to the Sanders classification, 108 patients were type II, 138 patients were type III, and 56 cases were type IV. A univariate analysis was conducted with sex, age, smoking history, history of diabetes, cause of injury, Sanders type, tension blisters, time from injury to surgery, preoperative haemoglobin, preoperative albumin, operation time, and bone grafting as possible risk factors. The factors with statistically significant differences were selected for multivariate binary logistic regression analysis. The clinical cut-off values of these risk factors were calculated using characteristic curves. Results: The follow-up lasted for at least 1 year for all patients, with a mean follow-up time of 15.8 months. The results demonstrated 7.9% (24/302) infection rate after plate internal fixation of calcaneal fractures by the traditional lateral L-shaped approach. Univariate analysis showed that a history of diabetes, preoperative albumin, preoperative haemoglobin, time from injury to surgery, and operation time were correlated with incision infection (p < 0.05). Additionally, multivariate regression analysis indicated that a shorter time from injury to surgery (OR = 1.475, 95% CI: 1.024-2.125, p = 0.037), lower preoperative albumin (OR = 1.559, 95% CI: 1.191-2.041, p = 0.001), and longer operation time (OR = 1.511, 95% CI: 1.219-1.874, p < 0.001) were risk factors for postoperative incision infection, and their cut-off values were 10.5 days, 38.5 g/L, and 84.5 minutes, respectively. Conclusion: Longer preoperative stay and operation time were two risk factors for postoperative incision infection. However, lower preoperative albumin level is the highest risk factor in this study. Trial registration: The trial was registered in the China Clinical Trial Registry (ChiCTR2100047038). [ABSTRACT FROM AUTHOR]

Objective: Soft tissue defects and postoperative wound healing complications related to calcaneus fractures may result in significant morbidity. The aim of this study was to investigate whether percutaneous minimally invasive screw internal fixation (PMISIF) can change this situation in the treatment of calcaneal fractures, and aimed to explore the mechanical effects of different internal fixation methods on Sanders type III calcaneal fractures through finite element analysis., Methods: This retrospective analysis focused on 83 patients with Sanders II and III calcaneal fractures from March 2017 to March 2022. Among them, 32 patients underwent PMISIF, 24 patients underwent tarsal sinus incision plate internal fixation (TSIPIF), and 27 patients underwent extended lateral incision plate internal fixation (ELIPIF). The present study aimed to compare various parameters, including the perioperative hospital stay, intraoperative blood loss, operative time, postoperative drainage volume, incidence of postoperative wound complications, and Gissane angle and Bohler angle data before surgery, after surgery, and at the last follow-up, among the three treatment groups. Additionally, three different finite element models were created to simulate Sanders III calcaneal fractures treated with PMISIF, TSIPIF, and ELIPIF. The models were subjected to longitudinal stresses of 350 and 700 N, and the displacement and stress distribution were analyzed to compare the stability of each model., Results: Compared with ELIPIF and TSIPIF, PMISIF has several advantages, including shorter operative times, smaller incisions, shorter hospital stays, and lower incidences of postoperative complications. At the 12-month time point after the operation, the percentages of patients with excellent and good American Orthopedic Foot and Ankle Society (AOFAS) functional scores were 96.9%, 91.7%, and 96.2%, respectively, for the three methods, demonstrating similar outcomes. Intraoperative blood loss in the PMISIF group was comparable to that in the TSIPIF group and lower than that in the ELIPIF group. There were no significant differences in the Gissane or Bohler angles among the three groups before or after the operation. However, the differences in the Gissane and Bohler angles after the operation within each group were statistically significant compared with those before the operation. Finite element analysis revealed that stress in all three internal fixation models was primarily concentrated on the subtalar articular surface, whereas displacement was mainly observed on the medial side of the subtalar articular surface. The peak stress and displacement of bone fragments and implants in the PMISIF model were lower than those in both the TSIPIF and ELIPIF models., Conclusion: PMISIF can achieve excellent and good rates comparable to those of TSIPIF and ELIPIF. Additionally, this approach offers the advantages of reduced operative trauma, a lower incidence of complications, and shorter preoperative preparation and hospitalization times. Furthermore, this approach can achieve a similar level of biomechanical stability., (© 2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

