Hui Wei-Jun, Chen Xiang-Hong, Zhang En-Bin, Yuan Zhi-Min, Wen Jing-Rong, Li Kang
Department of Orthopaedics, Gannan Tibetan Autonomous Prefecture People's Hospital, Hezuo, China.
Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China.
Int J Surg Case Rep. 2025 Sep;134:111671. doi: 10.1016/j.ijscr.2025.111671. Epub 2025 Jul 14.
Calcaneal fractures account for approximately 2 % of all fractures and are the most common tarsal fractures. The majority are caused by high-energy trauma, and 75 % of them are intra-articular fractures. Sustentaculum tali fracture often occurs concomitantly with severe calcaneal fractures. Isolated fractures of the sustentaculum tali are extremely uncommon, accounting for merely 1 % of calcaneal fractures. They are quite challenging to manage and there is no established surgical gold standard.
We reported a case of a young adult male patient who presented with pain and limited mobility in the right ankle after a rollover accident. CT scan revealed an isolated comminuted sustentaculum tali fracture. We performed open reduction via a medial approach and fixed the fracture with cannulated screws combined with a mini-plate. At the one-month postoperative follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) score reported good clinical outcome(84).Postoperative CT scans showed satisfactory fracture reduction and safe position of the internal fixation.
For isolated calcaneal sustentaculum tali comminuted fractures, we adopted anatomical reduction and fixation with cannulated screws combined with mini-plate fixation. This method enhances the supporting force, prevents lateral bone plate displacement, and avoids flexor tendon wear and nerve irritation caused by angular healing of the lateral bone plate. The postoperative results were satisfactory with no complications.
Cancellous screw combined with mini-plate fixation for sustentaculum tali fracture resulted in stablishing a firm fixation of sustentaculum tali fracture fragment into calcaneus bone, this fixation method demonstrates strong theoretical feasibility and can serve as a reference for clinicians.
跟骨骨折约占所有骨折的2%，是最常见的跗骨骨折。大多数由高能创伤引起，其中75%为关节内骨折。载距突骨折常与严重的跟骨骨折同时发生。孤立的载距突骨折极为罕见，仅占跟骨骨折的1%。其治疗颇具挑战性，且尚无既定的手术金标准。
我们报告了一例年轻成年男性患者，在翻车事故后出现右踝疼痛及活动受限。CT扫描显示为孤立的载距突粉碎性骨折。我们通过内侧入路进行切开复位，并用空心螺钉结合微型钢板固定骨折。术后1个月随访时，美国矫形足踝协会（AOFAS）评分显示临床效果良好（84分）。术后CT扫描显示骨折复位满意，内固定位置安全。
对于孤立的跟骨载距突粉碎性骨折，我们采用解剖复位并用空心螺钉结合微型钢板固定。该方法增强了支撑力，防止外侧骨板移位，避免了外侧骨板成角愈合引起的屈肌腱磨损和神经刺激。术后结果满意，无并发症。
松质骨螺钉结合微型钢板固定载距突骨折可使载距突骨折块牢固固定于跟骨，该固定方法具有较强的理论可行性，可为临床医生提供参考。
