Minimally invasive treatment of Sanders Ⅱ and Ⅲ calcaneal fractures in diabetes patients using musculoskeletal ultrasound combined with subtalar arthroscopy and a medial calcanetalar distractor
10.3760/cma.j.cn115530-20250208-00047
- VernacularTitle:肌骨超声结合距下关节镜、牵开器微创治疗糖尿病患者Sanders Ⅱ、Ⅲ型跟骨骨折的疗效分析
- Author:
Xiaoyu DAI
1
;
Yirong WANG
;
Kai DING
;
Chenyang XU
;
Yige ZHANG
;
Ziqiang ZHOU
;
Mingliang SUN
;
Wenge DING
Author Information
1. 苏州大学附属第三医院/常州市第一人民医院创伤骨科，常州 213000
- Publication Type:Journal Article
- Keywords:
Calcaneus;
Fractures, bone;
Arthroscopy;
Sanders typing;
Sural nerve
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(7):571-579
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the short-term efficacy of minimally invasive treatment of Sanders Ⅱ and Ⅲ calcaneal fractures in diabetes patients using subtalar arthroscopy assisted by preoperative musculoskeletal ultrasound to localize the lateral calcaneal branch of the sural nerve and a medial calcanetalar distractor.Methods:The clinical data of the 52 patients with diabetes mellitus were retrospectively analyzed who had been treated for Sanders Ⅱ and Ⅲ calcaneal fractures from March 2016 to August 2020 at Department of Traumatic Orthopedics, The Third Affiliated Hospital of Soochow University. There were 34 males and 18 females with an age of (61.7±14.5) years. According to the Sanders' classification, there were 23 cases of type Ⅱ and 29 cases of type Ⅲ. Preoperative musculoskeletal ultrasonography was routinely performed to locate the lateral calcaneal branch of the sural nerve in all patients. The surgical procedures were subtalar arthroscopy combined with percutaneous prying reduction and screw fixation assisted by a calcanetalar joint distractor. Incision healing, local skin paraesthesia and other conditions were observed regularly in all patients. The short-term efficacy was assessed by comparing calcaneal lengths, calcaneal widths, calcaneal heights, B?hler angles and Gissane angles at pre-surgery, 3 days, 12 months and the last follow-up after surgery, as well as by comparing visual analogue scale (VAS) pain scores, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and Maryland scores at pre-surgery, 12 months and the last follow-up after surgery.Results:All the 52 patients were followed up for (23.7±3.2) months after successful surgery. No incision-related complications were reported. The calcaneal radiographic parameters (calcaneal lengths, calcaneal widths, calcaneal heights, B?hler angles and Gissane angles) at 3 days, 12 months and the last follow-up after surgery were significantly improved compared with the values before surgery ( P<0.05), but there were no significant differences regarding the calcaneal radiographic parameters between 3 days, 12 months and the last follow-up after surgery ( P>0.05). The VAS pain scores, AOFAS ankle-hindfoot scores and Maryland scores at 12 months and the last follow-up after surgery were significantly improved compared with those before surgery ( P<0.05). Conclusion:In the minimally invasive treatment of Sanders Ⅱ and Ⅲ calcaneal fractures in diabetes patients, preoperative musculoskeletal ultrasonography to locate the lateral calcaneal branch of the sural nerve, followed by subtalar arthroscopy combined with percutaneous prying reduction and screw fixation assisted by a calcanetalar joint distractor can lead to good short-term efficacy.