BackgroundCalcaneal fracture is common and carries high morbidity and disability. Its treatment is therefore of vital concern. Many topics concerning calcaneal fracture remain controversial, and the subject has not yet been well-researched. We aim to analyze and illustrate the trends in development, overall knowledge structure, “hotspots,” and research frontiers on the topic of calcaneal fracture.MethodsLiterature relating to calcaneal fracture published between 2000 and 2021 was retrieved from Science Citation Index Expanded (SCIE) database of the Web of Science. Three bibliometric tools (Bibliometrix, CiteSpace, and VOSviewer software) were used for analysis and the generation of knowledge maps. Annual trends in publication counts and the relative contributions of different countries, regions, institutions, authors, and journals, as well as keyword clusters, “hot topics,” and research frontiers, were analyzed.ResultsA total of 1,687 publications were included in the analysis. The number of calcaneal fracture articles published worldwide each year was highest in 2019, with a total of 128 articles. The United States has made the greatest contribution to the field, with the largest number of publications and the highest H-index. Foot & Ankle International was the most productive journal, publishing a total of 167 articles on calcaneal fracture during the study period. Hebei Medical University of China and the University of California, San Francisco were the most prolific institutions. Professors T. Schepers, S. Rammelt, H. Zwipp, and Y. Z. Zhang have made remarkable contributions to the field. However, the degree of collaboration between researchers and among institutions was relatively low, and took place mainly in Europe and the Americas. All relevant keywords could be categorized into three clusters: studies of internal fixation, studies of fractures, and studies of osteoporosis. A trend of balanced and diversified development could be seen within these clusters. Keywords with ongoing “citation bursts,” such as sinus tarsi approach, wound complications, minimally invasive technique, extensile lateral approach, surgical treatment, and plate, may continue to be research “hotspots” in the near future.ConclusionBased on current global trends, the number of publications on calcaneal fracture will continue to increase. Topics such as minimally invasive techniques and complications have become important hotspots of research. We recommend enhancing international communication and collaboration for future research in this field.

Background: Minimally invasive reduction and fixation techniques via a sinus tarsi approach (STA) have been developed in an attempt to avoid the potential complications associated with an extensile lateral approach (ELA) and to be less invasive. Objective: Minimally invasive approach including sinus tarsi approach (STA) in displaced intra articular calcaneal fracture displaced intra-articular calcaneal fractures (DIACF) with reference to: Change from baseline in calcaneal height, change from baseline in calcaneal width, change from baseline in calcaneal length, change from baseline in Bohler angle, change from baseline in Gissane angle. Methodology: This meta-analysis was carried out in accordance with the Cochrane Handbook of Systematic Reviews of Intervention and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to answer the question of minimal invasive of lateral sinus tarsi in displaced intra articular calcaneal fracture. The study protocol was registered into the International Prospective Register of Systematic Reviews on September 09, 2020 with a registration number (PROSPERO: CRD42022359197). Results: Running our search strategy on PubMed 69 studies, and the Cochrane library resulting in 221 studies and trials. We discarded 12 studies after screening the title and Abstract. Then we screened 18 studies to assess their eligibility for inclusion; and in last 10 years. The total sample size for this meta-analysis was 12 participants. 484 patients who completed STA surgery and 514 patients completed ELA surgery. Data Sources: Medline databases (PubMed, cochrane) and all materials available in the Internet till 2023. Conclusion: In conclusion, using the minimally invasive sinus tarsi approach (STA) is associated with a significant change in calcaneal height and Gissane angle when compared to extended lateral approach (ELA) when used to manage the displaced intra-articular calcaneal fractures (DIACF). [ABSTRACT FROM AUTHOR]

