Application of three-dimensional printing technology for closed reduction and percutaneous cannulated screws fixation of displaced intraarticular calcaneus fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WU Min , GUAN Jianzhong , XIAO Yuzhou , WANG Zhaodong , CHEN Xiaotian , ZHAO Zhi , ZHANG Kuankuan , ZHU Jun

Department of Orthopedics, Laboratory of Tissue and Transplant in Anhui Province, the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233003, P.R.China;

Corresponding author：

WU Min, Email: wumin200207@163.com

Keywords：

Three-dimensional printing; intraarticular calcaneal fracture; cannulated screw; internal fixation; percutaneous

DOI：

10.7507/1002-1892.201705040

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Objective To evaluate the effectiveness of three-dimensional (3-D) printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation. Methods A retrospective analysis was performed of the 19 patients (19 feet) with intraarticular calcaneal fracture who had been treated between March 2015 and May 2016. There were 13 males and 6 females with an average age of 38.2 years (range, 24-73 years). There were 3 open fractures and 16 closed fractures. By Sanders classification, 12 cases were type Ⅱ, 7 cases were type Ⅲ. By Essex-Lopresti classification, 13 cases were tongue type, 6 cases were joint-depression type. The time from injury to surgery was 1-10 days (mean, 4.7 days). A thin slice CT scan was taken of bilateral calcaneus in patients. By using the mirror imaging technique, the contralateral mirror image and the affected side calcaneus model were printed according to 1∶1 ratio. The displacement of fracture block was observed and contrasted, and the poking reduction was simulated. Calcaneal fracture was treated by percutaneous minimally invasive poking reduction and cannulate screw fixation. The Böhler angle and Gissane angle at immediate after operation and last follow-up was measured on X-ray films, and compared with preoperative measurement. The functional recovery was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) scores. Results The operation time was 25-70 minutes (mean, 45 minutes). The intraoperative blood loss was 10-40 mL (mean, 14.5 mL). All the incisions healed by first intention and had no relevant postoperative complications such as skin necrosis, nail tract infection, and osteomyelitis. All the patients were followed up 12-25 months (mean, 14.6 months). All patients obtained fracture healing, and the fracture healing time was 8-14 weeks (mean, 10.3 weeks). No screw withdrawal or breakage occurred during follow-up; only 1 patient with Sanders type Ⅱ fracture, whose calcaneus height was partially lost at 6 weeks after operation, the other patients had no reduction loss and fracture displacement, and no traumatic arthritis occurred. The Böhler angle and Gissane angle at immediate after operation and last follow-up were significantly improved when compared with preoperative ones (P<0.05), but there was no significant difference between at immediate after operation and last follow-up (P>0.05). The AOFAS score was 76-100 (mean, 88.2), and the results were excellent in 10 feet, good in 7, and fair in 2, the excellent and good rate was 89.5%. Conclusion 3-D printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation can reduce the surgical trauma, improve the quality of reduction and fixation, and make the operation more safe, accurate, and individualized.

Citation： WU Min, GUAN Jianzhong, XIAO Yuzhou, WANG Zhaodong, CHEN Xiaotian, ZHAO Zhi, ZHANG Kuankuan, ZHU Jun. Application of three-dimensional printing technology for closed reduction and percutaneous cannulated screws fixation of displaced intraarticular calcaneus fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1316-1321. doi: 10.7507/1002-1892.201705040 Copy

