Study on sustentaculum tali screw placement for constant fragment of calcaneal fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Zhenhui ¹ , ZHAO Chengli ² , CHEN Yifei ² , LI Nan ¹ , ZHANG Tao ¹ , XIN Jingyi ¹ ,  MA Xinlong ¹

1. Department of Orthopaedics, Tianjin Hospital, Tianjin, 300211, P.R.China;
2. Department of Orthopaedics, Xiqing Hospital of Tianjing, Tianjin, 300000, P.R.China;

Corresponding author：

MA Xinlong, Email: maxinlong8686@sina.com

Keywords：

Calcaneal fracture; constant fragment; sustentaculum tali; screw placement; entry point

DOI：

10.7507/1002-1892.201801041

Video：

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ObjectiveTo investigate the anatomical characters of the sustentaculum tali (ST), accurate entry point and direction for the placement of ST screw from posterior subtalar joint facet to the constant fragment (CF) in calcaneal fractures.MethodsA total of 100 patients with calcaneal fractures performed ankle CT scans were enrolled between January 2016 and April 2016. According to the inclusion criteria, the clinical data of 33 patients were analyzed, including 18 males and 15 females, with a median age of 41.0 years (range, 18-60 years). There were 16 cases on left side and 17 cases on the right side. Three-dimensional (3D) calcaneal model was reconstructed by Mimics 17.0 software, and the ST anatomical references were measured, including the length of upper and lower edge, the length and height of the midline, the horizontal angle between the midline and foot plantar surface. The parameters of the optimal entry point position (P’ point) and placement angle of the ST screw were determined. The length of ST screw was also measured. The differences between males and females or left and right sides were compared.ResultsThe length of upper edge of the ST was (16.60±2.23) mm, lower edge (20.65±2.90) mm, midline (20.56±2.62) mm, and the height of midline was (9.61±1.36) mm. The horizontal angle between the midline and foot plantar surface was (23.43±3.36)°. The vertical distance from P’ point to the lowest point of the tarsal sinus was (3.09±1.65) mm, while the horizontal distance was (14.29±2.75) mm. The distance from P’ point to the apex of the lateral talus, subchondral bone of subtalar joint, calcaneocuboid joint was (11.41±3.22), (6.59±2.22), (34.58±3.75) mm, respectively. The horizontal angle between the ST screw and foot plantar surface was (–1.17±2.07)°. The anteversion angle of ST screw was (16.18±2.05)° and the length was (41.64 ± 3.09) mm. There were significant differences in the length of upper and lower edge, the length and height of the midline, the distance from P’ point to the apex of the lateral talus, subchondral bone of subtalar joint, and calcaneocuboid joint, and the anteversion angle and length of the ST screw between males and females (P<0.05). There was no significant difference in above all parameters between left and right sides (P>0.05).ConclusionAfter appropriate reduction of the calcaneal fractures, the entry point of ST screw was recommended at about 14 mm posterior and about 3 mm upper related to the foot horizontal line through the lowest tarsal sinus point; and the direction of ST screw placement was about 17° anteversion for males and 15° anteversion for females.

Citation： SUN Zhenhui, ZHAO Chengli, CHEN Yifei, LI Nan, ZHANG Tao, XIN Jingyi, MA Xinlong. Study on sustentaculum tali screw placement for constant fragment of calcaneal fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(5): 581-586. doi: 10.7507/1002-1892.201801041 Copy

