The early efficacy of a multi-functional ankle distractor combined with robot-assisted reduction and fixation for Sanders type Ⅱ and Ⅲ calcaneal fractures
Li Liang, Yang Long, Chen Zhanbin, Shi Rongjian, Xu Mingliang, Cao Guangchao
Department of Foot and Ankle Surgery, Xuzhou Renci Hospital, Xuzhou 221000, China
Abstract：Objective This study aimed to explore the surgical method and early clinical efficacy of a multi-functional ankle distractor in combination with robot-assisted reduction and fixation techniques for Sanders type Ⅱ and Ⅲ calcaneal fractures. Methods A series of case reports was conducted. Thirteen cases of closed calcaneal fractures, including 10 males and 3 females with a mean age of 22-48 (35.2±7.5) years, from September 2020 to September 2022 were included at the Department of Foot and Ankle Surgery, Xuzhou Renci Hospital. Nine cases were on the right foot, and four cases were on the left foot. Moreover, four cases were Sanders type Ⅱ, and nine cases were Sanders type Ⅲ. All patients underwent surgery utilizing a multi-functional ankle distractor and robot-assisted reduction and fixation techniques. The indicators were as follows: (1) Preoperative waiting time, surgical time, number of nail placements during surgery, and postoperative wound healing were observed. (2) Regular follow-up was conducted after surgery to observe subtalar joint activity, walking gait, fracture healing time, and occurrence of complications, such as non-union, malunion, and traumatic arthritis. (3) X-ray films were taken 6 months after surgery to measure and compare the recovery of the calcaneal varus angle, Böhler angle, Gissane angle, and calcaneal width before and after surgery. (4) Pain visual analogue scale (VAS) was used to compare the degree of pain in the subtalar joint of the affected foot before and after surgery at 6 months. The ankle and hindfoot function scoring system of the American Orthopedic Foot and Ankle Society (AOFAS) was used to evaluate the recovery of the subtalar joint function. Results (1) Thirteen patients underwent surgery successfully. All patients achieved successful nail placement and primary wound healing. The preoperative waiting time was 1-3 (1.2±0.6) days, and the surgical time was 58-82 (70.7±8.0) min. (2) These patients were followed up for 6-24 (13.6±5.4) months. Only one patient experienced subtalar joint stiffness but improved after rehabilitation exercise, and the rest of the patients had good ankle joint activity and normal gait. No complications, such as non-union, malunion, or traumatic arthritis, occurred. The mean to fracture healing times was 10-14 (12.4±1.0) weeks. (3) At 6 months after surgery, the angle of calcaneal varus and calcaneal width were 3.2°±0.8° and (34.0±1.6) mm, respectively, which were smaller than those before surgery (11.0°±3.5° and [43.3±3.9] mm, respectively). Meanwhile, the Böhler angle and Gissane angle were 30.6°±3.9° and 133.1°±6.0°, respectively, which were greater than those before surgery (9.3°±3.2° and 89.0°±7.1°, respectively). The differences were statistically significant (all P values <0.001). (4) The VAS score for foot and subtalar joint pain at 6 months after surgery was (1.4±0.9) score, which was lower than that before surgery (6.7±1.1) score. The AOFAS score was (94.5±3.8) score, which was higher than that before surgery score (63.2±5.9). The differences were statistically significant (all P values <0.001). Thirteen patients were evaluated for their subtalar joint function based on the AOFAS score at 6 months post-surgery, with 12 cases rated as excellent and one case rated as good. Conclusion The multi-functional ankle distractor in combination with the robot-assisted reduction and internal fixation techniques is used to treat Sanders Ⅱ and Ⅲ calcaneal fractures. The nails can be accurately placed during the operation to effectively correct the calcaneal varus, with little trauma and satisfactory early clinical effect.
李亮, 杨龙, 陈占斌, 石荣剑, 徐明亮, 曹广超. 撑开器撑开复位联合机器人导航置钉治疗SandersⅡ、Ⅲ型跟骨骨折的早期疗效观察[J]. 中华解剖与临床杂志, 2023, 28(10): 646-651.
Li Liang, Yang Long, Chen Zhanbin, Shi Rongjian, Xu Mingliang, Cao Guangchao. The early efficacy of a multi-functional ankle distractor combined with robot-assisted reduction and fixation for Sanders type Ⅱ and Ⅲ calcaneal fractures. Chinese Journal of Anatomy and Clinics, 2023, 28(10): 646-651.
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2023, Vol. 28 
