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Cancellous screw combined with mini-plate fixation for isolated comminuted sustentaculum tali fractures: A case
Wei-Jun Hui1, Xiang-Hong Chen1, En-Bin Zhang1
1Department of Orthopaedics, Gannan Tibetan Autonomous Prefecture People's Hospital, Hezuo, China.
Introduction And Importance:
Calcaneal fractures account for approximately 2 % of all fractures and are the most common tarsal fractures. The majority are caused by high-energy trauma, and 75 % of them are intra-articular fractures. Sustentaculum tali fracture often occurs concomitantly with severe calcaneal fractures. Isolated fractures of the sustentaculum tali are extremely uncommon, accounting for merely 1 % of calcaneal fractures. They are quite challenging to manage and there is no established surgical gold standard.
Presentation Of Case:
We reported a case of a young adult male patient who presented with pain and limited mobility in the right ankle after a rollover accident. CT scan revealed an isolated comminuted sustentaculum tali fracture. We performed open reduction via a medial approach and fixed the fracture with cannulated screws combined with a mini-plate. At the one-month postoperative follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) score reported good clinical outcome(84).Postoperative CT scans showed satisfactory fracture reduction and safe position of the internal fixation.
Clinical Discussion:
For isolated calcaneal sustentaculum tali comminuted fractures, we adopted anatomical reduction and fixation with cannulated screws combined with mini-plate fixation. This method enhances the supporting force, prevents lateral bone plate displacement, and avoids flexor tendon wear and nerve irritation caused by angular healing of the lateral bone plate. The postoperative results were satisfactory with no complications.
Conclusion:
Cancellous screw combined with mini-plate fixation for sustentaculum tali fracture resulted in stablishing a firm fixation of sustentaculum tali fracture fragment into calcaneus bone, this fixation method demonstrates strong theoretical feasibility and can serve as a reference for clinicians.