Background: Stress fractures occur to the musculoskeletal system on a frequent basis. This injury in the foot and ankle is relatively benign and treated conservatively with a walking boot or postoperative shoe. The use of an injectable bone graft has shown success with bone marrow edema and osteoarthritis in the knee, thus the same effects would be seen worthy of stress fractures relating to other parts of the body such as the foot and ankle. The foot and ankle sustains a high level of stress and is prone to stress fractures. This retrospective analysis documents several cases of stress fractures treated with an injectable allograft. Methodology/Procedures: A retrospective analysis was conducted on twenty-eight individuals, ages 20-75, who underwent bone repair with an injectable calcium phosphate graft by one of the study investigators. Diagnosis was made with MRI imaging studies prior to surgical intervention. Intraoperatively, fluoroscopy was used to identify the surgical site to be injected. After appropriate targeted position of a cannula, the graft was injected into the site of injury. Retrospective analysis was performed by chart review and phone contact to each participant with a minimum follow-up of twelve months post-procedure. A prewritten questionnaire was used to acquire patient and procedure feedback after verbal consent was obtained. Results: A total of twenty-seven patients were evaluated. Thirteen underwent injection of bone graft for calcaneal stress fractures, six for talus stress fractures, three for metatarsal fractures, and one for a fibula fracture. One individual presented with both a calcaneus and a talus stress fracture, one with a cuboid and a metatarsal fracture and two patients with both metatarsal and cuneiform fractures. Of those represented in this trial, 24 out of the 27 patients felt no pain and were back to their normal lifestyle and routines four weeks post-procedure. At their 12-month follow-up questionnaire conducted verbally, patients continued to report no pain and actively had resumed their lifestyles. Discussion: The analysis showed that 80% of participants had a minimum of 75% relief twelve-months post-procedure. Only 3/25 patients reported a level 5 or higher on a pain scale of 10, after the use of this treatment. Most participants returned to lifestyle activities quickly and were pain-free after a short postoperative period of treating their bone marrow lesion. [ABSTRACT FROM AUTHOR]

The sinus tarsi approach (STA) is a relatively novel and minimally invasive procedure that reduces soft tissue complications during surgery for displaced intra-articular calcaneal fractures (DIACF). We aimed to evaluate the effectiveness of this approach by comparing the functional and radiographic outcomes obtained after the STA and the extensile lateral approach (ELA) in DIACF. The medical records of 73 patients underwent surgery for displaced intra-articular calcaneal fractures between 2013 and 2018 were retrospectively analyzed. The cases were divided into two groups. The first group classified as STA (n: 39) and the second one classified as ELA (n: 34). Pre-Postoperative Boehler-Gissane angle, calcaneal length, height and width, postoperative AOFAS scores, and postoperative complication rates for each case were recorded and statistically compared. The AOFAS score was 82.5±4.4 points in the STA group whereas it was 79.5±5.4 points in the ELA group (p: 0.01). According to AOFAS scoring, 74.4% of patients in the STA group had an excellent-good outcome, whereas it was 55.9% in the ELA group. The postoperative Boehler angles were 28.5±8.4 degrees in the STA group and 26.3±8.3 degrees in the ELA group (p: 0.26). The postoperative Gissane angles were 122.2±8.9 degrees in the STA group and 128.7±10.5 degrees in the ELA group (p:0.005). Superficial infection was observed in one patient in STA group. Wound infections and necrosis in four patients and non-union was seen in one patient in ELA group. Minimally invasive surgery with STA is a feasible and effective surgical treatment method that provides adequate postoperative radiological alignment and functional results and minimizes soft tissue dissection in DIACFs. [Med-Science 2021; 10(3.000): 752-57]

