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. 2024 Mar 5;19(1):166.
doi: 10.1186/s13018-024-04606-1.

Biomechanical characteristics of Sanders type II and III calcaneal fractures fixed by open reduction and internal fixation and percutaneous minimally invasive fixation

Wu Ren #  1   2 , Kailu Zhang  1   2 , Ziya Zhao  1   2 , Xueling Zhang #  1   2 , Fei Lin  1 , Yawei Li  1 , Ke Bao  1 , Jun Yang  3 , Jinlong Chang  4   5 , Jia Li  6   7
Affiliations

Biomechanical characteristics of Sanders type II and III calcaneal fractures fixed by open reduction and internal fixation and percutaneous minimally invasive fixation

Wu Ren et al. J Orthop Surg Res. .

Abstract

Background: This work investigated the differences in the biomechanical properties of open reduction and internal fixation (ORIF) and percutaneous minimally invasive fixation (PMIF) for the fixation of calcaneal fractures (Sanders type II and III calcaneal fractures as examples) through finite element analysis.

Methods: Based on CT images of the human foot and ankle, according to the principle of three-point fixation, namely the sustentaculum tali, the anterior process and the calcaneal tuberosity were fixed. Three-dimensional finite element models of Sanders type II and III calcaneal fractures fixed by ORIF and PMIF were established. The proximal surfaces of the tibia, fibula and soft tissue were constrained, and ground reaction force and Achilles tendon force loads were added to simulate balanced standing.

Results: The maximum stress was 80.54, 211.59 and 113.88 MPa for the calcaneus, screws and plates in the ORIF group and 70.02 and 209.46 MPa for the calcaneus and screws in the PMIF group, respectively; the maximum displacement was 0.26, 0.21 and 0.12 mm for the calcaneus, screws and plates in the ORIF group and 0.20 and 0.14 mm for the calcaneus and screws in the PMIF group, respectively. The values obtained from the simulation were within the permissible stress and elastic deformation range of the materials used in the model, and there was no significant stress concentration. The maximum stress and displacement of the calcaneus and implants were slightly lower in the PMIF group than in the ORIF group when fixing Sanders type II and III calcaneal fractures.

Conclusions: This study may provide a reference for optimising the design of implants, the development of individualised preoperative plans and the choice of clinical surgical approach.

Keywords: Biomechanics; Calcaneal fracture; Finite element analysis; Internal fixation; Sander classification.

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Conflict of interest statement

The authors declare that there are no competing interests.

Figures

Fig. 1
Fig. 1
Modelling steps for the fixation of Sanders type II and III calcaneal fractures by ORIF and PMIF
Fig. 2
Fig. 2
The CT images of Sanders type II and type III calcaneal fractures a IIa: fracture line lateral to the fracture line; b IIb: fracture line medial; c IIc: fracture line adjacent to the sustentaculum tali; and d, e and f three-part fracture of the posterior talar articular surface of type III: IIIab, IIIac, IIIbc
Fig. 3
Fig. 3
a Fixation of Sanders type II fracture by ORIF; b fixation of Sanders type II fracture by PMIF; c fixation of Sanders type III fracture by ORIF; and d fixation of Sanders type III fracture by PMIF
Fig. 4
Fig. 4
a The loading and boundary conditions of the model; b finite element model of the foot–ankle complex
Fig. 5
Fig. 5
The MFF Membrane Pressure Testing System measures plantar pressure
Fig. 6
Fig. 6
Comparison of plantar pressure distribution between FEA and measurement
Fig. 7
Fig. 7
The magnitude and distribution of von Mises stress (MPa) of Sanders type II (a1-a3); Sanders type III (b1-b3) calcaneal fractures fixed by ORIF
Fig. 8
Fig. 8
The magnitude and distribution of von Mises stress (MPa) of Sanders type II (a1-a2); Sanders type III (b1-b2) calcaneal fractures fixed by PMIF
Fig. 9
Fig. 9
The magnitude and distribution of displacement (mm) of Sanders type II (a1-a3); Sanders type III (b1-b3) calcaneal fractures fixed by ORIF
Fig. 10
Fig. 10
The magnitude and distribution of displacement (mm) of Sanders type II (a1-a2); Sanders type III (b1-b2) calcaneal fractures fixed by PMIF
See this image and copyright information in PMC

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