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A novel distractor–assisted reduction combined with the sinus tarsi approach for joint depression–type calcaneal fractures

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Abstract

Purpose

A novel percutaneous distractor with the advantage of axial and direct distraction was designed for the minimally invasive treatment of calcaneal fractures. The purpose of this study was to investigate the clinical results and complications of a novel distractor combined with sinus tarsi approach (STA) in treatment of the joint depression-type of calcaneal fractures.

Methods

Fifty-four patients with the depression-type of calcaneal fractures (30 Sanders type II, 22 Sanders type III, 2 Sanders type IV) who were subjected to the novel distractor combined with STA were retrospectively assessed. Calcaneal height, width, and length; Bohler’s angle; and the Gissane angle were evaluated pre-operatively and post-operatively. Clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) pain scores from the last follow-up. Complications were also recorded.

Results

Fifty-two patients achieved an average follow-up of 24.3 months (range 18 to 34 months), and two patients were lost to follow-up six months post-operatively. There was significant difference between pre-operative and post-operative calcaneal height, width, and length; Bohler’s angle; and Gissane angle (p < 0.01), but no significant difference was detected between the post-operative and normal side Bohler’s angle (p > 0.05). The AOFAS ankle and hind foot score was 88.4 ± 6.6, and the VAS score was 1.9 ± 0.7 at the last follow-up. Nine (17.3%) patients developed complications: One experienced skin necrosis and two had screws loosening; three patients developed early degenerative changes of the subtalar joint; two had no symptoms; one had light pain around the subtalar joint without medical treatment; complex regional pain syndrome (CRPS) developed in one patient after seven months post-operatively; and two developed transient ankle stiffness.

Conclusion

The novel distractor combined with the STA effectively reconstructs the facet depression-type of calcaneal fractures (sanders type II and III) with minimal complications.

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Author notes

  1. Hongning Zhang and Guodong Shen are contributed equally to this work.

Authors and Affiliations

  1. The 8Th Clinical Medical College, Guangzhou University of Chinese Medicine, Foshan, Guangdong, China

    Hongning Zhang, Guodong Shen, Zhiqiang Xu, Junqing Gao, Junhui Lai, Kangyong Yang, Xue Li, Yunxuan Zou, Zhibin Lai, Yongzhan Zhu & Ke Jie

  2. Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, Guangdong, China

    Hongning Zhang, Guodong Shen, Zhiqiang Xu, Junqing Gao, Junhui Lai, Kangyong Yang, Xue Li, Yunxuan Zou, Zhibin Lai, Yongzhan Zhu & Ke Jie

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  1. Hongning Zhang
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Contributions

Setting the research plan and the operative procedures that will be involved in the study: Hongning Zhang; Guodong Shen; Yongzhan Zhu. The operating surgeons: Hongning Zhang; Guodong Shen; Yongzhan Zhu. Writing the introduction, patients, and method: Zhiqiang Xu; Junqing Gao. The radiological measures on the PACS system: Junhui Lai; Kangyong Yang; Xue Li. Statistical analysis and writing the results: Yunxuan Zou; Zhibin Lai; Ke Jie. Writing the discussion and the abstract: Hongning Zhang; Guodong Shen; Yongzhan Zhu. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yongzhan Zhu.

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Zhang, H., Shen, G., Xu, Z. et al. A novel distractor–assisted reduction combined with the sinus tarsi approach for joint depression–type calcaneal fractures. International Orthopaedics (SICOT) 47, 251–263 (2023). https://doi.org/10.1007/s00264-022-05625-5

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