Category: Hindfoot; Trauma Introduction/Purpose: Calcaneal Sanders type II or III fractures are highly disabling with significant burden. Surgical treatment modalities include open reduction and internal fixation (ORIF) techniques and a variety of minimally invasive surgical (MIS) approaches. ORIF techniques are associated with complications and traditional MIS techniques need extensive intraoperative fluoroscopic procedures. The present study aims to investigate the effects of three different minimally invasive internal fixation (MIIF) techniques used to treat Sanders type II intra-articular calcaneal fractures using finite element analyses. Methods: A 64-row spiral computed tomography scan was used to observe the calcaneus of a healthy adult. The scanning data were imported into Mimics in a DICOM format. Using a new model of a Sanders type II-B intra-articular calcaneal fracture, three minimally invasive techniques were simulated. Technique A involved fixation using an isolated minimally invasive locking plate; Technique B used a minimally invasive locking plate with one medial support screw; and Technique C simulated a screw fixation technique using four 4.0-mm screws. After simulating a 640-N load on the subtalar facet, the maximum displacement and von Mises stress of fragments and implants were recorded to evaluate the biomechanical stability of different fixation techniques using finite element analyses. Results: After stress loading, the maximum displacements of the fragments and implants were located at the sustentaculum tali and the tip of sustentaculum tali screw, respectively, in the three techniques; however, among the three techniques, Technique B had better results for displacement of both. The maximum von Mises stress on the fragments was < 56 Mpa, and stress on the implants using the three techniques was less than the yield strength, with Technique C having the least stress. Conclusion: All three techniques were successful in providing a stable fixation for Sanders type II intra-articular calcaneal fractures, while the minimally invasive calcaneal locking plate with medial support screw fixation approach exhibited greater stability, leading to improved enhancement for the facet fragment; however, screw fixation dispersed the stress more effectively than the other two techniques. [ABSTRACT FROM AUTHOR]

The aim of this study was to measure the inter- and intraobserver variations as well as integrality of the Zwipp, Crosby-Fitzgibbons, Sanders, and Eastwood-Atkins classification systems based on more accurate CT scans. Five hundred and forty-nine patients with intra-articular calcaneal fractures from January 2018 to December 2019 taken from a database in our level-I trauma center (3 affiliated hospitals) were included. For each case, normative CT (1 mm slices) scans were available. Four different observers reviewed all CT scans 2 times according to these 4 most prevalent fracture classification systems (FCSs) within a 2-month interval. For these 4 FCSs, the kappa [κ] coefficient was used to evaluate interobserver reliability and intraobserver reproducibility, and the percentage that can be classified was used to indicate integrality. The κ values were measured for Zwipp (κ = 0.38 interobserver, κ = 0.61 intraobserver), Crosby-Fitzgibbons (κ = 0.48 interobserver, κ = 0.79 intraobserver), Sanders (κ = 0.40 interobserver, κ = 0.57 intraobserver), and Eastwood-Atkins (κ = 0.44 interobserver, κ = 0.72 intraobserver). Furthermore, the integralities were calculated for Zwipp (100%), Crosby-Fitzgibbons (100%), Sanders (92%) as well as Eastwood-Atkins (89.6%). Compared with previous literatures, CT scanning with higher accuracy can significantly improve intraobserver reproducibility of Zwipp and Eastwood-Atkins FCSs, but it has no positive effect on variability of Sanders FCS and interobserver reliability of Crosby-Fitzgibbons FCS. In terms of integrality, Zwipp and Crosby-Fitzgibbons FCSs appear to be superior to the other 2 FCSs. [ABSTRACT FROM AUTHOR]

