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. 2023 Aug 8;24(1):636.
doi: 10.1186/s12891-023-06748-5.

3D simulation of percutaneous sustentaculum tali screw insertion in calcaneal fractures

Xian Li #  1   2 , Xiao-Ke Wang  1 , Lian-Kui Yu #  2 , Chao Zhang  2 , Ming-Ming Zhao  2 , Jun Yan  3 , Li-Ren Han  4
Affiliations

3D simulation of percutaneous sustentaculum tali screw insertion in calcaneal fractures

Xian Li et al. BMC Musculoskelet Disord. .

Abstract

Background: In calcaneal fractures, the percutaneous screw fixation (PSF) is currently considered to be the better choice, but it is difficult to accurately place the screw into the sustentaculum tali (ST) during the operation. In this study, the ideal entry point, angle, diameter and length of the screw were calculated by simulating the operation process.

Methods: We retrospectively collected the calcaneus computed tomography (CT) scans of 180 adults, DICOM-formatted CT-scan images of each patient were imported into Mimics software to establish calcaneus model. Virtual screws were placed on the lateral of the posterior talar articular surface (PTAS), the lateral edge of the anterior process of calcaneus (APC), and the calcaneal tuberosity, respectively, the trajectory and size of the screws were calculated.

Results: The mean maximum diameter of the PTAS screw was 42.20 ± 3.71 mm. The vertical distance between the midpoint of the APC optimal screw trajectory and the lowest point of the tarsal sinus was 10.67 ± 1.84 mm, and the distance between the midpoint of the APC optimal screw trajectory and the calcaneocuboid joint was 5 mm ~ 19.81 ± 2.08 mm. The mean maximum lengths of APC screws was 44.69 ± 4.81 mm, and the Angle between the screw and the coronal plane of the calcaneus from proximal to distal was 4.72°±2.15° to 20.52°±3.77°. The optimal point of the maximum diameter of the calcaneal tuberosity screw was located at the lateral border of the achilles tendon endpoint. The mean maximum diameters of calcaneal tuberosity screws was 4.46 ± 0.85 mm, the mean maximum lengths of screws was 65.31 ± 4.76 mm. We found gender-dependent differences for the mean maximum diameter and the maximum length of the three screws.

Conclusions: The study provides effective positioning for percutaneous screw fixation of calcaneal fractures. For safer and more efficient screw placement, we suggest individualised preoperative 3D reconstruction simulations. Further biomechanical studies are needed to verify the function of the screw.

Keywords: Calcaneal fracture; Digital measurement; Percutaneous screw fixation; Sustentaculum tali.

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Conflict of interest statement

Xian Li, Xiao-ke Wang, Lian-kui Yu, Chao-Zhang, Ming-ming Zhao, Jun Yan, Li-ren Han declare there is no conflicts of interest regarding the publication of this paper.

Figures

Fig. 1
Fig. 1
Three screws simulated on the calcaneal specimen and the screws X-ray perspective. (A1-A3) APC Kirschner wire trajectory. (B1-B3) PTAS Kirschner wire trajectory. (C1-C3) Kirschner wire trajectory of calcaneal tuberosity. (D1-D3) Three screws were placed in the calcaneal specimen
Fig. 2
Fig. 2
The measurement of virtual PTAS screw in the model. (A, B) Observed from the lateral and medial of the opaque 3D model,respectively. The screws did not penetrate the cortical bone. (C, D) Adjusted to the optimal length of the screw from the translucent 3D model. (E) Angle α: subtalar convergence angle. (F) Angle β: anteversion angle
Fig. 3
Fig. 3
The measurement of virtual APC screws in the model. (A) The entry points of six screws were the most proximal and the most distal safe positions. The red points in the middle of the screws was the ideal entry point. (B) Three screws were placed at the optimal entry point. (C) L1: The perpendicular distance from the optimal entry point to the lowest point on the lateral margin of the sinuses tarsi. (D) L2: The length of the calcaneocuboid joint surface to the midpoint of the farthest insertion trajectory. (E) Angle γ: anteversion angle between the APC screw and the horizontal plane of the calcaneus. (F) Angle δ: the angle between the APC screw and the coronal plane of the calcaneus
Fig. 4
Fig. 4
The measurement of virtual calcaneal tuberosity screw in the model. (A) Adjusted to the optimal lengths and diameters of the screws from the translucent calcaneus model. (B) The lateral border of calcaneal tuberosity was the optimal entry point. (C) Angle θ: the angle between the screw and the horizontal plane of the calcaneus. (D) Angle π: the angle between the screw and the sagittal plane of the calcaneus
Fig. 5
Fig. 5
Axial views of the calcaneus and vertical views of the screws. (A) Axial view of the calcaneus. (B) Vertical view of the PTAS screw. (C) Vertical view of the APC screw. (D) Axial view of the calcaneus shows the screw breaking through the medial bone cortex. (E, F) The screw penetrates the bone cortex in the calcaneal specime
See this image and copyright information in PMC

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