Clinical effect analysis of plate fixation and screw fixation via tarsal sinus approach in the treatment of Sander Ⅱ Ⅲand Ⅳ calcaneal fracture

Clinical effect analysis of plate fixation and screw fixation via tarsal sinus approach in the treatment of Sander Ⅱ Ⅲand Ⅳ calcaneal fracture | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical effect analysis of plate fixation and screw fixation via tarsal sinus approach in the treatment of Sander Ⅱ Ⅲand Ⅳ calcaneal fracture Hongxian Zhao, Zijia Wang, Mingming Yang, Anlin Liang, Shichang Gao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4497178/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective The aim of this study is to compare the efficacy of plate fixation via the tarsal sinus approach with screw fixation alone in treating Sander type II, III, and IV fractures. Method Between 2016 and 2023, a comprehensive study encompassing 73 patients and 78 feet with calcaneus fractures was conducted. The investigation compared the efficacy of open reduction plate fixation (ORPF) (18 cases) against open reduction screw fixation (ORSF) (60 cases). Parameters such as operation duration, intraoperative blood loss, hospital stay duration, postoperative imaging metrics (including calcaneal length, width, height, Bohler Angle, Gissane Angle, and Angle of calcaneus varus), postoperative complications, and the AOFAS score one year post-surgery were meticulously analyzed and compared across both treatment groups. Results No significant discrepancies were observed between the two groups concerning calcaneal dimensions, including length, width, height, Bohler Angle, Gissane Angle, and Angle of calcaneus varus post-operation (p > 0.05). Moreover, throughout the long-term postoperative monitoring period, no notable distinctions were evident in these parameters between the two groups. Notably, the ORSF group exhibited reduced intraoperative hemorrhage (p = 0.026), shorter procedural duration (p = 0.028), and fewer occurrences of postoperative complications such as pain or superficial infections. However, the incidence of long-term postoperative complications did not demonstrate statistical significance. Furthermore, there were no discernible variations in AOFAS scores between the groups at the latest follow-up assessment. Conclusion Both open reduction screw internal fixation and open reduction plate internal fixation have been shown to be effective methods for clinically treating calcaneal fractures, with both techniques yielding positive postoperative imaging results. However, internal fixation with open reduction screws has been found to have several advantages over open reduction plate internal fixation, including less bleeding, shorter operation time, and fewer short-term complications. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction The calcaneus is the largest tarsal bone in the human body, It appears as an irregular rectangle. It is mainly composed of cancellous bone [1] . Fractures of the calcaneus are the most common type of tarsal bone injuries, and about 75% of total calcaneal fractures are intraarticular. Usually due to external trauma such as crushing or falling from a height [2] 。X-ray is the most basic imaging examination method to determine calcaneal fracture and guide treatment including lateral and axial radiographs. Bohler and Gissane are important indicators on lateral radiographs. The former reflects the height of the calcaneus and the degree of joint compression, while the latter reflects the position and displacement of the joint, axial radiographs were used to evaluate the extent of calcaneal widening [3] . The primary goal of treating calcaneal fractures is to reestablish the smooth articular surface and to restore the length, width, height, and alignment of the calcaneus. Typical surgical approaches involve the tarsal sinus incision and the lateral L-shaped incision. As minimally invasive techniques gain favor, tarsal sinus incisions are increasingly being utilized in clinical settings. Open reduction and plate fixation stand out as the prevailing methods for treatment in current clinical practice. [4] . Indeed, open reduction with screw internal fixation is increasingly gaining popularity in orthopedic procedures. The aim of this study was to assess the impact of screw fixation on the restoration of calcaneal height, width, length, angle, complications, and functional recovery in comparison to traditional plate fixation. Patients and methods We conducted a retrospective analysis of patients who were admitted to our department between December 2016 and December 2023 with calcaneal fractures. To be included in the study, patients needed to have a closed calcaneal fracture, imaging data available both before and after surgery, and complete follow-up information. Patients with fractures of other bones, a history of surgery, calcaneal tumors, or other severe complications were excluded from the study. Prior to surgery, each patient underwent lateral and axial radiographs and computed tomography scans of the affected calcaneus. The follow-up period ranged from 12 to 16 months, with an average of 13 months. Our study methodology was approved by an institutional review board, and all patients provided written informed consent. Surgical technique: 1. Open reduction and plate fixation（Figure 1） After the patient had been anesthetized, they were positioned on their side and the area was disinfected twice with 5% iodophor. A towel was then placed over the area, and a tourniquet was applied for 90 minutes at 40Kpa. A sinus tarsi incision was made from the tip of the fibula oblique to the base of the 4th metatarsal bone. The skin was cut, and the starting point of the short extensor toes was then cut and turned upward. The articular capsule was also incised. Two 3.0mm diameter K-wires were drilled into both sides of the Achilles tendon insertion point and then reset. A 3.0mm diameter K-wire was also drilled into the calcaneal tubercle from the outside in and pulled backward and downward to correct the shortening and inversion of the calcaneal bone, restoring its height and length. Rotation deformity was also corrected through prying, and temporary fixation was achieved using K-wires. Resettability was observed under fluoroscopy, and allograft bone was used to fill any large defects found. An steel plate was then inserted, and holes were drilled with the front two screws driven upward into the carrier process, while the rear screws were fixed in the calcaneal tubercles and the body. The subtalar articular surface was drilled again, and a 3.5mm diameter cortical bone screw was inserted to fix it. The lateral, Borden, and axial positions were then fixed satisfactorily under fluoroscopy. After irrigation, a drainage tube was inserted, and the starting point of the short extensor toe muscle was repaired before the incision was closed. 2. Open reduction and screw fixation（Figure 2） After the patient had been anesthetized, they were positioned prone, the area was disinfected twice with 5% iodophor, and a towel was placed over the site. A tourniquet was applied at 40Kpa for 90 minutes. Two external stent screws were drilled into the calcaneal tubercles and reduced using the Westhues method to address the collapsed fracture. Following reduction, three K-wire guides were drilled: two to control the length of the calcaneus and one to the calcaneal process. Support fixation was achieved using 70mm and 60mm screws with a diameter of 5.5mm, while 44mm screws with a diameter of 3.5mm were utilized to pressurize and fix the calcaneal process. Allograft bone was then used to fill any significant defects. The lateral, Borden, and axial positions were satisfactorily fixed under fluoroscopy. After irrigation, a drainage tube was inserted, and the incision was closed. Postoperative management After the surgery, the affected limb was kept elevated to reduce swelling. The drainage tube was removed once the drainage volume was less than 20ml/day, and X-rays were reviewed. Patients were advised to begin exercising their toes and ankles early after surgery. The wound was cleaned with iodophor every two days until the stitches were absorbed