Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical and Radiological Outcomes of 'Blocking Kirschner Wire Technique' in Displaced Intra-Articular Calcaneal Fractures via the Extended Sinus Tarsi Approach

전위된 관절 내 종골 골절에서 확장된 족근동 접근법을 통한 Kirschner Wire 강선 지지대 고정술의 임상 및 영상학적 결과

  • Lee, Jeong-Kil (Department of Orthopaedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine) ;
  • Kang, Chan (Department of Orthopaedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Kim, Sang-Bum (Department of Orthopaedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine) ;
  • Lee, Gi-Soo (Department of Orthopaedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine) ;
  • Hwang, Jung-Mo (Department of Orthopaedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • An, Byung-Kuk (Department of Orthopaedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine)
  • 이정길 (충남대학교 의과대학 세종충남대학교병원 정형외과학교실) ;
  • 강찬 (충남대학교 의과대학 충남대학교병원 정형외과학교실) ;
  • 김상범 (충남대학교 의과대학 세종충남대학교병원 정형외과학교실) ;
  • 이기수 (충남대학교 의과대학 세종충남대학교병원 정형외과학교실) ;
  • 황정모 (충남대학교 의과대학 충남대학교병원 정형외과학교실) ;
  • 안병국 (충남대학교 의과대학 충남대학교병원 정형외과학교실)
  • Received : 2020.04.07
  • Accepted : 2020.08.27
  • Published : 2021.06.30
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to retrospectively evaluate the effect of 'Blocking Kirschner Wire (K-Wire) Technique', which has been developed to reduce protrusion of the lateral wall, in maintaining the level of reduction through clinical and radiological outcomes. Materials and Methods: Twenty-two patients with displaced intra-articular calcaneal fractures who used the blocking K-wire to maintain reduction (group A) and 44 patients that did not use blocking K-wire and were paired in 1:2 ratio with those Group A patients (group B), between January 2015 and December 2017 were enrolled in the study. All surgical procedures were performed via the extended sinus tarsi approach, and internal fixation using cannulated screws, Steinmann pins and K-wires was performed. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale and postoperative recovery of exercise ability were compared for postoperative clinical outcomes. The radiological results were compared the Böhler angle, Gissane angle, calcaneal height and width, step off of posterior calcaneal joint, and the degree of protrusion of the lateral wall. Moreover, postoperative complications in both groups were compared. Results: There were no significant differences in the clinical outcomes of the two groups (p=0.924, p=0.961). The amount of Böhler angle, Gissane angle, calcaneal height and width, and step off of posterior calcaneal joint from the radiological results was not significantly different between the two groups (p=0.170, p=0.441, p=0.230, p=0.266, and p=0.400). However, the degree of protrusion of the lateral wall was 1.78 mm and 4.95 mm in group A and group B, respectively, and the difference between the two groups was significant (p=0.017). Although sural nerve entrapment and painful exostosis were more frequent in group B, they were occurred in a non-significant manner (p=0.293, p=0.655). Conclusion: Most of the clinical and radiological results as well as the complications were not significantly different between the two groups. However, the degree of protrusion of the calcaneus lateral wall in group A was promising. The 'Blocking K-Wires Technique' established by the authors may be an effective surgical option for maintaining the reduction of the lateral wall protrusion in displaced intraarticular calcaneal fractures.

