| Part I:Minimally invasive sinus tarsi approach and extended lateral L-shaped approach for the open reduction and internal fixation of Sanders type III calcaneal fractures:a prospective randomized controlled studyObjective:To prospectively compare the efficacy and post-operative results of a minimally invasive sinus tarsi approach for open reduction and internal fixation of Sanders type ? calcaneal fractures,to the traditional L-shaped incision open reduction and internal fixation.Methods:From January 2013 to May 2014,35 cases of Sanders type ? Calcaneal fractures were randomly divided into 2 groups.In one group,limited open reduction and internal fixation via the sinus tarsi approach method was used(minimally invasive group).In the control group,we performed the ORIF via the traditional lateral L-shaped approach(traditional group).Data was recorded intra-operatively,3 months and 24 months post-operatively.The Bohler angle and Gissane angle were measured and recorded.Furthermore,the AOFAS score,VAS score and SF-36 scores were recorded after 24 months to assess function and to calculate the incidence of complications.Results:Of the total 35 cases of calcaneal Sanders type ? fractures,19 cases(54.3%)were assigned to the minimally invasive group,and 16(45.7%)cases were assigned to the traditional group.One case in the traditional group was eventually lost to follow-up.For the minimally invasive group,the mean follow-up time was 28.2 months;mean follow-up time for the traditional group was 28.9 months.At 3 months follow-up,all fractures achieved bone union.At 3 months and at 2 years post-operatively,after radiographic comparison,there was no significant loss of reduction.At 3 months after surgery and at 2 years after surgery,the difference in Bohler angle and Gissane angle between the minimally invasive group and traditional group was not statistically significant.At the end of follow-up,there was no significant difference between the two group,according to the AOFAS score,SF-36 and VAS score.In the minimally invasive group,the following complications were noted:3 cases(15.8%)of subtalar joint stiffness and 2 patients(10.5%)presented with traumatic subtalar arthritis.In the traditional group,2 patients(13.3%)had wound complications,7 cases(46.7%)presented with subtalar joint stiffness,1 patient(6.7%)had traumatic subtalar arthritis,although inter-group differences were not statistically significant.Conclusion:Minimally invasive sinus tarsi approach open reduction and internal fixation for Sanders type ? can provide similar results to the traditional lateral L-shaped incision,but with a lower incidence of complication.Part ?:The Biomechanical Study of Minimal Invasive Treatment for Sanders Type ? Intra-articular Calcaneal fractures via Sinus Tarsi Approach.Objective:A biomechanical study was performed on Sanders type III intra-articular calcaneal fracture cadaver specimens.It is aimed to identify the efficacy and reliability of rafting fixation of the posterior facet combined with media-lateral column screws fixation.Methods:Five cadaver lower extremity specimens were prepared to established the Sanders type III intra-articular calcaneal fractures.High flex fragment plate system was used to fixed the posterior facet with the rafting technique,and two cannulated screws were also utilized to support the media-lateral columns.The anterior part of calcaneus,the medial part of posterior facet,the lateral part of posterior facet,and posterior calcaneal tubercle fragment were marked as Fragment A,Fragment M,Fragment L,and Fragment P respectively.After identifying the distance between the four rigid bodies as AM,AL,AP,ML,AP and LP,the moving traces of these rigid bodies were followed by the Qualisys system.On the biomechanical test platform,800N cycle loading tests and 2000N ultimate loading tests were performed on each cadaver specimens.All the data were collected and analyzed carefully.Results:During the cycle loading tests,the median and mean value of the shifts(AM,AL,AP,ML,MP,LP)between every two rigid bodies were 1.60,1.68,2.45,2.20,1.20,2.00mm and 1.99,2.05,2.05,2.48,1.17,1.97mm.However,the mean and median value of the shifts(AM,AL,AP,ML,MP,LP)between every two rigid bodies during the ultimate tests,were 2.10,1.85,2.40,2.10,1.50,1.70mm,and2.09,1.88,2.44,2.10,1.59,1.69mm respectively.All the fixation systems survived these two load tests,and kept intact and reliability.There was no fractured screw,implant loosening and plate broken happen.Only one cannulated screw was bent during the ultimate test.Conclusion:The plate fixation of the posterior facet with rafting technique combined with media-lateral column screws fixation is an effective and reliable internal fixation mode for treating Sanders type III intra-articular calcaneal fractures,which reached the original expectation.Part? The Postoperative Plantar Pressure Analysis of Sanders Type III Intra-articular Calcaneal FracturesObjective:This study is to evaluate the efficacy and importance of pedobarography in the analyzing the postoperative plantar pressure changes of Sanders type III intra-articular calcaneal fractures.Methods:From August 2013 to May 2016,22 cases(male 17,female 5,mean age 42.90 ± 13.07,range 21 to 68 years)of Sanders type III Calcaneal fractures were collected that were treated in our trauma center.The Bohler angle and Gissane angle were measured and recorded by X-ray examination 12months after surgery.Furthermore,the AOFAS score,and SF-36 scores were recorded to assess the postoperative function.At the final follow-up,the plantar pressures were compared between the operated feet and the healthy feet.Maximum pressure area and contact surface area were measured,while the arch indexes were calculated.Results:All the fractures archived bony healed.The average follow-up period was 15.91±±2.88(range 12 to 22)months.At the final follow-up,the Bohler angle changed from 13.87±6.58°to 31,63±5.33°,the Gissane angle changed from 100.02±10.580 to 112.96 ±7.31° respectively.The final mean AOFAS score was 82.54 ± 10.87,and the mean SF-36 score was 88.27 ± 5.51.The arch index of the operated feet was 29.76 ± 3.88,and the healthy feet was 29.17 ± 3.23.Both feet was a slight low arch.The pedobarography showed that the contact area of the affected foot was slightly smaller than that of the healthy foot.There was a decrease in the first metatarsal and hindfoot pressure,and the foot pressure center was obviously lateralized,while an increase in the midfoot pressure was also observed.Conclusion:Pedobarography is an effective and easy-to-use method for analysis of the postoperative plantar pressure of calcaneal fractures.The gait analysis is a feasible way to assess the final clinical results of the calcaneal fractures. |
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