and fell off. Measured outcomes Calcaneal width, height, length, Bohler Angle Gissane Angle and Angle of calcaneus varus were measured as anatomic parameters before surgery(BO), three days(PO), one month, three months, six months and one year after surgery. Wound complications and length of hospital stay were recorded. Clinical functional outcomes were evaluated using the AOFAS scoring system when the patients underwent a postoperative examination at ≥1 year postoperatively. Statistical methods SPSS 22.0 software was used for statistical processing. The measurement data were represented by mean ± standard deviation and compared by independent sample t test. The count data were represented by n(%), and the number of descriptive cases was compared by χ2 test. P≤0.05 was considered statistically significant. Result A total of 73 patients and 78 feet with calcaneus fractures from 2016 to 2023 were studied. The ORPF group(18) was compared to ORSF group (60).There were 34 patients with sander type II, 22 patients with sander type III, and 4 patients with sander type IV in the ORSF group.In the ORPF group, there were 11 patients with sander type II, 5 with sander type III, and 2 with sander type IV. The rest of the data is shown in Table 1. The average operative time for the ORSF group was 118.93±60.41 minutes, while for the ORPF group, it was 158.72±82.45 minutes (p=0.028). In terms of intraoperative bleeding, the ORSF group experienced 53.17±49.21ml, whereas the ORPF group had 88.33±79.65ml (p=0.026).Regarding the time elapsed from injury to surgery, the ORSF group had an average of 8.87±6.07 days, compared to 11.47±9.74 days in the ORPF group (p=0.181). The postoperative hospitalization duration was 7.6±7.72 days for the ORSF group and 11.59±6.55 days for the ORPF group (p=0.056). The postoperative data of the two groups compared with the preoperative data suggested that the two fixation methods were effective. The gissane Angle increased from 104.28±4.85° before operation to 114.47±5.13° after operation in ORSF group, and from 102.15±5.56° before operation to 114.46±4.88°after operation in ORPF group. The bohler Angle increased from 13.90±6.27° before operation to 23.67±4.89° after operation in the ORSF group, and from 12.35±6.63° before operation to 25.93±5.94° after operation in the ORPF group. The Angle of calcaneus varus decreased from 12.36±5.15° before operation to 7.40±2.19° after operation in ORSF group, and from 14.29±4.29° before operation to 7.93±2.15° after operation in ORPF group. The calcaneus width decreased from 47.90±4.45mm to 43.12±3.98mm in ORSF group and from 48.61±3.81mm to 42.59±3.58mm in ORPF group. The length of calcaneus decreased from 79.84±6.59mm before operation to 74.61±5.85mm after operation in ORSF group, and from 79.01±6.72mm to 74.26±6.01mm in ORPF group. The calcaneus height in OPSF group increased from 42.94mm before surgery to 48.50mm after surgery. The ORPF group increased from 43.90mm before surgery to 49.44mm after surgery. The differences in the above data were not statistically significant. There was no statistically significant difference in the data of these 6 items at 1 month, 3 months, 6 months and 1 year after surgery. Only in 3 months, ORPF group had lower varus Angle of calcaneus than ORSF group. Complications 5 patients(8.33％) in the ORSF group developed soft tissue complications, including surface infection and pain.5 patients(27.78%) in the ORPF group developed soft tissue complications. There were no cases of wound nonunion or chronic osteomyelitis in either group.12 patients(20%) in the ORSF group had screws removed at least one year after surgery, including 4 patients(6.67%) who had internal fixation devices removed because of pain or discomfort while walking.6 patients(33.33%) in the ORPF group had plates removed, 2 of whom(11.11%) had Pain or discomfort while walking. 7(11.67%) patients in the ORSF group developed persistent lateral posterior foot pain, which we call peroneal tendinitis. 3(16.67%) patients in the ORPF group had the same symptoms. At the last follow-up, the AOFAS score was 93.56±7.28 in the ORSF group and 91.63±7.67 in the ORPF group. There was no significant difference between the two groups (p=0.507). Discussion The calcaneus is the most considerable weight-bearing tarsal bone, which makes it vulnerable to injury. The purpose of calcaneal fracture treatment is to restore the normal anatomic relationship of calcaneal bone, maintain the stability after reduction, and maximize the recovery of the function of the affected foot [5] .The main complications after calcaneal fracture surgery were infection and flap necrosis (13.6%), neurovascular injury (2.8%), post-traumatic arthritis (1.2%), poor reduction (0.8%), and nonunion (0.1%). Other literature has shown that the incidence of serious infection after closed calcaneal fracture is 0–20%, and osteomyelitis after open calcaneal fracture is as high as 19%-31% [6] . This may be related to the lack of soft tissue around the calcaneus and the degree of soft tissue injury. In addition, the degree of calcaneal fracture, the age of the patient, smoking, and other underlying diseases all have an impact on wound healing [7] . More and more physicians are choosing to use minimally invasive techniques to treat displaced intraarticular calcaneal fractures, including the Palmer approach [8] , Smile incision [9] , Ollier approach [10] , and tarsal sinus approach [11, 12] . Plate effectively resists rotational and axial stresses to achieve stable fixation and has the expected low rates of loosening and failure of fixation [13] , with no screw loosening or plate breakage occurring during follow-up in our case series. For patients with screw fixation alone, the calcaneal fracture block is stabilized using three screws, representing the most biomechanically sound fixation approach. The initial screw is directed inward from the lateral wall towards the carrier process, traversing beneath the subtalar articular surface horizontally, thus providing robust support for the reduced articular surface. Subsequently, the second and third screws are positioned along the coronal plane, extending from the calcaneal tubercle towards the anterior aspect of the calcaneus near the calcaneocuboid joint [14] . In our study of 60 cases that underwent open reduction screw fixation, we found that the Bohler Angle, Gissane Angle, calcaneal width, calcaneal length, calcaneal height, calcaneal varus Angle, and calcaneal function were restored to clinically acceptable levels, comparable to those observed in patients who underwent open reduction plate fixation. Furthermore, we observed good fixation strength during long-term follow-up after surgery. The Angle of Bohler's and Gissane's is an important parameter for evaluating the shape of calcaneum bone, which has a significant impact on clinical therapeutic effect [15] . Research indicates that an increase in calcaneal bone width can potentially result in lateral impingement syndrome, also known as peroneal tenosynovitis. Individuals who experience calcaneal fractures, particularly those with dislocated intra-articular fractures, often endure long-term chronic complications. Among these, lateral hindfoot pain stands out as one of the most prevalent sequelae, impacting the quality of life and mobility of affected patients. [16] .In foot movement, the lateral wall of the calcaneus is rubbed against the peroneal tendon, causing pain below the lateral malleolus [17, 18] . Our study demonstrated that the two surgical modalities had a similar ability to restore calcaneus width, which was supported by long-term postoperative follow-up results. Compared with plate, screw fixation causes less bleeding, shorter operative time, and fewer short postoperative complications. When using screws, the primary purpose of a tarsal sinus incision is to reduce the articular surface under direct vision without extensive subcutaneous tissue dissection as with plates [19] . The tension around the edge of the incision increases after plate insertion, which is also detrimental to soft tissue repair [20] . Our study also confirmed that the ORSF group had fewer postoperative soft