Sustentaculum Tali Screw In Treatment Of Sanders Type â…¡ And â…¢ Calcaneal Fractures

Purpose: To present a surgical technique of open reduction and internal fixation of Sanderstype Ⅱand Ⅲ calcaneal fractures with calcaneal locking plates and to evaluate the clinical andradiological outcome.Methods:38calcaneal fractures（Sanders type Ⅱ or Ⅲ）were stabilized by calcaneallocking plate in our department, between January2010and October2012. According to theSanders classification,16fractures were classified as type Ⅱ,22fractures as type Ⅲ. In Group A(screw in), the articular fragment was fixed to the sustentaculum tali with one screw, including13males and5females, with a mean age of38.56(range25to55) years. In Group B (screw out), thefragment was not fixed to the sustentaculum tali with screws, including16males and4females,with a mean age of42.35(range29to53) years. The results were evaluated according to thechanges of B hler’s angle and Maryland Foot Score and100-mm VAS score.Results: All patients were followed up, with a mean14-month follow-up period (range:12-20months). All of the patients in the two groups displayed satisfactory restoration of B hler’s angleand subtalar joint congruity. In the sustentaculum tali screw group, the mean decrease of theB hler’s angles between the postoperative radiograph and radiograph at the1-year follow-up was(2.0±1.1). In the non-sustentaculum tali screw group, a further decrease of the average B hler’sangle of (3.0±1.8) was found between the postoperative radiograph and radiograph at one yearafter operation. The loss of the B hler’s angles was less in the sustentaculum tali screw group thanin the non-sustentaculum tali screw group, and this difference was statistically significant (P<0.05).The sustentaculum tali screw group scored higher (mean88.6; range71to99) than did the non-sustentaculum tali screw group (mean82.4; range63to99) on the Maryland Foot Score at the1-year follow-up visit, with the differences being statistically significant (P<0.05), suggesting thatresults can be improved by the sustentaculum tali screw. The sustentaculum tali screw group hadless pain (mean13.4; range0to40) than did the non-sustentaculum tali screw group (mean22.5;range3to52) as measured with the100-mm visual analog scale, and this difference wasstatistically significant (P<0.05). Conclusions: The sustentaculum tali screw could significantly improve the stability of theposterior facet and has less pain after surgery. It implies that increasing the rigidity of fixation willimprove clinical outcome in treatment of intra-articular calcaneal fractures.