Anatomical calcaneal external fixator self-designed according to the morphology of heel_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIA Shen ¹ , ZHAO Zeyu ¹ , XU Yongqing ² , LÜ Qian ² , PU Shaoquan ² , CHEN Hanfen ² , QI Xin ² ,  ZHU Yueliang ²

1. Clinical College of 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming Yunnan, 650032, P.R.China;
2. Department of Orthopaedics and Traumatology, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650032, P.R.China;

Corresponding author：

ZHU Yueliang, Email: zhuyuelianghu@sina.com

Keywords：

Calcaneus; hind foot; morphology; anatomical type; external fixator

DOI：

10.7507/1002-1892.201908149

Video：

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Objective The anatomical calcaneal external fixator was designed by measuring and calculating the morphological data of the heel.Methods A total of 100 normal people were randomly selected to obtain 200 hind foot data, including 45 males and 55 females, with an average age of 43.9 years (range, 19-67 years). According to the principles of human engineering and local anatomy, the morphological data of the heel in the weight-bearing standing position and supine position were measured with the direct measurement mode. The heel length, heel width, heel height, medial ankle height, lateral ankle height, and calcaneal pitch angle (CPA) were measured by vernier calipers and ulnar markers in weight-bearing standing position, and the gender groups and left and right foot groups were compared; the shape of the hind foot in the supine position was measured by three-dimensional (3D) dot matrix inverse model method. According to the stereoscopic data of the comprehensive anatomical morphology of the heel, the anatomical calcaneal external fixator was designed with AutoCAD 2019 and other 3D industrial design softwares.Results The measurements of shoe size, heel length, heel width, heel height, medial ankle height, lateral ankle height, and CPA in male were significantly higher than those in female (P<0.05). There was no significant difference between the left and right feet in the other indexes except that the height of the medial malleolus of the left foot was significantly lower than that of the right foot (t=−2.827, P=0.005). The measurement of 3D dot matrix inverse model in supine position showed that the heel part was non-circular arc edge, and many groups of arc edges fluctuate in a limited range. Based on the above data, an anatomical calcaneal external fixator was designed, which could fit the anatomic radian in theory, so as to be flexible in configuration. On this basis, the ordinary configuration, compression configuration, and orthodontic configuration were designed to meet the treatment needs of calcaneal fractures in different degrees. The ordinary configuration was suitable for patients with Sanders Ⅰ, ⅡA, and ⅡB calcaneal fractures with no or slight displacement of intra-articular fractures; the ordinary configuration was mainly used for simple fixing. The compression configuration was suitable for patients with Sanders ⅡC, ⅢA, and ⅢB, tongue fractures, and avulsion fractures with severe displacement of intra-articular fractures; the compression configuration used obliquely drawn console wires to fix the displaced bones. The orthodontic configuration was suitable for patients with Sanders ⅢC and Ⅳ calcaneal fractures with severe displacement of intra-articular fractures or severe calcaneal bone defects; the orthodontic configuration was a multi-module design, which took into account the stable fixation of the fracture and the arbitrary adjustment of the joint fixation angle.Conclusion The hind foot is special for morphology, so the external fixator designed based on the vernier caliper measurement method and 3D dot matrix measuring plate measurement method is an anatomical type and its configuration can theoretically meet stable and flexible clinical needs.

Citation： XIA Shen, ZHAO Zeyu, XU Yongqing, LÜ Qian, PU Shaoquan, CHEN Hanfen, QI Xin, ZHU Yueliang. Anatomical calcaneal external fixator self-designed according to the morphology of heel. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(4): 475-481. doi: 10.7507/1002-1892.201908149 Copy