tissue complications than the ORPF group. The study's follow-up analysis revealed that there were no statistically significant differences in AOFAS scores and long-term complication rates between the two surgical methods, at the last follow-up. These findings provide further evidence that both surgical techniques are equally effective in preserving articular surface stability and restoring calcaneal function. Our trial had several limitations, including fewer patients in the ORPF group, fewer patients with Sander type IV fractures, shorter follow-up times, and retrospective and single-center design, such that the effect of selection bias cannot be denied. Conclusion Both open reduction screw internal fixation and open reduction plate internal fixation have been shown to be effective methods for clinically treating calcaneal fractures, with both techniques yielding positive postoperative imaging results. However, internal fixation with open reduction screws has been found to have several advantages over open reduction plate internal fixation, including less bleeding, shorter operation time, and fewer short-term complications. Declarations Funding No funding is available for this article. Authors ’ contributions All authors have read and approved the manuscript. All authors contributed to the article. Study design has been suggested by Shichang Gao. Mingming Yang and Anlin Liang performed the operations. Data were collected and analyzed by Hongxian Zhao and Zijia Wang. The manuscript was drafted and designed by Hongxian Zhao. Shichang Gao revised the manuscript. Availability of data and materials The datasets generated and analyzed during the current study are not publicly available due to individual privacy of participants but are available from the corresponding author on reasonable request. Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate All experimental protocols were approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University. All procedures performed in studies were in accordance with the 1964 Helsinki declaration. All patients involved in this study gave their consent for the participation, and the informed consent was obtained from all participants. Consent for publication All patients involved in this study gave their consent for the anonymized data to be used for scientific purposes and published in a scientific journal. 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Crawford, Managing Complications of Calcaneus Fractures, Foot and ankle clinics 22 (2017) 105-116. C. Bibbo, N. Siddiqui, J. Fink, J. Powers, D. A. Ehrlich and S. J. Kovach, Wound Coverage Options for Soft Tissue Defects Following Calcaneal Fracture Management (Operative/Surgical), Clinics in podiatric medicine and surgery 36 (2019) 323-337. I. Palmer, The mechanism and treatment of fractures of the calcaneus; open reduction with the use of cancellous grafts, The Journal of bone and joint surgery. American volume 30a (1948) 2-8. W. B. Wiley, J. D. Norberg, C. J. Klonk and I. J. Alexander, "Smile" incision: an approach for open reduction and internal fixation of calcaneal fractures, Foot & ankle international 26 (2005) 590-592. T. Schepers, B. C. Kieboom, G. H. Bessems, L. M. Vogels, E. M. van Lieshout and P. Patka, Subtalar versus triple arthrodesis after intra-articular calcaneal fractures, Strategies in trauma and limb reconstruction 5 (2010) 97-103. N. 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Tables ORSF ORPF χ2 /t P Age 43.2±11.81 45.16±10.85 0.614 0.541 Sex Male 48 15 0.099 0.753 Female 12 3 Ⅱ 34 11 Sander Ⅲ 22 5 0.719 0.698 Ⅳ 4 2 Side Left 36 9 0.567 0.451 Right 24 9 BMI 24.07±3.83 24.19±3.15 0.107 0.915 Table 1 :general information ORSF ORPF T P Operation time(min) intraoperative bleeding(ml) 118.93±60.41 53.17±49.21 158.72±82.45 88.33±79.65 2.244 2.278 0.028 0.026 postoperative hospitalization duration(days) 7.6±7.72 11.59±6.55 1.937 0.056 The time between operation and injury(days) 8.87±6.07 11.47±9.74 1.352 0.181 Table 2 :perioperative indicators ORSF ORPF T P BO 104.28±4.85 102.15±5.56 1.578 0.119 PO 114.47±5.13 114.46±4.88 0.011 0.991 1M 115.64±5.61 116.38±6.14 0.249 0.805 3M 114.40±6.37 114.70±5.84 0.095 0.925 6M 115.52±4.67 115.31±4.91 0.092 0.928 1Y 116.61±3.41 118.90±5.31 1.400 0.173 Table 3 :Gissane angle(°) ORSF ORPF T P BO 13.9±6.27 12.35±6.63 0.909 0.366 PO 23.66±4.89 25.93±5.94 1.641 0.105 1M 24.50±5.11 27.30±5.69 1.187 0.244 3M 25.11±4.67 28.34±3.34 1.457 0.157 6M 23.61±3.79 26.38±4.63 1.474 0.164 1Y 24.27±3.42 26.35±4.43 1.404 0.172 Table 4 :Bohler angle(°) ORSF ORPF T P BO 12.36±6.15 14.29±4.59 1.450 0.151 PO 7.40±2.19 7.93±2.15 0.888 0.377 1M 6.86±2.24 8.14±1.63 1.234 0.224 3M 6.26±2.12 8.25±1.12 2.053 0.047 6M 6.83±1.91 7.87±1.13 1.277 0.211 1Y 6.95±1.71 7.81±0.86 1.575 0.125 Table 5 :calcaneal varus Angle(°) ORSF ORPF T P AO 47.90 48.62 0.619 0.538 PO 43.13 42.59 0.515 0.608 1M 41.74 40.33 0.797 0.431 3M 41.38 40.41 0.643 0.526 6M 41.39 40.18 0.767 0.452 1Y 41.38 39.52 1.666 0.108 Table 6 :width of calcaneus(mm) ORSF ORPF T P AO 42.94 43.90 0.919 0.361 PO 48.50 49.44 1.007 0.317 1M 48.10 46.15 1.187 0.245 3M 48.55 49.42 0.518 0.609 6M 48.28 49.33 0.675 0.507 1Y 49.62 48.46 0.731 0.471 Table 7 :Height of calcaneus(mm) ORSF ORPF T P BO 79.84 79.01 0.468 0.641 PO 74.62 74.26 0.228 0.820 1M 71.79 69.95 0.777 0.443 3M 72.05 71.74 0.132 0.896 6M 72.69 71.30 0.350 0.730 1Y 73.69 71.95 0.965 0.344 Table 8 :length of calcaneus(mm) ORSF ORPF χ2 /t P Surface infection and postoperative pain 5(8.33%) 5(27.78%) 4.684 0.03 Remove internal fixation 12(20%) 6(33.33%) 1.387 0.239 Pain or discomfort while walking 4(6.67%) 2(11.11%) 0.385 0.535 AOFAS 93.56±0.73 91.63±7.67 0.670 0.507 Peroneal tendinitis 7(11.67%) 3(16.67%) 0.310 0.578 Table 9 : Postoperative complications and AOFAS score Additional Declarations No competing interests reported. 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08:27:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":184105,"visible":true,"origin":"","legend":"\u003cp\u003eplate fixation\u003c/p\u003e","description":"","filename":"figure11718192573028.png","url":"https://assets-eu.researchsquare.com/files/rs-4497178/v1/3ccac5b6a70c5c2e52e0168a.png"},{"id":59474417,"identity":"854f9467-78c6-4e04-9e79-c27850e7ab6a","added_by":"auto","created_at":"2024-07-02 08:27:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":120505,"visible":true,"origin":"","legend":"\u003cp\u003escrew fixation\u003c/p\u003e","description":"","filename":"figure21718192585528.png","url":"https://assets-eu.researchsquare.com/files/rs-4497178/v1/34e98d199c667b7146fe5f28.png"},{"id":59473917,"identity":"574c1923-3e4f-4294-bbae-090c83a10eb7","added_by":"auto","created_at":"2024-07-02 08:19:58","extension":"png","order_by":3,"title":"Figure 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7","display":"","copyAsset":false,"role":"figure","size":52910,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"figure71718104190674.png","url":"https://assets-eu.researchsquare.com/files/rs-4497178/v1/4e8aacdc0f67db8aae2adbea.png"},{"id":59474415,"identity":"683d2a71-8081-46b6-b331-d533ac0c5e43","added_by":"auto","created_at":"2024-07-02 08:27:58","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":58706,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"figure81718104196208.png","url":"https://assets-eu.researchsquare.com/files/rs-4497178/v1/3f9426461ad751e0b0ccdbfc.png"},{"id":77666023,"identity":"35e4cdda-6df0-4011-bbc9-632ac3ff0a56","added_by":"auto","created_at":"2025-03-04 06:02:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1454725,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4497178/v1/5ec169e2-8256-4f5a-b424-fd4be1237614.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical effect analysis of plate fixation and screw fixation via tarsal sinus approach in the treatment of Sander Ⅱ Ⅲand Ⅳ calcaneal fracture","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe calcaneus is the largest tarsal bone in the human body, It appears as an irregular rectangle. It is mainly composed of cancellous bone\u003csup\u003e[1]\u003c/sup\u003e. Fractures of the calcaneus are the most common type of tarsal bone injuries, and about 75% of total calcaneal fractures are intraarticular. Usually due to external trauma such as crushing or falling from a height\u003csup\u003e[2]\u003c/sup\u003e。