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Computer-assisted virtual surgical technology in pre-operative design for the reconstruction of calcaneal fracture malunion

  • Minfei Qiang
  • Kun Zhang
  • Yanxi ChenEmail author
  • Xiaoyang Jia
  • Xiong Wang
  • Song Chen
  • Shuguang Wang
Original Paper
  • 17 Downloads

Abstract

Purpose

No computer-assisted pre-operative design for calcaneal fracture malunions has been presented. The aim of the study is to evaluate the intra-operative realization of computer-assisted pre-operative planning (CAPP) and the clinical outcomes based on computer-assisted virtual surgical technology for calcaneal malunions.

Methods

Between 2010 and 2016, 20 patients with 21 calcaneal fracture malunions were retrospectively reviewed with the average follow-up time of 22.3 months (range, 12 to 43 months), which were operatively treated with the help of CAPP. The CAPP steps included the image segmentation, exostectomy of lateral wall, simulated reconstruction of calcaneal thalamus, morphological evaluation, and the implantation of internal fixation devices. Post-operative outcomes were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, SF-36 physical component summary (PCS), VAS for pain, range of motion of ankle, and the morphological parameters of the calcaneus including the axial length of the calcaneus, the height of the posterior facet, the talocalcaneal angle, Böhler’s angle, and Gissane’s angle.

Results

The mean time required for CAPP was 41.8 minutes. All the surgical processes were carried out according to CAPP. Six patients (6 feet) were treated with the joint-preserving osteotomy. Fourteen patients (15 feet) underwent the subtalar distraction bone block arthrodesis, among which the medial displacement calcaneal osteotomy was additionally performed in six patients (6 feet). At the final follow-up, the average AOFAS, SF-36 PCS, and VAS scores were significantly improved to 77.4, 64.3, and 1.4, respectively (P < 0.001). The postoperative calcaneal morphological parameters and the range of motion of ankle were significantly restored (P < 0.05).

Conclusion

CAPP can assist surgeons in understanding calcaneal malunions, thereby improving intraoperative correction and reconstruction. The satisfying clinical and radiographic outcomes could be provided after treating calcaneal malunions aided by the computer-assisted virtual surgical technology.

Keywords

Calcaneal fracture Malunion Osteotomy Computer-assisted surgery Computed tomography Three-dimensional imaging 

Notes

Funding information

This study was funded by the National Natural Science Foundation of China (Grant number 81672141).