1.	Germann CA, Perron AD, Miller MD, et al. Orthopedic pitfalls in the ED: calcaneal fractures. Am J Emerg Med, 2004, 22(7):607-611.
2.	Talarico LM, Vito GR, Zyryanov SY. Management of displaced intraarticular calcaneal fractures by using external ring fixation, minimally invasive open reduction, and early weightbearing. J Foot Ankle Surg, 2004, 43(1): 43-50.
3.	Gotha HE, Zide JR. Current controversies in management of calcaneus fractures. Orthop Clin North Am, 2017, 48(1): 91-103.
4.	Pelliccioni AA, Bittar CK, Zabeu JL. Surgical treatment of intraarticular calcaneous fractures of sanders’ types Ⅱ and Ⅲ. Systematic review. Acta Ortop Bras, 2012, 20(1): 39-42.
5.	Gitajn IL, Abousayed M, Toussaint RJ, et al. Anatomic alignment and integrity of the sustentaculum tali in intra-articular calcaneal fractures: is the sustentaculum tali truly constant? J Bone Joint Surg (Am), 2014, 96(12): 1000-1005.
6.	Bussewitz BW, Hyer CF. Screw placement relative to the calcaneal fracture constant fragment: an anatomic study. J Foot Ankle Surg, 2015, 54(3): 392-394.
7.	Pazour J, Krivohlavek M, Lukas R. Positions of sustentacular screw in osteosynthesis of calcaneal fractures: clinical and radiographic study. Acta Chir Orthop Traumatol Cech, 2016, 83(3): 182-185.
8.	Kelikian AS, Sarrafian SK. Sarrafian’s anatomy of the foot and ankle: descriptive, topographic, functional. 3th ed. UK: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2011: 61-69.
9.	Putnam SM,Linn MS,Spraggs-Hughes A, et al. Simulating clamp placement across the trans-syndesmotic angle of the ankle to minimize malreduction: A radiological study. Injury, 2017, 48(3): 770-775.
10.	Phisitkul P, Sullivan JP, Goetz JE, et al. Maximizing safety in screw placement for posterior facet fixation in calcaneus fractures: a cadaveric radio-anatomical study. Foot Ankle Int, 2013, 34(9): 1279-1285.
11.	Lowery RB, Calhoun JH. Fractures of the calcaneus. Part Ⅰ: Anatomy, injury mechanism, and classification. Foot Ankle Int, 1996, 17(4): 230-235.
12.	Sanders R, Vaupel ZM, Erdogan M, et al. Operative treatment of displaced intraarticular calcaneal fractures: long-term (10-20 Years) results in 108 fractures using a prognostic CT classification. J Orthop Trauma, 2014, 28(10): 551-563.
13.	Chu CH, Chen YY, Lin KP, et al. Anatomic locking plate for displaced intraarticular calcaneal fracture: design and application. J Foot Ankle Surg, 2017, 56(6): 1165-1169.
14.	Hsu AR, Anderson RB, Cohen BE. Advances in surgical management of intra-articular calcaneus fractures. J Am Acad Orthop Surg, 2015, 23(7): 399-407.
15.	Agren PH, Wretenberg P, Sayed-Noor AS. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg (Am), 2013, 95(15): 1351-1357.
16.	Franke J, Wendl K, Suda AJ, et al. Intraoperative three-dimensional imaging in the treatment of calcaneal fractures. J Bone Joint Surg (Am), 2014, 96(9): e72.
17.	Gitajn IL, Toussaint RJ, Kwon JY. Assessing accuracy of sustentaculum screw placement during calcaneal fixation. Foot Ankle Int, 2013, 34(2): 282-286.
18.	Qiang M, Chen Y, Zhang K, et al. 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: 72-77.
19.	Olexa TA, Ebraheim NA, Haman SP. The sustentaculum tali: anatomic, radiographic, and surgical considerations. Foot Ankle Int, 2000, 21(5): 400-403.
20.	Gras F, Marintschev I, Wilharm A, et al. Sustentaculum tali screw placement for calcaneus fractures—different navigation procedures compared to the conventional technique. Z Orthop Unfall, 2010, 148(3): 309-318.
21.	Eckardt H, Lind M. Effect of intraoperative three-dimensional imaging during the reduction and fixation of displaced calcaneal fractures on articular congruence and implant fixation. Foot Ankle Int, 2015, 36(7): 764-773.
22.	王冰, 李涛, 朱裕成, 等. 跟骨前部与载距突关系的解剖学研究及其临床意义. 中国临床解剖学杂志, 2012, 30(2): 131-135.
23.	Wang C, Huang D, Ma X, et al. Sustentacular screw placement with guidance during ORIF of calcaneal fracture: an anatomical specimen study. J Orthop Surg Res, 2017, 12(1): 78.
24.	Bryant A, Tinley P, Singer K. A comparison of radiographic measurements in normal, hallux valgus, and hallux limitus feet. J Foot Ankle Surg, 2000, 39(1): 39-43.