X-ray is the most basic imaging examination method to determine calcaneal fracture and guide treatment including lateral and axial radiographs. Bohler and Gissane are important indicators on lateral radiographs. The former reflects the height of the calcaneus and the degree of joint compression, while the latter reflects the position and displacement of the joint, axial radiographs were used to evaluate the extent of calcaneal widening\u003csup\u003e[3]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe primary goal of treating calcaneal fractures is to reestablish the smooth articular surface and to restore the length, width, height, and alignment of the calcaneus. Typical surgical approaches involve the tarsal sinus incision and the lateral L-shaped incision. As minimally invasive techniques gain favor, tarsal sinus incisions are increasingly being utilized in clinical settings. Open reduction and plate fixation stand out as the prevailing methods for treatment in current clinical practice.\u003csup\u003e[4]\u003c/sup\u003e. Indeed, open reduction with screw internal fixation is increasingly gaining popularity in orthopedic procedures. The aim of this study was to assess the impact of screw fixation on the restoration of calcaneal height, width, length, angle, complications, and functional recovery in comparison to traditional plate fixation.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003eWe conducted a retrospective analysis of patients who were admitted to our department between December 2016 and December 2023 with calcaneal fractures. To be included in the study, patients needed to have a closed calcaneal fracture, imaging data available both before and after surgery, and complete follow-up information. Patients with fractures of other bones, a history of surgery, calcaneal tumors, or other severe complications were excluded from the study. Prior to surgery, each patient underwent lateral and axial radiographs and computed tomography scans of the affected calcaneus. The follow-up period ranged from 12 to 16 months, with an average of 13 months. Our study methodology was approved by an institutional review board, and all patients provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical technique:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Open reduction and plate fixation（Figure 1）\u003c/p\u003e\n\u003cp\u003eAfter the patient had been anesthetized, they were positioned on their side and the area was disinfected twice with 5% iodophor. A towel was then placed over the area, and a tourniquet was applied for 90 minutes at 40Kpa. A sinus tarsi incision was made from the tip of the fibula oblique to the base of the 4th metatarsal bone. The skin was cut, and the starting point of the short extensor toes was then cut and turned upward. The articular capsule was also incised. Two 3.0mm diameter K-wires were drilled into both sides of the Achilles tendon insertion point and then reset. A 3.0mm diameter K-wire was also drilled into the calcaneal tubercle from the outside in and pulled backward and downward to correct the shortening and inversion of the calcaneal bone, restoring its height and length. Rotation deformity was also corrected through prying, and temporary fixation was achieved using K-wires. Resettability was observed under fluoroscopy, and allograft bone was used to fill any large defects found. An steel plate was then inserted, and holes were drilled with the front two screws driven upward into the carrier process, while the rear screws were fixed in the calcaneal tubercles and the body. The subtalar articular surface was drilled again, and a 3.5mm diameter cortical bone screw was inserted to fix it. The lateral, Borden, and axial positions were then fixed satisfactorily under fluoroscopy. After irrigation, a drainage tube was inserted, and the starting point of the short extensor toe muscle was repaired before the incision was closed.\u003c/p\u003e\n\u003cp\u003e2. Open reduction and screw fixation（Figure 2）\u003c/p\u003e\n\u003cp\u003eAfter the patient had been anesthetized, they were positioned prone, the area was disinfected twice with 5% iodophor, and a towel was placed over the site. A tourniquet was applied at 40Kpa for 90 minutes. Two external stent screws were drilled into the calcaneal tubercles and reduced using the Westhues method to address the collapsed fracture. Following reduction, three K-wire guides were drilled: two to control the length of the calcaneus and one to the calcaneal process. Support fixation was achieved using 70mm and 60mm screws with a diameter of 5.5mm, while 44mm screws with a diameter of 3.5mm were utilized to pressurize and fix the calcaneal process. Allograft bone was then used to fill any significant defects. The lateral, Borden, and axial positions were satisfactorily fixed under fluoroscopy. After irrigation, a drainage tube was inserted, and the incision was closed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter the surgery, the affected limb was kept elevated to reduce swelling. The drainage tube was removed once the drainage volume was less than 20ml/day, and X-rays were reviewed. Patients were advised to begin exercising their toes and ankles early after surgery. The wound was cleaned with iodophor every two days until the stitches were absorbed and fell off.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasured outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCalcaneal width, height, length, Bohler Angle Gissane Angle and Angle of calcaneus varus were measured as anatomic parameters before surgery(BO), three days(PO), one month, three months, six months and one year after surgery. Wound complications and length of hospital stay were recorded. Clinical functional outcomes were evaluated using the\u0026nbsp;AOFAS scoring system\u0026nbsp;when the patients underwent a postoperative examination at\u0026nbsp;\u0026ge;1 year postoperatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS 22.0 software was used for statistical processing. The measurement data were represented by mean \u0026plusmn; standard deviation and compared by independent sample t test. The count data were represented by n(%), and the number of descriptive cases was compared by \u0026chi;2 test. P\u0026le;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003eA total of 73 patients and 78 feet with calcaneus fractures from 2016 to 2023 were studied. The ORPF group(18) was compared to ORSF group (60).There were 34 patients with sander type II, 22 patients with sander type III, and 4 patients with sander type IV in the ORSF group.In the ORPF group, there were 11 patients with sander type II, 5 with sander type III, and 2 with sander type IV. The rest of the data is shown in Table 1.\u003c/p\u003e\n\u003cp\u003eThe average operative time for the ORSF group was \u0026nbsp;118.93\u0026plusmn;60.41 minutes, while for the ORPF group, it was 158.72\u0026plusmn;82.45 minutes (p=0.028). In terms of intraoperative bleeding, the ORSF group experienced 53.17\u0026plusmn;49.21ml, whereas the ORPF group had 88.33\u0026plusmn;79.65ml (p=0.026).Regarding the time elapsed from injury to surgery, the ORSF group had an average of 8.87\u0026plusmn;6.07 days, compared to 11.47\u0026plusmn;9.74 days in the ORPF group (p=0.181). The postoperative hospitalization duration was 7.6\u0026plusmn;7.72 days for the ORSF group and 11.59\u0026plusmn;6.55 days for the ORPF group (p=0.056).