Purpose: Calcaneal fractures are one of the most challenging injuries to treat and one of the most divisive. The purpose of this historical review is to highlight the evidence of calcaneal fracture and its treatment through history. Methods: Archaeological, religious, artistic, literary and historical accounts were searched for descriptions of calcaneal fracture to give a thorough overview of the subject. The scientific literature was searched to highlight the evolution of treatment techniques. Results: For over 2500 years, the only available option was conservative treatment due to the high risk of infection and limb loss in a world without antibiotics, plastic surgery techniques and adequate osteosynthesis devices. At the beginning of the twentieth century, treatment was still rather crude, consisting of closed reduction by impaction by a Cotton's mallet, immobilisation of the foot into presses and strict bed rest in a plaster cast for five weeks. Only in the case of untreatable pain, triple arthrodesis could be employed. Regardless, the results were dismal. The debate on the superiority of open reduction and primary subtalar arthrodesis over open and closed reduction spans the entire history of medicine. Conclusion: The long path of history has brought great improvement in the treatment of calcaneus fracture, but the debate about the best treatment is far from being over. There is a lack of good quality randomised control trials conducted according to an agreed set of outcome scores despite some excellent efforts. Therefore, despite the attempts made over the years and new, more precise prognostic scores, the outcomes of each technique in use today are as unique as the individuals who suffer from a calcaneal fracture. [ABSTRACT FROM AUTHOR]

Objective To assess the clinical outcomes of open calcaneal fractures with medial wounds treated with one‐stage management, including early modern wound care, sequential reduction, and frame structure fixation using percutaneous Kirschner wires. Methods A total of 19 patients with open calcaneal fractures admitted to our hospital from May 2016 to March 2019 were selected in this study. Twelve type‐II and seven type‐IIIA medial open injuries were identified according to the classification of Gustilo and Anderson. Fractures were stratified by Sanders classification, including nine type‐II fractures, seven type‐III fractures, and three type‐IV fractures. All patients accepted one‐stage irrigation and debridement, sequential reduction of calcaneal fractures through the open medial wound, percutaneous Kirschner wire fixation, and primary closure of wounds covered with vacuum‐assisted closure (VAC) device. The Bohler angle, the Gissane angle, and the width of the calcaneus were compared before and after surgery. The functional results were evaluated according to the Paley and Hall score system, visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, Maryland Foot Score, and related complications. Results The follow‐up duration for all patients ranged from 14 to 28 months (mean, 22.7 months). The angle of Bohler and Giasane was increased from (−7.6° ± 15.0°) and (96.6° ± 7.6°) before surgery to (23.7° ± 6.1°) and (124.1° ± 7.1°) postoperatively (P

Objective The aim of this study was to introduce a novel method of simultaneous in situ decompression of lateral calcaneal bulge and subtalar arthrodesis via a single incision for malunion after calcaneal fractures and evaluate the feasibility of this method. Methods From September 2010 to October 2011, six patients (five males and one female) with malunion and delayed heel pain after conservative treatment of displaced intra‐articular calcaneal fractures were included in our study. The mean age of the six patients was 32.9 years (range, 25–71 years). Patients were treated with this novel technique at our department and the functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scores during follow‐up. Information of the six patients including surgical data and pre/postoperative function scores were retrospectively analyzed using SPSS 19.0 statistical software. Results The average operation time between wire insertion and incision suture was 42.2 ± 11.5 min (range, 25–56 min). The blood loss in all patients was all less than 50 ml each. The average fluoroscopy time was 25.7 ± 11.6 s (range, 11–43 s). No wound‐related and other short‐term complications were recorded. Six patients who were included in our study were followed for an average period of 66.2 ± 4.7 months (range, 60–73 months). There was no patient lost to follow up. Heel pain was observed to be greatly improved preoperatively in all of the six patients. All patients restored to normal activity of life after surgery. Radiological evidence of fusion was observed in five patients. The average fusion time of these five patients was 3.5 months (range, 2–4 months). The remaining one failed to achieve fusion and the hardware removal was performed due to screw tail irritation. This patient was satisfied with the final outcomes subjectively after removal of hardware. The mean AOFAS scores at 24 months postoperative were 82.0 ± 7.0, which was greatly improved compared to preoperative (44.8 ± 10.7) (P