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2.	Dhillon MS, Prabhakar S. Treatment of displaced intra-articular calcaneus fractures: a current concepts review. SICOT J, 2017, 3: 59.
3.	Veltman ES, Doornberg JN, Stufkens SA, et al. Long-term outcomes of 1, 730 calcaneal fractures: systematic review of the literature. J Foot Ankle Surg, 2013, 52(4): 486-490.
4.	Sharr PJ, Mangupli MM, Winson IG, et al. Current management options for displaced intra-articular calcaneal fractures: Non-operative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. A contemporary review. Foot Ankle Surg, 2016, 22(1): 1-8.
5.	Aldridge JM 3rd, Easley M, Nunley JA. Open calcaneal fractures: results of operative treatment. J Orthop Trauma, 2004, 18(1): 7-11.
6.	Ziran BH, Smith WR, Anglen JO, et al. External fixation: how to make it work. Instr Course Lect, 2008, 57: 37-49.
7.	Fornaciari P, Gilgen A, Zwicky L, et al. Isolated talonavicular fusion with tension band for Müller-Weiss syndrome. Foot Ankle Int, 2014, 35(12): 1316-1322.
8.	Hohmann E, Myburgh J, Keough N, et al. Inter- and intraclass correlations for three standard foot radiographic measurements for plantar surface angles. Which measure is most reliable? Foot Ankle Surg, 2019, 25(5): 646-653.
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11.	李军, 黄泽宇, 方跃, 等. Ilizarov外固定行踝关节融合治疗晚期创伤性踝关节炎疗效分析. 中国修复重建外科杂志, 2017, 31(11): 1311-1315.
12.	Paley D, Fischgrund J. Open reduction and circular external fixation of intraarticular calcaneal fractures. Clin Orthop Relat Res, 1993, (290): 125-131.
13.	Lamm BM, Gottlieb HD, Paley D. A two-stage percutaneous approach to charcot diabetic foot reconstruction. J Foot Ankle Surg, 2010, 49(6): 517-522.
14.	Ganadhiepan G, Miramini S, Patel M, et al. Bone fracture healing under Ilizarov fixator: Influence of fixator configuration, fracture geometry, and loading. Int J Numer Method Biomed Eng, 2019, 35(6): e3199.
15.	Esparon T, Thomson CM, Rea PM, et al. Circular frame fixation for calcaneal fractures risks injury to the medial neurovascular structures: A cadaveric description. Injury, 2016, 47(12): 2700-2705.
16.	Qiang M, Chen Y, Zhang K, et al. Measurement of three-dimensional morphological characteristics of the calcaneus using CT image post-processing. J Foot Ankle Res, 2014, 7(1): 19.
17.	Imamura M, Imamura ST, Salomão O, et al. Pedobarometric evaluation of the normal adult male foot. Foot Ankle Int, 2002, 23(9): 804-810.
18.	Oznur A, Komurcu M, Marangoz S, et al. A new perspective on management of open calcaneus fractures. Int Orthop, 2008, 32(6): 785-790.
19.	Teichtahl AJ, Wluka AE, Wijethilake P, et al. Wolff’s law in action: a mechanism for early knee osteoarthritis. Arthritis Res Ther, 2015, 17: 207.
20.	Frost HM. Wolff’s Law and bone’s structural adaptations to mechanical usage: an overview for clinicians. Angle Orthod, 1994, 64(3): 175-188.
21.	Wallin KJ, Cozzetto D, Russell L, et al. Evidence-based rationale for percutaneous fixation technique of displaced intra-articular calcaneal fractures: a systematic review of clinical outcomes. J Foot Ankle Surg, 2014, 53(6): 740-743.
22.	朱跃良, 徐永清, 秦泗河. Ilizarov器械、技术和哲学蠡测. 中国修复重建外科杂志, 2018, 32(2): 1238-1240.
23.	丁玉兰. 人机工程学. 北京: 北京理工大学出版社, 2005: 73-82.
24.	高士濂. 实用解剖图谱·下肢分册. 上海: 上海科学技术出版社, 2012: 257-358.
25.	濮良贵, 纪名刚. 机械设计. 8版. 北京: 高等教育出版社, 2006: 3-21.
26.	胥少汀, 葛宝丰, 徐印坎. 实用骨科学. 北京: 人民军医出版社, 2012: 34-47.
27.	秦泗河, 李刚. Ilizarov技术骨科应用进展. 北京: 人民军医出版社, 2014: 21-24.