\u003c/p\u003e\n\u003cp\u003eThe postoperative data of the two groups compared with the preoperative data suggested that the two fixation methods were effective. The gissane Angle increased from 104.28\u0026plusmn;4.85\u0026deg; before operation to 114.47\u0026plusmn;5.13\u0026deg; after operation in ORSF group, and from 102.15\u0026plusmn;5.56\u0026deg; before operation to 114.46\u0026plusmn;4.88\u0026deg;after operation in ORPF group. The bohler Angle increased from 13.90\u0026plusmn;6.27\u0026deg; before operation to 23.67\u0026plusmn;4.89\u0026deg; after operation in the ORSF group, and from 12.35\u0026plusmn;6.63\u0026deg; before operation to 25.93\u0026plusmn;5.94\u0026deg; after operation in the ORPF group. The Angle of calcaneus varus decreased from 12.36\u0026plusmn;5.15\u0026deg; before operation to 7.40\u0026plusmn;2.19\u0026deg; after operation in ORSF group, and from 14.29\u0026plusmn;4.29\u0026deg; before operation to 7.93\u0026plusmn;2.15\u0026deg; after operation in ORPF group. The calcaneus width decreased from 47.90\u0026plusmn;4.45mm to 43.12\u0026plusmn;3.98mm in ORSF group and from 48.61\u0026plusmn;3.81mm to 42.59\u0026plusmn;3.58mm in ORPF group. The length of calcaneus decreased from 79.84\u0026plusmn;6.59mm before operation to 74.61\u0026plusmn;5.85mm after operation in ORSF group, and from 79.01\u0026plusmn;6.72mm to 74.26\u0026plusmn;6.01mm in ORPF group. The calcaneus height in OPSF group increased from 42.94mm before surgery to 48.50mm after surgery. The ORPF group increased from 43.90mm before surgery to 49.44mm after surgery. The differences in the above data were not statistically significant. There was no statistically significant difference in the data of these 6 items at 1 month, 3 months, 6 months and 1 year after surgery. Only in 3 months, ORPF group had lower varus Angle of calcaneus than ORSF group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e5 patients(8.33％) in the ORSF group developed soft tissue complications, including surface infection and pain.5 patients(27.78%) in the ORPF group developed soft tissue complications. There were no cases of wound nonunion or chronic osteomyelitis in either group.12 patients(20%) in the ORSF group had screws removed at least one year after surgery, including 4 patients(6.67%) who had internal fixation devices removed because of pain or discomfort while walking.6 patients(33.33%) in the ORPF group had plates removed, 2 of whom(11.11%) had Pain or discomfort while walking. 7(11.67%) patients in the ORSF group developed persistent lateral posterior foot pain, which we call peroneal tendinitis. 3(16.67%) patients in the ORPF group had the same symptoms. At the last follow-up, the AOFAS score was 93.56\u0026plusmn;7.28 in the ORSF group and 91.63\u0026plusmn;7.67 in the ORPF group. There was no significant difference between the two groups (p=0.507).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe calcaneus is the most considerable weight-bearing tarsal bone, which makes it vulnerable to injury. The purpose of calcaneal fracture treatment is to restore the normal anatomic relationship of calcaneal bone, maintain the stability after reduction, and maximize the recovery of the function of the affected foot\u003csup\u003e[5]\u003c/sup\u003e.The main complications after calcaneal fracture surgery were infection and flap necrosis (13.6%), neurovascular injury (2.8%), post-traumatic arthritis (1.2%), poor reduction (0.8%), and nonunion (0.1%). Other literature has shown that the incidence of serious infection after closed calcaneal fracture is 0\u0026ndash;20%, and osteomyelitis after open calcaneal fracture is as high as 19%-31%\u003csup\u003e[6]\u003c/sup\u003e. This may be related to the lack of soft tissue around the calcaneus and the degree of soft tissue injury. In addition, the degree of calcaneal fracture, the age of the patient, smoking, and other underlying diseases all have an impact on wound healing\u003csup\u003e[7]\u003c/sup\u003e. More and more physicians are choosing to use minimally invasive techniques to treat displaced intraarticular calcaneal fractures, including the Palmer approach\u003csup\u003e[8]\u003c/sup\u003e, Smile incision\u003csup\u003e[9]\u003c/sup\u003e, Ollier approach\u003csup\u003e[10]\u003c/sup\u003e, and tarsal sinus approach\u003csup\u003e[11, 12]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePlate effectively resists rotational and axial stresses to achieve stable fixation and has the expected low rates of loosening and failure of fixation\u003csup\u003e[13]\u003c/sup\u003e, with no screw loosening or plate breakage occurring during follow-up in our case series. For patients with screw fixation alone, the calcaneal fracture block is stabilized using three screws, representing the most biomechanically sound fixation approach. The initial screw is directed inward from the lateral wall towards the carrier process, traversing beneath the subtalar articular surface horizontally, thus providing robust support for the reduced articular surface. Subsequently, the second and third screws are positioned along the coronal plane, extending from the calcaneal tubercle towards the anterior aspect of the calcaneus near the calcaneocuboid joint\u003csup\u003e[14]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our study of 60 cases that underwent open reduction screw fixation, we found that the Bohler Angle, Gissane Angle, calcaneal width, calcaneal length, calcaneal height, calcaneal varus Angle, and calcaneal function were restored to clinically acceptable levels, comparable to those observed in patients who underwent open reduction plate fixation. Furthermore, we observed good fixation strength during long-term follow-up after surgery. The Angle of Bohler's and Gissane's is an important parameter for evaluating the shape of calcaneum bone, which has a significant impact on clinical therapeutic effect\u003csup\u003e[15]\u003c/sup\u003e. Research indicates that an increase in calcaneal bone width can potentially result in lateral impingement syndrome, also known as peroneal tenosynovitis. Individuals who experience calcaneal fractures, particularly those with dislocated intra-articular fractures, often endure long-term chronic complications. Among these, lateral hindfoot pain stands out as one of the most prevalent sequelae, impacting the quality of life and mobility of affected patients.\u003csup\u003e[16]\u003c/sup\u003e.In foot movement, the lateral wall of the calcaneus is rubbed against the peroneal tendon, causing pain below the lateral malleolus\u003csup\u003e[17, 18]\u003c/sup\u003e. Our study demonstrated that the two surgical modalities had a similar ability to restore calcaneus width, which was supported by long-term postoperative follow-up results.\u003c/p\u003e \u003cp\u003eCompared with plate, screw fixation causes less bleeding, shorter operative time, and fewer short postoperative complications. When using screws, the primary purpose of a tarsal sinus incision is to reduce the articular surface under direct vision without extensive subcutaneous tissue dissection as with plates\u003csup\u003e[19]\u003c/sup\u003e. The tension around the edge of the incision increases after plate insertion, which is also detrimental to soft tissue repair\u003csup\u003e[20]\u003c/sup\u003e. Our study also confirmed that the ORSF group had fewer postoperative soft tissue complications than the ORPF group. The study's follow-up analysis revealed that there were no statistically significant differences in AOFAS scores and long-term complication rates between the two surgical methods, at the last follow-up. These findings provide further evidence that both surgical techniques are equally effective in preserving articular surface stability and restoring calcaneal function.\u003c/p\u003e \u003cp\u003eOur trial had several limitations, including fewer patients in the ORPF group, fewer patients with Sander type IV fractures, shorter follow-up times, and retrospective and single-center design, such that the effect of selection bias cannot be denied.