Background: The optimal surgical treatment of intra-articular calcaneal fractures (IACF) is still under debate. In the literature, results are based on clinical or radiographical findings. Few studies have evaluated the effect of patient expectations on patient-reported outcomes after surgery and little is known about outcomes directly reported by the patient who experienced it. Patient reported outcome measures (PROMs) may represent a viable and useful tool for evaluating the efficacy of the procedure and can be considered as an indicators of health-care quality. The aim of this study is to evaluate PROMs after minimally invasive reduction and percutaneous Kirschner-wires fixation for IACF, and to compare PROMs to pre-operative and last follow-up radiographic findings. Methods: 33 consecutive patients with IACF treated with minimally invasive reduction and percutaneous K-wires fixation were included. Data collection included demographics, pre-operative and last available Böhler and Gissane angle X-rays, foot function index (FFI), and foot and ankle outcome score (FAOS). Results: At a mean follow up of 36.7 months, the mean FFI score was 24.3 ± 19.9 and the mean FAOS score was 68 ± 24.8. Patients with better Gissane angle showed better activity limitations FFI subscores. Moreover, worse pre-operative Gissane and Böhler angle were significantly associated with a worse total FAOS score and subscores. Conclusions: Minimally invasive reduction and percutaneous K-wires fixation provided satisfactory PROMs. Despite these results, prospective randomized studies are required to confirm the validity and reliability of PROMs in evaluating different treatments.

Introduction: Treating complex calcaneus fractures remains challenging. This study evaluated the influence of 3D printing and simulation on precision screw insertion into the calcaneus sustentaculum tali (ST)., Hypothesis: 3D printing and simulation improve the treatment for calcaneal fracture., Patients and Methods: This retrospective cohort study included 85 patients admitted with 93 Sanders type II-IV intra-articular fractures from January 2015 to June 2020. Multi-slice computed tomography (MSCT) images were used in the conventional group, and MSCT data were used to construct a 3D model of the calcaneus to simulate screw insertion and verify parameter accuracy in the 3D group., Results: The designed parameters (upward and backward oblique angles and screw-path length) were similar to the actual values in the 3D group (p=0.428,0.287,0.585) but not in the conventional group (p=0.01,0.002,0.023). The Maryland foot functional score, accuracy rate, and average screw number were higher and operative time was shorter in the 3D group (p=0.005,0.007,0.000,0.000)., Discussion: Preoperative simulation using the 3D printing model helped guide the screws into the ST more accurately, lending better-quality treatment for Sanders type II-IV calcaneal fractures., Level of Proof: III; Retrospective case-control study., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: There is currently no established gold standard for the treatment of calcaneal fractures., Objectives: To conduct a clinical and radiological evaluation of patients following intra-articular calcaneal fractures treated with the Polish modification of the Ilizarov method., Material and Methods: This was a 2-center retrospective study. We evaluated 27 patients (2 women and 25 men) aged 28-73 years (mean age 50.5 years) after treatment of intra-articular calcaneal fractures with the Polish modification of the Ilizarov method. We assessed pain using a visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) scores, patient satisfaction with treatment, use of analgesics, duration of Ilizarov treatment, length of hospital stay, duration of surgery, patient's declared willingness to choose the same treatment again, complications, degenerative changes, Böhler angle, inflection angle, and Gissane angle., Results: The mean follow-up period was 3 years and 2 months. Following treatment, the mean VAS pain score was 2.3. Prior to surgery, all patients were taking analgesics in comparison with only 2 patients (7.4%) at long-term follow-up. The treatment was rated as satisfactory by 11 patients, with 16 patients rating it as highly satisfactory. The mean post-treatment AOFAS score was 76.6 points. The Ilizarov fixator was removed after a mean period of 88 days. The mean duration of hospital stay was 7.4 days. The mean duration of the procedure was 44 min. All patients would choose the same treatment again. Complications were observed in 5 patients. The long-term follow-up visit revealed degenerative changes in the talocalcaneal joint in 8 patients. The median Böhler angle was 5.5° preoperatively and 28.5° postoperatively, p < 0.001. The median preoperative inflection angle of 160° decreased to 145°, p < 0.001. The median preoperative Gissane's angle of 119° increased significantly to a median postoperative value of 143°, p < 0.001., Conclusions: The patients achieved good clinical and radiological outcomes.

