Effect of Sustentaculum Screw Position on Outcomes of Intraarticular Calcaneal Fracture Treated with Screw Only Technique

Main Article Content

Adisorn Chongmuenwai, MD

Abstract

Background: Placement of sustentaculum screws is an important procedure in calcaneal fixation. Inaccurate position may decrease stability of the fixation.


Purpose: The aims of this study are to evaluate the effect of sustentaculum screw position on the decrease of Bohler's angle and FAAM (Foot and Ankle Ability Measure) score.


Materials and Methods:  Retrospective review of patients who underwent operative fixation of calcaneus fracture using screw only technique through sinus tarsi approach between July 2017 to March 2020 in Maharat Nakhon Ratchasima hospital. Postoperative sustentaculum screw positions were assessed with 3D-CT scan. Position of screws were grouped into good fixation (screw placed on cortical area of sustentaculum tali) and poor fixation group (screw placed out of cortical area of sustentaculum tali). The postoperative and 6-month follow-up Bohler's angles were compared. The FAAM was used to evaluate the clinical outcome at 6 months.


Results: 38 patients (7females and 31males) with mean age of 48±11.6 were reviewed. The age of patients, preoperative Bohler’s angles and type of fractures showed no significant difference between two groups of the sustentaculum screw position. Postoperative 3D-CT scan classified 13 cases into the good fixation and 25 cases into the poor fixation groups. The decrease of Bohler's angle and FAAM score at 6 months showed no statistically difference between two group (P > 0.05).


Conclusions: Position of the sustentaculum screw do not show statistical difference of the decrease of Bohler’s angle and FAAM score in operative treatment of intraarticular calcaneal fracture using screws only technique.

Downloads

Download data is not yet available.

Article Details

Section
Original Articles

References

1. Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in l20 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res. 1993; (290): 87-95.
2. Potter MQ, Nunley JA. Long-term functional outcomes after operative treatment for intra-articular fractures of the calcaneus. J Bone Joint Surg Am. 2009; 91: 1854-60.
3. Veltman ES, Doornberg JN, Stufkens SA, Luitse JS, van den Bekerom MP. Long-term outcomes of 1,730 calcaneal fractures: systematic review of the literature. J Foot Ankle Surg. 2013; 52: 486-90.
4. Olexa TA, Ebraheim NA, Haman SP. The sustentaculum tali: anatomic, radiographic, and surgical considerations. Foot Ankle Int. 2000; 21: 400-3.
5. Gitajn IL, Toussaint RJ, Kwon JY. Assessing accuracy of sustentaculum screw placement during calcaneal fixation. Foot Ankle Int. 2013; 34: 282-6.
6. Lin PP, Roe S, Kay M, Abrams CF, Jones A, Placement of screws in the sustentaculum tali. A calcaneal fracture model. Clin Orthop Relat Res. 1998; (352): 194-201.
7. Phisitkul P, Sullivan JP, Goetz JE, Marsh JL. Maximizing safety in screw placement for posterior facet fixation in calcaneus fractures: a cadaveric radio-anatomical study. Foot Ankle Int. 2013; 34: 1279-85.
8. Jordan C, Mirzabeigi E, Williams S. Determining the angle of screw placement for internal fixation of calcaneal fractures. J Orthop Trauma. 1999; 13: 47-50.
9. Gitajn IL, Toussaint RJ, Kwon JY. Assessing accuracy of sustentaculum screw placement during calcaneal fixation. Foot Ankle Int. 2013; 34: 282-6.
10. Kendoff D, Citak M, Gardner M, Kfuri Jr M, Thumes B, Krettek C, Hüfner T. Three-dimensional fluoroscopy for evaluation of articular reduction and screw placement in calcaneal fractures. Foot Ankle Int. 2007; 28: 1165-71.
11. de Muinck Keizer RJ, Beerekamp MS, Ubbink DT, Beenen LF, Schepers T, Goslings JC. Systematic CT evaluation of reduction and hardware positioning of surgically treated calcaneal fractures: a reliability analysis. Arch Orthop Trauma Surg. 2017; 137: 1261-1267.
12. Qiang M, Chen Y, Zhang K, Li H, Dai H. Effect of sustentaculum screw placement on outcomes of intra-articular calcaneal fracture osteosynthesis: a prospective cohort study using 3D CT. Int J Surg. 2015; 19: 72-7.
13. Ni M, Wong DW, Mei J, Niu W, Zhang M. Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures. Sci China Life Sci. 2016; 59: 958-64.
14. Arunakul M, Arunakul P, Suesiritumrong C, Angthong C, Chernchujit B. Validity and reliability of Thai version of the foot and ankle ability measure (FAAM) subjective form. J Med Assoc Thai. 2015; 98: 561-7.
15. Cottom JM, Baker JS. Restoring the anatomy of calcaneal fractures: A simple technique with radiographic review. Foot Ankle Spec. 2017; 10: 235-9.
16. Olexa TA, Ebraheim NA, Haman SP. The sustentaculum tali: anatomic, radiographic, and surgical considerations. Foot Ankle Int. 2000; 21: 400-3.
17. Gitajn IL, Toussaint RJ, Kwon JY. Assessing accuracy of sustentaculum screw placement during calcaneal fixation. Foot Ankle Int. 2013; 34: 282-6.
18. Backes M, Schepers T, Beerekamp MSH, Luitse JS, Goslings JC, Schep NW. Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach. Int Orthop. 2014; 38: 767-73.
19. Kir MC, Ayanoglu S, Cabuk H, Dedeoglu SS, Imren Y, Karslioglu B, et al. Mini-plate fixation via sinus tarsi approach is superior to cannulated screw in intra-articular calcaneal fractures: A prospective randomized study. J Orthop Surg (Hong Kong). 2018; 26: 2309499018792742.
20. Bailey EJ, Waggoner SM, Albert MJ, Hutton WC. Intraarticular calcaneus fractures: A biomechanical comparison of two fixation methods. J Orthop Trauma. 1997; 11: 34-7.
21. Pang QJ, Yu X, Guo ZH. The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture: a finite element analysis. Pak J Med Sci. 2014; 30: 1099-103.
22. Qiang M, Chen Y, Jia X, Zhang K, Li H, Jiang Y, et al. Post-operative radiological predictors of satisfying outcomes occurring after intra-articular calcaneal fractures: a three dimensional CT quantitative evaluation. Int Orthop. 2017; 41: 1945-51.
23. O'Farrell DA, O'Byrne JM, McCabe JP, Stephens MM. Fractures of the os calcis: improved results with internal fixation. Injury. 1993; 24: 263-5.