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBoth open reduction screw internal fixation and open reduction plate internal fixation have been shown to be effective methods for clinically treating calcaneal fractures, with both techniques yielding positive postoperative imaging results. However, internal fixation with open reduction screws has been found to have several advantages over open reduction plate internal fixation, including less bleeding, shorter operation time, and fewer short-term complications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding is available for this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the manuscript. All authors contributed to the article. Study design has been suggested by Shichang Gao. Mingming Yang and Anlin Liang performed the operations. Data were collected and analyzed by Hongxian Zhao and Zijia Wang. The manuscript was drafted and designed by Hongxian Zhao. Shichang Gao revised the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to individual privacy of participants but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll experimental protocols were approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University. All procedures performed in studies were in accordance with the 1964 Helsinki declaration. All patients involved in this study gave their consent for the participation, and the informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients involved in this study gave their consent for the anonymized data to be used for scientific purposes and published in a scientific journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest regarding the publication of this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eN. Wei, Y. Zhou, W. Chang, Y. Zhang and W. Chen, Displaced Intra-articular Calcaneal Fractures: Classification and Treatment, Orthopedics 40 (2017) e921-e929.\u003c/li\u003e\n\u003cli\u003eS. Rammelt, C. Marx, G. Swords and M. Swords, Recognition, Treatment, and Outcome of Calcaneal Fracture-Dislocation, Foot \u0026amp; ankle international 42 (2021) 706-713.\u003c/li\u003e\n\u003cli\u003eJ. Xiao, Z. Xin, X. Fu, J. Huang, B. Zhang and H. Yu, Treatment of Fracture of the Calcaneus via Bone Axial X-Ray Image-Based Minimally Invasive Approach, Computational and mathematical methods in medicine 2022 (2022) 3012589.\u003c/li\u003e\n\u003cli\u003eG. Zhang, S. Ding and Z. Ruan, Minimally invasive treatment of calcaneal fracture, The Journal of international medical research 47 (2019) 3946-3954.\u003c/li\u003e\n\u003cli\u003eB. E. Scammell, Calcaneal fractures, BMJ (Clinical research ed.) 349 (2014) g4779.\u003c/li\u003e\n\u003cli\u003eM. P. Clare and W. S. Crawford, Managing Complications of Calcaneus Fractures, Foot and ankle clinics 22 (2017) 105-116.\u003c/li\u003e\n\u003cli\u003eC. Bibbo, N. Siddiqui, J. Fink, J. Powers, D. A. Ehrlich and S. J. Kovach, Wound Coverage Options for Soft Tissue Defects Following Calcaneal Fracture Management (Operative/Surgical), Clinics in podiatric medicine and surgery 36 (2019) 323-337.\u003c/li\u003e\n\u003cli\u003eI. Palmer, The mechanism and treatment of fractures of the calcaneus; open reduction with the use of cancellous grafts, The Journal of bone and joint surgery. American volume 30a (1948) 2-8.\u003c/li\u003e\n\u003cli\u003eW. B. Wiley, J. D. Norberg, C. J. Klonk and I. J. Alexander, \u0026quot;Smile\u0026quot; incision: an approach for open reduction and internal fixation of calcaneal fractures, Foot \u0026amp; ankle international 26 (2005) 590-592.\u003c/li\u003e\n\u003cli\u003eT. Schepers, B. C. Kieboom, G. H. Bessems, L. M. Vogels, E. M. van Lieshout and P. Patka, Subtalar versus triple arthrodesis after intra-articular calcaneal fractures, Strategies in trauma and limb reconstruction 5 (2010) 97-103.\u003c/li\u003e\n\u003cli\u003eN. Gould, Lateral approach to sinus tarsi, Foot \u0026amp; ankle 3 (1983) 244-246.\u003c/li\u003e\n\u003cli\u003eT. Schepers, The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review, International orthopaedics 35 (2011) 697-703.\u003c/li\u003e\n\u003cli\u003eC. H. Chen, C. Hung, Y. C. Hsu, C. S. Chen and C. C. Chiang, Biomechanical evaluation of reconstruction plates with locking, nonlocking, and hybrid screws configurations in calcaneal fracture: a finite element model study, Medical \u0026amp; biological engineering \u0026amp; computing 55 (2017) 1799-1807.\u003c/li\u003e\n\u003cli\u003eB. W. Bussewitz and C. F. Hyer, Screw placement relative to the calcaneal fracture constant fragment: an anatomic study, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 54 (2015) 392-394.\u003c/li\u003e\n\u003cli\u003eJ. Persson, S. Peters, S. Haddadin, P. F. O\u0026apos;Loughlin, C. Krettek and R. Gaulke, The prognostic value of radiologic parameters for long-term outcome assessment after an isolated unilateral calcaneus fracture, Technology and health care : official journal of the European Society for Engineering and Medicine 23 (2015) 285-298.\u003c/li\u003e\n\u003cli\u003eW. Chen, X. Li, Y. Su, Q. Zhang, W. R. Smith, X. Zhang and Y. Zhang, Peroneal tenography to evaluate lateral hindfoot pain after calcaneal fracture, Foot \u0026amp; ankle international 32 (2011) 789-795.\u003c/li\u003e\n\u003cli\u003eM. Q. Potter and J. A. Nunley, Long-term functional outcomes after operative treatment for intra-articular fractures of the calcaneus, The Journal of bone and joint surgery. American volume 91 (2009) 1854-1860.\u003c/li\u003e\n\u003cli\u003eD. Makki, H. M. Alnajjar, S. Walkay, U. Ramkumar, A. J. Watson and P. W. Allen, Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases, The Journal of bone and joint surgery. British volume 92 (2010) 693-700.\u003c/li\u003e\n\u003cli\u003eJ. A. Humphrey, A. Woods and A. H. N. Robinson, The epidemiology and trends in the surgical management of calcaneal fractures in England between 2000 and 2017, The bone \u0026amp; joint journal 101-b (2019) 140-146.\u003c/li\u003e\n\u003cli\u003eT. L. Nosewicz, S. A. Dingemans, M. Backes, J. S. K. Luitse, J. C. Goslings and T. Schepers, A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures, Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons 25 (2019) 580-588.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003eORSF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003eORPF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.520210896309315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026chi;2 /t\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.344463971880494%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e43.2\u0026plusmn;11.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e45.16\u0026plusmn;10.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.520210896309315%\" valign=\"top\"\u003e\n \u003cp\u003e0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.344463971880494%\" valign=\"top\"\u003e\n \u003cp\u003e0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.16871704745167%\" rowspan=\"2\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.520210896309315%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.344463971880494%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.724137931034484%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.13793103448276%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.13793103448276%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.520210896309315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.344463971880494%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003eSander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.520210896309315%\" valign=\"top\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.344463971880494%\" valign=\"top\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003eⅣ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.520210896309315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.344463971880494%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.16871704745167%\" rowspan=\"2\"\u003e\n \u003cp\u003eSide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.520210896309315%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.344463971880494%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.724137931034484%\" valign=\"top\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.13793103448276%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.13793103448276%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.16871704745167%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e24.07\u0026plusmn;3.