Compliance with ethical standards

The retrospective study was approved by the Institutional Review Committee of Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. And written informed consents were obtained.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Potter MQ, Nunley JA (2009) Long-term functional outcomes after operative treatment for intra-articular fractures of the calcaneus. J Bone Joint Surg Am 91:1854–1860.  https://doi.org/10.2106/JBJS.H.01475 CrossRefGoogle Scholar
  2. 2.
    Eckstein C, Kottmann T, Fuchtmeier B et al (2016) Long-term results of surgically treated calcaneal fractures: an analysis with a minimum follow-up period of twenty years. Int Orthop 40:365–370.  https://doi.org/10.1007/s00264-015-3042-x CrossRefGoogle Scholar
  3. 3.
    Clare MP, Lee WR, Sanders RW (2005) Intermediate to long-term results of a treatment protocol for calcaneal fracture malunions. J Bone Joint Surg Am 87(5):963–973.  https://doi.org/10.2106/JBJS.C.01603 CrossRefGoogle Scholar
  4. 4.
    Banerjee R, Saltzman C, Anderson RB, Nickisch F (2011) Management of calcaneal malunion. J Am Acad Orthop Surg 19:27–36CrossRefGoogle Scholar
  5. 5.
    Stapleton JJ, Belczyk R, Zgonis T (2009) Surgical treatment of calcaneal fracture malunions and posttraumatic deformities. Clin Podiatr Med Surg 26:79–90.  https://doi.org/10.1016/j.cpm.2008.10.003 CrossRefGoogle Scholar
  6. 6.
    Reddy V, Fukuda T, Ptaszek AJ (2007) Calcaneus malunion and nonunion. Foot Ankle Clin 12:125–135.  https://doi.org/10.1016/j.fcl.2006.12.004 CrossRefGoogle Scholar
  7. 7.
    Rammelt S, Zwipp H (2013) Corrective arthrodeses and osteotomies for post-traumatic hindfoot malalignment: indications, techniques, results. Int Orthop 37:1707–1717.  https://doi.org/10.1007/s00264-013-2021-3 CrossRefGoogle Scholar
  8. 8.
    Al-Ashhab ME (2013) Treatment for calcaneal malunion. Eur J Orthop Surg Traumatol 23:961–966.  https://doi.org/10.1007/s00590-012-1110-0 CrossRefGoogle Scholar
  9. 9.
    Ketz J, Clare M, Sanders R (2016) Corrective osteotomies for malunited extra-articular calcaneal fractures. Foot Ankle Clin 21:135–145.  https://doi.org/10.1016/j.fcl.2015.09.006 CrossRefGoogle Scholar
  10. 10.
    Young KW, Lee KT, Lee YK, Jang MS, Yoon JH, Kim JH (2011) Calcaneal reconstruction for the late complication of calcaneus fracture. Orthopedics 34:e634–e638.  https://doi.org/10.3928/01477447-20110826-03 Google Scholar
  11. 11.
    Rammelt S, Grass R, Zwipp H (2013) Joint-preserving osteotomy for malunited intra-articular calcaneal fractures. J Orthop Trauma 27:e234–e238.  https://doi.org/10.1097/BOT.0b013e318290ff07 CrossRefGoogle Scholar
  12. 12.
    Chen Y, Qiang M, Zhang K, Li H, Dai H (2015) Novel computer-assisted preoperative planning system for humeral shaft fractures: report of 43 cases. Int J Med Robot 11:109–119.  https://doi.org/10.1002/rcs.1604 CrossRefGoogle Scholar
  13. 13.
    Cimerman M, Kristan A (2007) Preoperative planning in pelvic and acetabular surgery: the value of advanced computerised planning modules. Injury 38:442–449.  https://doi.org/10.1016/j.injury.2007.01.033 CrossRefGoogle Scholar
  14. 14.
    Suero EM, Hufner T, Stubig T, Krettek C, Citak M (2010) Use of a virtual 3D software for planning of tibial plateau fracture reconstruction. Injury 41:589–591.  https://doi.org/10.1016/j.injury.2009.10.053 CrossRefGoogle Scholar
  15. 15.
    Chen Y, Jia X, Qiang M et al (2018) Computer-assisted virtual surgical technology versus three-dimensional printing technology in preoperative planning for displaced three and four-part fractures of the proximal end of the humerus. J Bone Joint Surg Am 100:1960–1968.  https://doi.org/10.2106/JBJS.18.00477 CrossRefGoogle Scholar
  16. 16.
    Hernandez D, Garimella R, Eltorai AEM, Daniels AH (2017) Computer-assisted orthopaedic surgery. Orthop Surg 9:152–158.  https://doi.org/10.1111/os.12323 CrossRefGoogle Scholar
  17. 17.
    Qiang M, Chen Y, Jia X, Zhang K, Li H, Jiang Y, Zhang Y (2017) Post-operative radiological predictors of satisfying outcomes occurring after intra-articular calcaneal fractures: a three dimensional CT quantitative evaluation. Int Orthop 41:1945–1951.  https://doi.org/10.1007/s00264-017-3577-0 CrossRefGoogle Scholar
  18. 18.
    Gutekunst DJ, Liu L, Ju T, Prior FW, Sinacore DR (2013) Reliability of clinically relevant 3D foot bone angles from quantitative computed tomography. J Foot Ankle Res 6:38.  https://doi.org/10.1186/1757-1146-6-38 CrossRefGoogle Scholar
  19. 19.
    Qiang M, Chen Y, Zhang K, Li H, Dai H (2014) Measurement of three-dimensional morphological characteristics of the calcaneus using CT image post-processing. J Foot Ankle Res 7:19.  https://doi.org/10.1186/1757-1146-7-19 CrossRefGoogle Scholar
  20. 20.
    Yu GR, Hu SJ, Yang YF, Zhao HM, Zhang SM (2013) Reconstruction of calcaneal fracture malunion with osteotomy and subtalar joint salvage: technique and outcomes. Foot Ankle Int 34:726–733.  https://doi.org/10.1177/1071100713479766 CrossRefGoogle Scholar
  21. 21.
    Kleeman JT, Myerson MS (2000) Medial displacement calcaneal osteotomy. Tech Orthop 15:197–203CrossRefGoogle Scholar
  22. 22.
    Ding L, He Z, Xiao H et al (2013) Risk factors for postoperative wound complications of calcaneal fractures following plate fixation. Foot Ankle Int 34:1238–1244.  https://doi.org/10.1177/1071100713484718 CrossRefGoogle Scholar
  23. 23.
    Shi G, Li B, Yang X, Zhang C, Zhang H, Ma H (2016) Subtalar joint fusion through modified lateral approach in treatment of severe calcaneal malunion. J Pract Orthop 22:126–129, 188.  https://doi.org/10.13795/j.cnki.sgkz.2016.02.009 Google Scholar
  24. 24.
    Savory KM, Wulker N, Stukenborg C, Alfke D (1998) Biomechanics of the hindfoot joints in response to degenerative hindfoot arthrodeses. Clin Biomech (Bristol, Avon) 13:62–70CrossRefGoogle Scholar
  25. 25.
    Zhang K, Chen Y, Qiang M, Hao Y (2016) Effects of five hindfoot arthrodeses on foot and ankle motion: measurements in cadaver specimens. Sci Rep 6:35493.  https://doi.org/10.1038/srep35493 CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Trauma, Shanghai East HospitalTongji University School of MedicineShanghaiChina
  2. 2.Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina

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