title: [MANUFACTURE AND CLINICAL APPLICATION OF SCREW DIRECTOR OF CALCANEOUS SUSTENTACULUM TALI FOR TREATMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES].
abstract: OBJECTIVE
  To evaluate the clinical results of the self-manufactured screw director of the calcaneous sustentaculum tali in the surgical treatment of intra-articular calcaneal fractures.
  
  
  METHODS
  Between May 2012 and October 2013, 40 patients (47 feet) underwent surgical treatment of intra-articular calcaneal fractures, and the clinical data were analyzed. There were 29 males and 11 females with an average age of 46 years (range, 25-68 years). According to Sanders classification, 17 feet were rated as type II, 20 feet as type III, and 10 feet as type IV. The average time from injury to admission was 6.02 hours (range, 1-12 hours). All the patients were treated with the screw director of the calcaneous sustentaculum tali to fix the sustentaculum tali. The intraoperative times of fluoroscopy were recorded. The Böhler angle and Gissane angle were measured at pre- and post-operation. The clinical functional outcomes were evaluated according to the Maryland foot score system.
  
  
  RESULTS
  The intraoperative times of fluoroscopy were 2-4 times (mean, 2.85 times). Radiographic examination showed 45 screws were accurately implanted into the middle of the sustentaculum tali in implanted 47 screws except 1 screw which penetrated into the anteroinferior of the sustentaculum tali and 1 screw which penetrated into the anterior of the sustentaculum tali. The accurate rate of screw implant was 95.7%. All patients were followed up for an average of 12 months (range, 8-18 months). During the follow-up, incision skin necrosis and infection occurred in 2 cases, and sural nerve injury developed in 3 cases. Bone union was achieved at an average of 12.72 weeks (range, 9-18 weeks) postoperatively. The Böhler angle was improved significantly from (6.48 ± 3.67) degrees pre-operatively to (29.40 ± 4.65) degrees post-operatively (t = -31.38, P = 0.00). The Gissane angle was improved significantly from (99.30 ± 5.85) degrees preoperatively to (130.84 ± 5.08) post-operatively (t = -28.32, P = 0.00). The Maryland foot score was 90.66 on average (range, 65-98) at last follow-up; the results were excellent in 41 feet, good in 3 feet, and fair in 3 feet with an excellent and good rate of 93.6%.
  
  
  CONCLUSIONS
  The self-manufactured sc-ew director of the calcaneous sustentaculum tali can significantly improve the accuracy of the screw implanted into the sustentaculum tali and reduce the harm of intraoperative fluoroscopy to the body.
authors.forename: Binggen
authors.initials: B
authors.lastname: Liu
authors.forename: Qingjiang
authors.initials: Q
authors.lastname: Pang
authors.forename: Xiao
authors.initials: X
authors.lastname: Yu
authors.forename: Xianjun
authors.initials: X
authors.lastname: Chen
authors.forename: Zonghui
authors.initials: Z
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D001863:Bone Screws; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D005528:Foot; D033023:Foot Joints / Q000293:injuries / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D013497:Sural Nerve; D013580:Synostosis; D016896:Treatment Outcome