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.398945518453427%\" valign=\"top\"\u003e\n \u003cp\u003e24.19\u0026plusmn;3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.520210896309315%\" valign=\"top\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.344463971880494%\" valign=\"top\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e:general information\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.751773049645394%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.80851063829787%\" valign=\"top\"\u003e\n \u003cp\u003eORSF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.0354609929078%\" valign=\"top\"\u003e\n \u003cp\u003eORPF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.702127659574469%\" valign=\"top\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.702127659574469%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.751773049645394%\" valign=\"top\"\u003e\n \u003cp\u003eOperation time(min)\u003c/p\u003e\n \u003cp\u003eintraoperative bleeding(ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.80851063829787%\" valign=\"top\"\u003e\n \u003cp\u003e118.93\u0026plusmn;60.41\u003c/p\u003e\n \u003cp\u003e53.17\u0026plusmn;49.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.0354609929078%\" valign=\"top\"\u003e\n \u003cp\u003e158.72\u0026plusmn;82.45\u003c/p\u003e\n \u003cp\u003e88.33\u0026plusmn;79.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.702127659574469%\" valign=\"top\"\u003e\n \u003cp\u003e2.244\u003c/p\u003e\n \u003cp\u003e2.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.702127659574469%\" valign=\"top\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.751773049645394%\" valign=\"top\"\u003e\n \u003cp\u003epostoperative hospitalization duration(days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.80851063829787%\"\u003e\n \u003cp\u003e7.6\u0026plusmn;7.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.0354609929078%\"\u003e\n \u003cp\u003e11.59\u0026plusmn;6.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.702127659574469%\"\u003e\n \u003cp\u003e1.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.702127659574469%\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.751773049645394%\" valign=\"top\"\u003e\n \u003cp\u003eThe time between operation and injury(days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.80851063829787%\"\u003e\n \u003cp\u003e8.87\u0026plusmn;6.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.0354609929078%\"\u003e\n \u003cp\u003e11.47\u0026plusmn;9.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.702127659574469%\"\u003e\n \u003cp\u003e1.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.702127659574469%\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e:perioperative indicators\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eORSF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eORPF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eBO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e104.28\u0026plusmn;4.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e102.15\u0026plusmn;5.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003ePO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e114.47\u0026plusmn;5.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e114.46\u0026plusmn;4.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.991\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e115.64\u0026plusmn;5.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e116.38\u0026plusmn;6.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.805\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e3M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e114.40\u0026plusmn;6.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e114.70\u0026plusmn;5.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e115.52\u0026plusmn;4.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e115.31\u0026plusmn;4.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.928\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e116.61\u0026plusmn;3.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e118.90\u0026plusmn;5.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e:Gissane angle(\u0026deg;)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eORSF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eORPF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eBO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e13.9\u0026plusmn;6.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e12.35\u0026plusmn;6.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.909\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003ePO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e23.66\u0026plusmn;4.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e25.93\u0026plusmn;5.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e24.50\u0026plusmn;5.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e27.30\u0026plusmn;5.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e3M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e25.11\u0026plusmn;4.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e28.34\u0026plusmn;3.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e23.61\u0026plusmn;3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e26.38\u0026plusmn;4.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e24.27\u0026plusmn;3.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e26.35\u0026plusmn;4.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 4\u003c/strong\u003e:Bohler angle(\u0026deg;)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eORSF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eORPF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eBO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e12.36\u0026plusmn;6.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e14.29\u0026plusmn;4.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003ePO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e7.40\u0026plusmn;2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e7.93\u0026plusmn;2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.377\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6.86\u0026plusmn;2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8.14\u0026plusmn;1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e3M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6.26\u0026plusmn;2.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e8.25\u0026plusmn;1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e2.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6.83\u0026plusmn;1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e7.87\u0026plusmn;1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6.95\u0026plusmn;1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e7.81\u0026plusmn;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e:calcaneal varus Angle(\u0026deg;)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eORSF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eORPF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eAO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e47.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e48.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.538\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003ePO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e43.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e42.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.608\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e41.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e40.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.797\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e3M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e41.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e40.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.526\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e41.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e40.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e41.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e39.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u003c/strong\u003e:width of calcaneus(mm)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eORSF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eORPF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eAO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e42.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e43.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.919\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003ePO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e48.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e49.