Sustentacular screw placement with guidance during ORIF of calcaneal fracture: an anatomical specimen study
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RESEARCH ARTICLE
Open Access
Sustentacular screw placement with guidance during ORIF of calcaneal fracture: an anatomical specimen study Chen Wang†, Dichao Huang†, Xin Ma*, Xu Wang, Jiazhang Huang, Chao Zhang, Li Chen and Xiang Geng
Abstract Background: The sustentacular screw is essential to maintain the stability of the subtalar joint during ORIF (open reduction with internal fixation) of calcaneal fractures. Currently, the screw is still inserted based on surgeons’ anatomical experiences and nearly 40% of screws are misplaced from the sustentaculum. Previous studies demonstrated some methods of sustentacular screw placement through anatomical measurements or navigation system. The purposes of this study are to design an assistant guidance device that can effectively improve the accuracy of sustentacular screw placement and to compare the accuracy of this technique with traditional screw placement based on experience. Methods: A customized guidance device is designed, aiming to improve the accuracy of sustentacular screw placement. Twenty cadaveric specimens are used in the present study. Ten specimens are allocated into the guidance-assisted group, and others are included in the traditional screw insertion group. A total of 40 sustentacular screw placements are performed in each group. Fluoroscopic images are obtained after each screw placement. Only the screw that captures the sustentaculum both on the lateral and axial X-ray views was regarded as an accurate placement. Results: The accuracy rate in the guidance-assisted group is 87.5% (35 out of 40 times of insertions) while in the traditional screw insertion group, the accuracy rate is 65% (26 out of 40 times of insertions). A significant difference is found between the two groups (p = 0.018). Conclusions: The guidance-assisted technique is a convenient approach that can effectively improve the accuracy of sustentacular screw placement during the ORIF of calcaneal fractures. This study provides a novel technique that significantly facilitates sustentacular screw insertion and improves its accuracy. Keywords: Calcaneal fracture, Assistant of guidance, Sustentacular screw, ORIF, Accuracy
Background Calcaneal fractures comprise approximately 60% of tarsal bone fractures and approximately 2% of all fractures [1, 2]. These fractures can be intra-articular or extraarticular; intra-articular fractures comprise approximately 75% of all calcaneus fractures. The primary fracture line is oriented from plantar-medial to dorso-lateral and therefore creates the sustentacular fragment that varies in size based on the fracture line [1, 3–5].
* Correspondence: [email protected] † Equal contributors Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
The current surgery options for calcaneal fractures are closed reduction, percutaneous fixation, or open reduction with internal fixation (ORIF) [4]. The best method in achieving calcaneal anatomic reduction and morphology restoration of articular surface
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