목적: 종골 골절 후 발생하는 부정유합으로 인해 체부의 폭이 증가하면 후족부 외측의 통증이 발생한다. 외측벽 돌출을 줄이기 위해 저자들이 고안한 K-강선(Kirschner wire) 지지대의 정복 유지 효과를 임상 및 영상학적 결과로 후향적으로 평가해 보고자 하였다. 대상 및 방법: 2015년 1월부터 2017년 12월까지 전위된 관절 내 종골 골절 환자 중 정복 유지를 위해 K-강선 지지대를 사용한 환자 22명(A군)과 K-강선 지지대를 사용하지 않은 환자 중 A군 환자와 1:2로 짝지은 44명의 환자들(B군)을 대상으로 하였다. 모든 수술은 확장된 족근동 접근법으로 시행되었으며 유관나사와 Steinmann 핀, K-강선을 이용한 내고정술을 시행하였다. 술 후 임상적 평가로는 미국족부족관절학회의 족관절-후족부 수치와 수술 후 운동능력의 회복 정도를 비교하였다. 영상학적 결과는 Böhler 각, Gissane 각, 종골의 높이와 폭, 관절 내 함몰 정도와 종골 외측벽의 돌출 정도를 비교하였다. 또한 두 군의 환자에서 수술 후 발생한 합병증도 분석해 보았다. 결과: 임상적 결과는 두 군 간에 유의미한 차이가 없었다(p=0.924, p=0.961). 영상학적으로 Böhler 각, Gissane 각, 종골의 높이와 폭, 관절 내 함몰 정도에는 유의한 차이가 없었지만(p=0.170, p=0.441, p=0.230, p=0.266, p=0.400), 종골 외측벽의 돌출 정도는 A군이 평균 1.78 mm, B군이 4.95 mm로 유의한 차이가 있었다(p=0.017). B군에서 비복 신경 포착과 통증을 동반한 외골종의 빈도는 더 많았지만 통계적으로 유의한 차이가 없었다(p=0.293, p=0.655). 결론: 임상적 평가 및 영상학적 평가의 대부분과 두 군의 합병증 비교에서 유의한 차이는 없었으나 종골 외측벽의 돌출 정도에 있어서는 A군에서 우수한 결과를 보였다. 저자들이 고안한 K-강선 지지대 수술법은 전위된 관절 내 종골 골절에서 외측벽 돌출의 정복 유지에 효과적인 수술 방법이 될 수 있을 것이다.