1. Germann CA, Perron AD, Miller MD, et al. Orthopedic pitfalls in the ED: calcaneal fractures. Am J Emerg Med, 2004, 22(7):607-611.
2. Talarico LM, Vito GR, Zyryanov SY. Management of displaced intraarticular calcaneal fractures by using external ring fixation, minimally invasive open reduction, and early weightbearing. J Foot Ankle Surg, 2004, 43(1): 43-50.
3. Gotha HE, Zide JR. Current controversies in management of calcaneus fractures. Orthop Clin North Am, 2017, 48(1): 91-103.
4. Pelliccioni AA, Bittar CK, Zabeu JL. Surgical treatment of intraarticular calcaneous fractures of sanders’ types Ⅱ and Ⅲ. Systematic review. Acta Ortop Bras, 2012, 20(1): 39-42.
5. Gitajn IL, Abousayed M, Toussaint RJ, et al. Anatomic alignment and integrity of the sustentaculum tali in intra-articular calcaneal fractures: is the sustentaculum tali truly constant? J Bone Joint Surg (Am), 2014, 96(12): 1000-1005.
6. Bussewitz BW, Hyer CF. Screw placement relative to the calcaneal fracture constant fragment: an anatomic study. J Foot Ankle Surg, 2015, 54(3): 392-394.
7. Pazour J, Krivohlavek M, Lukas R. Positions of sustentacular screw in osteosynthesis of calcaneal fractures: clinical and radiographic study. Acta Chir Orthop Traumatol Cech, 2016, 83(3): 182-185.
8. Kelikian AS, Sarrafian SK. Sarrafian’s anatomy of the foot and ankle: descriptive, topographic, functional. 3th ed. UK: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2011: 61-69.
9. Putnam SM,Linn MS,Spraggs-Hughes A, et al. Simulating clamp placement across the trans-syndesmotic angle of the ankle to minimize malreduction: A radiological study. Injury, 2017, 48(3): 770-775.
10. Phisitkul P, Sullivan JP, Goetz JE, et al. Maximizing safety in screw placement for posterior facet fixation in calcaneus fractures: a cadaveric radio-anatomical study. Foot Ankle Int, 2013, 34(9): 1279-1285.
11. Lowery RB, Calhoun JH. Fractures of the calcaneus. Part Ⅰ: Anatomy, injury mechanism, and classification. Foot Ankle Int, 1996, 17(4): 230-235.
12. Sanders R, Vaupel ZM, Erdogan M, et al. Operative treatment of displaced intraarticular calcaneal fractures: long-term (10-20 Years) results in 108 fractures using a prognostic CT classification. J Orthop Trauma, 2014, 28(10): 551-563.
13. Chu CH, Chen YY, Lin KP, et al. Anatomic locking plate for displaced intraarticular calcaneal fracture: design and application. J Foot Ankle Surg, 2017, 56(6): 1165-1169.
14. Hsu AR, Anderson RB, Cohen BE. Advances in surgical management of intra-articular calcaneus fractures. J Am Acad Orthop Surg, 2015, 23(7): 399-407.
15. Agren PH, Wretenberg P, Sayed-Noor AS. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg (Am), 2013, 95(15): 1351-1357.
16. Franke J, Wendl K, Suda AJ, et al. Intraoperative three-dimensional imaging in the treatment of calcaneal fractures. J Bone Joint Surg (Am), 2014, 96(9): e72.
17. Gitajn IL, Toussaint RJ, Kwon JY. Assessing accuracy of sustentaculum screw placement during calcaneal fixation. Foot Ankle Int, 2013, 34(2): 282-286.
18. Qiang M, Chen Y, Zhang K, et al. 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: 72-77.
19. Olexa TA, Ebraheim NA, Haman SP. The sustentaculum tali: anatomic, radiographic, and surgical considerations. Foot Ankle Int, 2000, 21(5): 400-403.
20. Gras F, Marintschev I, Wilharm A, et al. Sustentaculum tali screw placement for calcaneus fractures—different navigation procedures compared to the conventional technique. Z Orthop Unfall, 2010, 148(3): 309-318.
21. Eckardt H, Lind M. Effect of intraoperative three-dimensional imaging during the reduction and fixation of displaced calcaneal fractures on articular congruence and implant fixation. Foot Ankle Int, 2015, 36(7): 764-773.
22. 王冰, 李涛, 朱裕成, 等. 跟骨前部与载距突关系的解剖学研究及其临床意义. 中国临床解剖学杂志, 2012, 30(2): 131-135.
23. Wang C, Huang D, Ma X, et al. Sustentacular screw placement with guidance during ORIF of calcaneal fracture: an anatomical specimen study. J Orthop Surg Res, 2017, 12(1): 78.
24. Bryant A, Tinley P, Singer K. A comparison of radiographic measurements in normal, hallux valgus, and hallux limitus feet. J Foot Ankle Surg, 2000, 39(1): 39-43.

Chinese Journal of Reparative and Reconstructive Surgery

Study on sustentaculum tali screw placement for constant fragment of calcaneal fracture

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