This case study presents a treatment algorithm including revision surgery for recurrent displacement of tongue type calcaneal fractures complicated by osteomyelitis and local soft tissue deficit. Most literature focuses on pathologic fractures through infected bone, with prior research citing suture anchors, one versus two stage curettage with use of antibiotic containing calcium phosphate cement. A 36 year old male sustained a displaced tongue type calcaneal fracture who initially underwent cannulated screw fixation. He was lost to early follow up due to social issues and was seen 30 days later with hardware failure, a large posterior soft tissue deficit, soft tissue and bone infection, and fracture recurrence. Patient underwent multiple staged surgeries involving incision and drainage, removal of failed hardware, bone biopsy, antibiotic bead placement, and long term IV antibiotics. Final reconstruction 9 days later included fracture reduction aided by Achilles z-lengthening, internal fixation, and a medial forearm fasciocutaneous free flap to address the posterior soft tissue deficit. Limb loss was a possible outcome without a multidisciplinary approach including a free flap from our plastic surgery partners. The treatment protocol outlined in this report emphasizes the importance of early removal of failed hardware, repeat irrigation and curettage, antibiotic impregnated beads for local antibiotic delivery, targeted IV antibiotic therapy, serial bone biopsy, and interdisciplinary consultation for management of a large skin defect compromised by infection.

Background: Treatment options for displaced intra-articular calcaneal fractures are still up for debate. The gold standard treatment for intra-articular calcaneal fractures is the conventional extensile lateral approach (ELA). Objective: achievement of good reduction with stable support for intra-articular calcaneal fractures by using trans calcaneal approach aiming for better functional outcome. Methods On the basis of a prospective cohort research, at Zagazig University Hospital Orthopedic Department we recruited 18 patients with comminuted fractures in the calcaneus who had been admitted to the hospital with intra-articular fractures, Extensive lateral approach and Tplate fixation were used to treat this condition 3 and 6 months after surgery, the American Orthopedic Foot And Ankle Society's functional assessment was performed. Results: All patients eventually achieved full union by the end of follow-up. Only one patient had delayed union. Most of patients (55.56%) had good outcome according to AOFAS score. 11.11% had excellent outcome. While about one third of patients had unsatisfactory outcome, either fair (27.77%) or poor (5.56) AOFAS score. In regard to complications, most of the studied group (61.11%) didn't have any complications, three patients had surgical site infection, and 11.11% of patients had sural neuritis. Conclusion: The trans-calcaneal method of reduction through ELA is an excellent method for treatment of displaced intra-articular calcaneal fractures, as it provides good exposure and facilitates anatomical reduction of fracture. [ABSTRACT FROM AUTHOR]

We conducted a prospective randomized controlled trial to compare the radiological and clinical outcomes of Sanders type III calcaneal fractures treated with percutaneous prodding reduction and K-wire fixation via a sinus tarsi approach (PPRKF) versus open reduction and internal fixation (ORIF). Fifty-one patients with closed, unilateral, Sanders type III calcaneal fractures were randomly assigned to the PPRKF group (n = 26) or the ORIF group (n = 25). The clinical outcomes evaluated were time to surgery, blood loss, operative time, hospital stay, wound healing time, wound complications, and Maryland foot score. Radiological results were evaluated on lateral and axial X-rays and computed tomography images and included Böhler's angle, Gissane's angle, and calcaneal width. Compared with the ORIF group, the PPRKF group had shorter time to surgery, shorter operative time, less blood loss, shorter hospital stay, shorter wound healing time, and fewer wound complications (p <.001). The postoperative Böhler's angle, Gissane's angle, and calcaneal width in both groups were significantly better than those measured preoperatively (p <.001) and did not differ between the PPRKF group and ORIF group (p >.05). Regarding clinical results, there was no significant difference in Maryland foot score between the two groups at 12 months after surgery (p >.05). Both PPRKF and ORIF can result in satisfactory clinical function. PPRKF is superior to ORIF in reducing the time to surgery, operative time, blood loss, hospital stay, wound healing time, and wound complications. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) is nowadays the cornerstone for fracture pattern delineation in calcaneal fracture, and for operative planning. It is often challenging for radiologists in generating clinically oriented and meaningful CT reports to the orthopedic surgeon. The article aims to review the commonly encountered calcaneal injuries and highlight the key points in the description of these injuries and implications of the underlying classification system with respect to the surgeon's perspective. A thorough understanding of the pathoanatomy and potential complications of calcaneal fractures also helps radiologists in tailoring the radiology report in contribution to overall patient's management and prognostication. By doing so, we suggest ways in which the radiologists can add value to the radiology report. [ABSTRACT FROM AUTHOR]