1.	Tomesen T, Biert J, Frölke JP. Treatment of displaced intra-articular calcaneal fractures with closed reduction and percutaneous screw fixation. J Bone Joint Surg (Am), 2011, 93(10): 920-928.
2.	沙良宽, 田家祥, 李敬祥, 等. 撬拨复位与切开复位内固定治疗 Sanders Ⅱ型跟骨骨折的比较. 中国修复重建外科杂志, 2016, 29(5): 558-562.
3.	Abdelgaid SM. Closed reduction and percutaneous cannulated screws fixation of displaced intra-articular calcaneus fractures. Foot Ankle Surg, 2012, 18(3): 164-179.
4.	吴敏, 官建中, 肖玉周, 等. 经皮撬拨复位空心钉内固定治疗 SandersⅡ、Ⅲ型跟骨骨折. 中国矫形外科杂志, 2016, 24(16): 1508-1513.
5.	Chung KJ, Hong DY, Kim YT, et al. Preshaping plates for minimally invasive fixation of calcaneal fractures using a real-size 3D-printed model as a preoperative and intraoperative tool. Foot Ankle Int, 2014, 35(11): 1231-1236.
6.	Pastides PS, Milnes L, Rosenfeld PF. Percutaneous Arthroscopic Calcaneal Osteosynthesis: A Minimally Invasive Technique for Displaced Intra-Articular Calcaneal Fractures. J Foot Ankle Surg, 2015, 54(5): 798-804.
7.	Di Schino M, Bensaïda M, Vandenbussche E, et al. Results of open reduction and cortico-cancellous autograft of intra-articular calcaneal fractures according to Palmer. Rev Chir Orthop Reparatrice Appar Mot, 2008, 94(2): 135-144.
8.	Gougoulias N, Khanna A, McBride DJ, et al. Management of calcaneal fractures: systematic review of randomized trials. Br Med Bull, 2009, 92: 153-167.
9.	Harvey EJ, Grujic L, Early JS, et al. Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int, 2001, 22(11): 868-873.
10.	Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
11.	Hammond AW, Crist BD. Percutaneous treatment of high-risk patients with intra-articular calcaneus fractures: a case series. Injury, 2013, 44(11): 1483-1485.
12.	Stulik J, Stehlik J, Rysavy M, et al. Minimally-invasive treatment of intra-articular fractures of the calcaneum. J Bone Joint Surg (Br), 2006, 88(12): 1634-1641.
13.	吴敏, 官建中, 肖玉周, 等. 经皮斯氏针撬拨复位空心钉内固定治疗跟骨关节内骨折. 中华解剖与临床杂志, 2014, 19(2): 143-146.
14.	赵志, 吴敏, 肖玉周, 等. 经皮撬拔空心钉固定与" L”型切口治疗跟骨骨折的临床疗效. 中国矫形外科杂志, 2016, 24(6): 495-499.
15.	杨晶. 计算机辅助设计 3D 打印技术在复杂跟骨骨折治疗中的应用. 国际骨科学杂志, 2017, 38(1): 51-54.
16.	Mahato NK. Morphology of sustentaculum tali: Biomechanical importance and correlation with angular dimensions of the talus. Foot, 2011, 21(4): 179-183.

1. Tomesen T, Biert J, Frölke JP. Treatment of displaced intra-articular calcaneal fractures with closed reduction and percutaneous screw fixation. J Bone Joint Surg (Am), 2011, 93(10): 920-928.
2. 沙良宽, 田家祥, 李敬祥, 等. 撬拨复位与切开复位内固定治疗 Sanders Ⅱ型跟骨骨折的比较. 中国修复重建外科杂志, 2016, 29(5): 558-562.
3. Abdelgaid SM. Closed reduction and percutaneous cannulated screws fixation of displaced intra-articular calcaneus fractures. Foot Ankle Surg, 2012, 18(3): 164-179.
4. 吴敏, 官建中, 肖玉周, 等. 经皮撬拨复位空心钉内固定治疗 SandersⅡ、Ⅲ型跟骨骨折. 中国矫形外科杂志, 2016, 24(16): 1508-1513.
5. Chung KJ, Hong DY, Kim YT, et al. Preshaping plates for minimally invasive fixation of calcaneal fractures using a real-size 3D-printed model as a preoperative and intraoperative tool. Foot Ankle Int, 2014, 35(11): 1231-1236.
6. Pastides PS, Milnes L, Rosenfeld PF. Percutaneous Arthroscopic Calcaneal Osteosynthesis: A Minimally Invasive Technique for Displaced Intra-Articular Calcaneal Fractures. J Foot Ankle Surg, 2015, 54(5): 798-804.
7. Di Schino M, Bensaïda M, Vandenbussche E, et al. Results of open reduction and cortico-cancellous autograft of intra-articular calcaneal fractures according to Palmer. Rev Chir Orthop Reparatrice Appar Mot, 2008, 94(2): 135-144.
8. Gougoulias N, Khanna A, McBride DJ, et al. Management of calcaneal fractures: systematic review of randomized trials. Br Med Bull, 2009, 92: 153-167.
9. Harvey EJ, Grujic L, Early JS, et al. Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int, 2001, 22(11): 868-873.
10. Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
11. Hammond AW, Crist BD. Percutaneous treatment of high-risk patients with intra-articular calcaneus fractures: a case series. Injury, 2013, 44(11): 1483-1485.
12. Stulik J, Stehlik J, Rysavy M, et al. Minimally-invasive treatment of intra-articular fractures of the calcaneum. J Bone Joint Surg (Br), 2006, 88(12): 1634-1641.
13. 吴敏, 官建中, 肖玉周, 等. 经皮斯氏针撬拨复位空心钉内固定治疗跟骨关节内骨折. 中华解剖与临床杂志, 2014, 19(2): 143-146.
14. 赵志, 吴敏, 肖玉周, 等. 经皮撬拔空心钉固定与" L”型切口治疗跟骨骨折的临床疗效. 中国矫形外科杂志, 2016, 24(6): 495-499.
15. 杨晶. 计算机辅助设计 3D 打印技术在复杂跟骨骨折治疗中的应用. 国际骨科学杂志, 2017, 38(1): 51-54.
16. Mahato NK. Morphology of sustentaculum tali: Biomechanical importance and correlation with angular dimensions of the talus. Foot, 2011, 21(4): 179-183.

Chinese Journal of Reparative and Reconstructive Surgery

Application of three-dimensional printing technology for closed reduction and percutaneous cannulated screws fixation of displaced intraarticular calcaneus fractures

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