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e48.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e46.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e3M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e48.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e49.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.518\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e48.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e49.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e49.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e48.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7\u003c/strong\u003e:Height of calcaneus(mm)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eORSF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eORPF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eBO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e79.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e79.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.641\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003ePO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e74.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e74.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.820\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e71.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e69.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.443\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e3M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e72.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e71.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.896\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e6M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e72.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e71.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.730\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e1Y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e73.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e71.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.965\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8\u003c/strong\u003e:length of calcaneus(mm)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92253521126761%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003eORSF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.8943661971831%\" valign=\"top\"\u003e\n \u003cp\u003eORPF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.549295774647888%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026chi;2 /t\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92253521126761%\" valign=\"top\"\u003e\n \u003cp\u003eSurface infection and\u0026nbsp;postoperative\u0026nbsp;pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\"\u003e\n \u003cp\u003e5(8.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.8943661971831%\"\u003e\n \u003cp\u003e5(27.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.549295774647888%\"\u003e\n \u003cp\u003e4.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92253521126761%\" valign=\"top\"\u003e\n \u003cp\u003eRemove internal fixation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e12(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.8943661971831%\" valign=\"top\"\u003e\n \u003cp\u003e6(33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.549295774647888%\" valign=\"top\"\u003e\n \u003cp\u003e1.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92253521126761%\" valign=\"top\"\u003e\n \u003cp\u003ePain or discomfort while walking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\"\u003e\n \u003cp\u003e4(6.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.8943661971831%\"\u003e\n \u003cp\u003e2(11.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.549295774647888%\"\u003e\n \u003cp\u003e0.385\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\"\u003e\n \u003cp\u003e0.535\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92253521126761%\" valign=\"top\"\u003e\n \u003cp\u003eAOFAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e93.56\u0026plusmn;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.8943661971831%\" valign=\"top\"\u003e\n \u003cp\u003e91.63\u0026plusmn;7.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.549295774647888%\" valign=\"top\"\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.92253521126761%\" valign=\"top\"\u003e\n \u003cp\u003ePeroneal tendinitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.309859154929576%\" valign=\"top\"\u003e\n \u003cp\u003e7(11.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.8943661971831%\" valign=\"top\"\u003e\n \u003cp\u003e3(16.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.549295774647888%\" valign=\"top\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.32394366197183%\" valign=\"top\"\u003e\n \u003cp\u003e0.578\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9\u003c/strong\u003e: Postoperative complications and AOFAS score\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4497178/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4497178/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThe aim of this study is to compare the efficacy of plate fixation via the tarsal sinus approach with screw fixation alone in treating Sander type II, III, and IV fractures.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eBetween 2016 and 2023, a comprehensive study encompassing 73 patients and 78 feet with calcaneus fractures was conducted. The investigation compared the efficacy of open reduction plate fixation (ORPF) (18 cases) against open reduction screw fixation (ORSF) (60 cases). Parameters such as operation duration, intraoperative blood loss, hospital stay duration, postoperative imaging metrics (including calcaneal length, width, height, Bohler Angle, Gissane Angle, and Angle of calcaneus varus), postoperative complications, and the AOFAS score one year post-surgery were meticulously analyzed and compared across both treatment groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eNo significant discrepancies were observed between the two groups concerning calcaneal dimensions, including length, width, height, Bohler Angle, Gissane Angle, and Angle of calcaneus varus post-operation (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Moreover, throughout the long-term postoperative monitoring period, no notable distinctions were evident in these parameters between the two groups. Notably, the ORSF group exhibited reduced intraoperative hemorrhage (p\u0026thinsp;=\u0026thinsp;0.026), shorter procedural duration (p\u0026thinsp;=\u0026thinsp;0.028), and fewer occurrences of postoperative complications such as pain or superficial infections. However, the incidence of long-term postoperative complications did not demonstrate statistical significance. Furthermore, there were no discernible variations in AOFAS scores between the groups at the latest follow-up assessment.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBoth open reduction screw internal fixation and open reduction plate internal fixation have been shown to be effective methods for clinically treating calcaneal fractures, with both techniques yielding positive postoperative imaging results. However, internal fixation with open reduction screws has been found to have several advantages over open reduction plate internal fixation, including less bleeding, shorter operation time, and fewer short-term complications.\u003c/p\u003e","manuscriptTitle":"Clinical effect analysis of plate fixation and screw fixation via tarsal sinus approach in the treatment of Sander Ⅱ Ⅲand Ⅳ calcaneal fracture","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-02 08:19:53","doi":"10.21203/rs.3.rs-4497178/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9ae06a4a-823e-4e9b-97d0-75cca119b1c5","owner":[],"postedDate":"July 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-04T05:38:38+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-02 08:19:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4497178","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4497178","identity":"rs-4497178","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}