Background: A thorough understanding of the clinical and radiographic anatomy of the calcaneus and its articulations is crucial when attempting less invasive procedures for intraarticular calcaneus fractures. Objective: The aim of this work is to evaluate the functional outcome and to assess the anatomical restoration of the calcaneus with radiographic measurements after percutaneous fixation of Sanders type II and type III calcaneal fractures by K-wires and cannulated screws. Patients and methods: This was a prospective study that is conducted on 23 patients whom were classified as Sanders type II, III Calcaneal fractures. This study was done at Alexandria Police Hospital and Zagazig University Hospital. These patients were followed up for at least 6 months postoperatively. All patients in the study were evaluated including history taking and clinical examination. All patients had preoperative lab investigations and were evaluated radiologically with X-ray calcaneus and CT scan, and were followed up at outpatient clinic twice in the first week then once a week for the next two months. Results: The final results at the end of this study were satisfactory in 91.3% of patients and unsatisfactory in 8.7% of patients. About (81.3%) of the excellent results were obtained in Sanders type II fractures, while 18.7 % of the excellent results were obtained in Sanders type III fractures. Conclusion: Less invasive surgical techniques for treating displaced intraarticular calcaneus fractures have been undertaken in an attempt to reduce complications and improve recovery when surgery is indicated. These emerging techniques may be beneficial in patients with soft-tissue compromise, multiple comorbidities, and displaced intraarticular fractures with minimal comminution. [ABSTRACT FROM AUTHOR]

The sinus tarsi approach (STA) is a relatively novel and minimally invasive procedure that reduces soft tissue complications during surgery for displaced intra-articular calcaneal fractures (DIACF). We aimed to evaluate the effectiveness of this approach by comparing the functional and radiographic outcomes obtained after the STA and the extensile lateral approach (ELA) in DIACF. The medical records of 73 patients underwent surgery for displaced intra-articular calcaneal fractures between 2013 and 2018 were retrospectively analyzed. The cases were divided into two groups. The first group classified as STA (n: 39) and the second one classified as ELA (n: 34). Pre-Postoperative Boehler-Gissane angle, calcaneal length, height and width, postoperative AOFAS scores, and postoperative complication rates for each case were recorded and statistically compared. The AOFAS score was 82.5±4.4 points in the STA group whereas it was 79.5±5.4 points in the ELA group (p: 0.01). According to AOFAS scoring, 74.4% of patients in the STA group had an excellent-good outcome, whereas it was 55.9% in the ELA group. The postoperative Boehler angles were 28.5±8.4 degrees in the STA group and 26.3±8.3 degrees in the ELA group (p: 0.26). The postoperative Gissane angles were 122.2±8.9 degrees in the STA group and 128.7±10.5 degrees in the ELA group (p:0.005). Superficial infection was observed in one patient in STA group. Wound infections and necrosis in four patients and non-union was seen in one patient in ELA group. Minimally invasive surgery with STA is a feasible and effective surgical treatment method that provides adequate postoperative radiological alignment and functional results and minimizes soft tissue dissection in DIACFs. [ABSTRACT FROM AUTHOR]