1. 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.
2. Dhillon MS, Prabhakar S. Treatment of displaced intra-articular calcaneus fractures: a current concepts review. SICOT J, 2017, 3: 59.
3. Veltman ES, Doornberg JN, Stufkens SA, et al. Long-term outcomes of 1, 730 calcaneal fractures: systematic review of the literature. J Foot Ankle Surg, 2013, 52(4): 486-490.
4. Sharr PJ, Mangupli MM, Winson IG, et al. Current management options for displaced intra-articular calcaneal fractures: Non-operative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. A contemporary review. Foot Ankle Surg, 2016, 22(1): 1-8.
5. Aldridge JM 3rd, Easley M, Nunley JA. Open calcaneal fractures: results of operative treatment. J Orthop Trauma, 2004, 18(1): 7-11.
6. Ziran BH, Smith WR, Anglen JO, et al. External fixation: how to make it work. Instr Course Lect, 2008, 57: 37-49.
7. Fornaciari P, Gilgen A, Zwicky L, et al. Isolated talonavicular fusion with tension band for Müller-Weiss syndrome. Foot Ankle Int, 2014, 35(12): 1316-1322.
8. Hohmann E, Myburgh J, Keough N, et al. Inter- and intraclass correlations for three standard foot radiographic measurements for plantar surface angles. Which measure is most reliable? Foot Ankle Surg, 2019, 25(5): 646-653.
9. Choi JY, Woo SH, Oh SH, et al. A comparative study of the feet of middle-aged women in Korea and the Maasai tribe. J Foot Ankle Res, 2015, 8: 68.
10. 夏和桃. 实用骨外固定学. 北京: 人民卫生出版社, 2013: 175-185.
11. 李军, 黄泽宇, 方跃, 等. Ilizarov外固定行踝关节融合治疗晚期创伤性踝关节炎疗效分析. 中国修复重建外科杂志, 2017, 31(11): 1311-1315.
12. Paley D, Fischgrund J. Open reduction and circular external fixation of intraarticular calcaneal fractures. Clin Orthop Relat Res, 1993, (290): 125-131.
13. Lamm BM, Gottlieb HD, Paley D. A two-stage percutaneous approach to charcot diabetic foot reconstruction. J Foot Ankle Surg, 2010, 49(6): 517-522.
14. Ganadhiepan G, Miramini S, Patel M, et al. Bone fracture healing under Ilizarov fixator: Influence of fixator configuration, fracture geometry, and loading. Int J Numer Method Biomed Eng, 2019, 35(6): e3199.
15. Esparon T, Thomson CM, Rea PM, et al. Circular frame fixation for calcaneal fractures risks injury to the medial neurovascular structures: A cadaveric description. Injury, 2016, 47(12): 2700-2705.
16. Qiang M, Chen Y, Zhang K, et al. Measurement of three-dimensional morphological characteristics of the calcaneus using CT image post-processing. J Foot Ankle Res, 2014, 7(1): 19.
17. Imamura M, Imamura ST, Salomão O, et al. Pedobarometric evaluation of the normal adult male foot. Foot Ankle Int, 2002, 23(9): 804-810.
18. Oznur A, Komurcu M, Marangoz S, et al. A new perspective on management of open calcaneus fractures. Int Orthop, 2008, 32(6): 785-790.
19. Teichtahl AJ, Wluka AE, Wijethilake P, et al. Wolff’s law in action: a mechanism for early knee osteoarthritis. Arthritis Res Ther, 2015, 17: 207.
20. Frost HM. Wolff’s Law and bone’s structural adaptations to mechanical usage: an overview for clinicians. Angle Orthod, 1994, 64(3): 175-188.
21. Wallin KJ, Cozzetto D, Russell L, et al. Evidence-based rationale for percutaneous fixation technique of displaced intra-articular calcaneal fractures: a systematic review of clinical outcomes. J Foot Ankle Surg, 2014, 53(6): 740-743.
22. 朱跃良, 徐永清, 秦泗河. Ilizarov器械、技术和哲学蠡测. 中国修复重建外科杂志, 2018, 32(2): 1238-1240.
23. 丁玉兰. 人机工程学. 北京: 北京理工大学出版社, 2005: 73-82.
24. 高士濂. 实用解剖图谱·下肢分册. 上海: 上海科学技术出版社, 2012: 257-358.
25. 濮良贵, 纪名刚. 机械设计. 8版. 北京: 高等教育出版社, 2006: 3-21.
26. 胥少汀, 葛宝丰, 徐印坎. 实用骨科学. 北京: 人民军医出版社, 2012: 34-47.
27. 秦泗河, 李刚. Ilizarov技术骨科应用进展. 北京: 人民军医出版社, 2014: 21-24.

Chinese Journal of Reparative and Reconstructive Surgery

Anatomical calcaneal external fixator self-designed according to the morphology of heel

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