Keywords

References

  1. Bae SY. Complications of calcaneal fracture. J Korean Foot Ankle Soc. 2013;17:84-92.
  2. Farouk A, Ibrahim A, Abd-Ella MM, El Ghazali S. Effect of subtalar fusion and calcaneal osteotomy on function, pain, and gait mechanics for calcaneal malunion. Foot Ankle Int. 2019;40:1094-103. https://doi.org/10.1177/1071100719853291
  3. Brauer CA, Manns BJ, Ko M, Donaldson C, Buckley R. An economic evaluation of operative compared with nonoperative management of displaced intra-articular calcaneal fractures. J Bone Joint Surg Am. 2005;87:2741-9. https://doi.org/10.2106/00004623-200512000-00019
  4. Howard JL, Buckley R, McCormack R, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma. 2003;17:241-9. https://doi.org/10.1097/00005131-200304000-00001
  5. Chung HJ, Ahn JK, Bae SY, Jung H. Operative treatment of intraarticular calcaneal fractures using extensile lateral approach. J Korean Foot Ankle Soc. 2009;13:60-7.
  6. Lee YT, Oh HC, Yoon HK, Jang JW, Jang KJ. Comparison of F calcaneal plate and locking calcaneal plate fixation using an lateral extensile approach to intra-articular calcaneal fractures. J Korean Foot Ankle Soc. 2012;16:175-80.
  7. Yu SO, Kim JS, Kim JJ. Combined percutaneous and minimal on internal fixation of calcaneal fractures using extensile lateral approach. J Korean Foot Ankle Soc. 2002;6:201-7.
  8. Schepers T. The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review. Int Orthop. 2011;35:697-703. https://doi.org/10.1007/s00264-011-1223-9
  9. Yeo JH, Cho HJ, Lee KB. Comparison of two surgical approaches for displaced intra-articular calcaneal fractures: sinus tarsi versus extensile lateral approach. BMC Musculoskelet Disord. 2015;16:63. https://doi.org/10.1186/s12891-015-0519-0
  10. Basile A, Albo F, Via AG. Comparison between sinus tarsi approach and extensile lateral approach for treatment of closed displaced intra-articular calcaneal fractures: a multicenter prospective study. J Foot Ankle Surg. 2016;55:513-21. https://doi.org/10.1053/j.jfas.2015.11.008
  11. Zhao B, Zhao W, Assan I. Steinmann pin retractor-assisted reduction with circle plate fixation via sinus tarsi approach for intra-articular calcaneal fractures: a retrospective cohort study. J Orthop Surg Res. 2019;14:363. https://doi.org/10.1186/s13018-019-1405-5
  12. Kir MC, Ayanoglu S, Cabuk H, 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.
  13. Yang KH, Chung JB, Yoon HK, Park SY, Yoon HS. Treatment of displaced intra-articular calcaneal fractures using a F-plate. J Korean Fract Soc. 2007;20:1-5. https://doi.org/10.12671/jkfs.2007.20.1.1
  14. Song JH, Kang C, Hwang DS, Kang DH, Park JW. Extended sinus tarsi approach for treatment of displaced intraarticular calcaneal fractures compared to extended lateral approach. Foot Ankle Int. 2019;40:167-77. https://doi.org/10.1177/1071100718803333
  15. Wong-Chung J, Marley WD, Tucker A, O'Longain DS. Incidence and recognition of peroneal tendon dislocation associated with calcaneal fractures. Foot Ankle Surg. 2015;21:254-9. https://doi.org/10.1016/j.fas.2015.01.013
  16. Kang DH, Kang C, Hwang DS, Song JH, Song SH. The value of axial loading three dimensional (3D) CT as a substitute for full weightbearing (standing) 3D CT: comparison of reproducibility according to degree of load. Foot Ankle Surg. 2019;25:215-20. https://doi.org/10.1016/j.fas.2017.10.014
  17. Kim ES, Seo HM, Lee KM, et al. Result of surgical treatment of intra-articular fractures of the calcaneus: based on CT classification and open reduction and internal fixation. J Korean Foot Ankle Soc. 2003;7:238-49.
  18. Park IH, Lee KB, Song KW, Lee JY, Yum DH. Surgical treatment for intraarticular calcaneal fracture using posterior approach. J Korean Orthop Assoc. 1991;26:96-105. https://doi.org/10.4055/jkoa.1991.26.1.96
  19. Freeman BJ, Duff S, Allen PE, Nicholson HD, Atkins RM. The extended lateral approach to the hindfoot. Anatomical basis and surgical implications. J Bone Joint Surg Br. 1998;80:139-42. https://doi.org/10.1302/0301-620X.80B1.0800139
  20. Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res. 1993;290:87-95.
  21. Johal HS, Buckley RE, Le IL, Leighton RK. A prospective randomized controlled trial of a bioresorbable calcium phosphate paste (alpha-BSM) in treatment of displaced intra-articular calcaneal fractures. J Trauma. 2009;67:875-82. https://doi.org/10.1097/TA.0b013e3181ae2d50
  22. Park HK, Ko JY, Lee SK, Baik JM. Surgical treatment for displaced intra-articular calcaneal fractures in elderly patients: comparison of the minimally invasive approach and extensile lateral approach. J Korean Fract Soc. 2019;32:135-42. https://doi.org/10.12671/jkfs.2019.32.3.135
  23. Gonzalez TA, Lucas RC, Miller TJ, Gitajn IL, Zurakowski D, Kwon JY. Posterior facet settling and changes in Bohler's angle in operatively and nonoperatively treated calcaneus fractures. Foot Ankle Int. 2015;36:1297-309. https://doi.org/10.1177/1071100715592448
  24. Thordarson DB, Bollinger M. SRS cancellous bone cement augmentation of calcaneal fracture fixation. Foot Ankle Int. 2005;26:347-52. https://doi.org/10.1177/107110070502600501
  25. Schildhauer TA, Bauer TW, Josten C, Muhr G. Open reduction and augmentation of internal fixation with an injectable skeletal cement for the treatment of complex calcaneal fractures. J Orthop Trauma. 2000;14:309-17. https://doi.org/10.1097/00005131-200006000-00001
  26. Soeur R, Remy R. Fractures of the calcaneus with displacement of the thalamic portion. J Bone Joint Surg Br. 1975;57:413-21. https://doi.org/10.1302/0301-620X.57B4.413
  27. Stephenson JR. Treatment of displaced intra-articular fractures of the calcaneus using medial and lateral approaches, internal fixation, and early motion. J Bone Joint Surg Am. 1987;69:115-30. https://doi.org/10.2106/00004623-198769010-00019
  28. Lee JY, Park IH, Kim GL, Kim TH, Oh BS. Minimally invasive reduction and pin fixation treatment for displaced intraarticular calcaneal fracture. J Korean Foot Ankle Soc. 2010;14:66-72.
  29. Pitts CC, Almaguer A, Wilson JT, Quade JH, Johnson MD. Radiographic and postoperative outcomes of plate versus screw constructs in open reduction and internal fixation of calcaneus fractures via the sinus tarsi. Foot Ankle Int. 2019;40:929-35. https://doi.org/10.1177/1071100719848063
  30. Ceccarelli F, Calderazzi F, Pedrazzi G. Is there a relation between AOFAS ankle-hindfoot score and SF-36 in evaluation of Achilles ruptures treated by percutaneous technique? J Foot Ankle Surg. 2014;53:16-21. https://doi.org/10.1053/j.jfas.2013.09.005