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Kayali H, Moghamis I, Radi M, Baroudi O, Hantouly A, Toubasi A, Foodoul MA, Alkhayarin M, Ahmed G. The role of patient positioning in surgical fixation of the calcaneus fractures using the lateral extensile approach. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1529-1534. [PMID: 38265742 PMCID: PMC10980634 DOI: 10.1007/s00590-023-03829-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Calcaneus is the most commonly fractured tarsal bone. Open reduction and internal fixation of the displaced intra-articular fractures is considered the gold standard treatment. The lateral extensile approach is the most commonly used approach, and usually, the patients are kept in lateral decubitus position. Recent study has descried calcaneus fracture fixation utilizing the lateral extensile approach with the patient in prone position. The aim of this study was to compare the postoperative radiological outcome, reoperation rate, operative and anesthesia time, infection and the wound complications rate between the two groups. METHODS The data of 49 adult patients with unilateral closed calcaneus fracture underwent open reduction and internal fixation using lateral extensile approach were collected. Postoperative Bohler's, Gissane angles and complications rate were compared between the two groups. RESULTS A total of 49 patients were included. Lateral position was utilized in 26 patients (53.1%), while 23 patients (46.9%) were operated in prone position. Majority of the patients were males 87.8% (43 patients), and the mean age of the patients was 31.12 ± 7.50. The most commonly mechanism of injury was fall from height in (91.8%) of the patients. The mean preoperative Bohler's angle was 9.33 ± 13.07 and increased to 22.69 ± 9.15 postoperatively. The mean preoperative angle of Gissane was 130.45 ± 26.98 whereas it was 124.76 ± 17.20 postoperatively. The mean postoperative Bohler's angle and angle of Gissane were significantly higher among patient who underwent fixation in lateral position (25.88 ± 6.62, 137.15 ± 11.17) when compared to the prone one (19.09 ± 10.35, 110.74 ± 10.81). There was no significant difference between the two groups regarding the reoperation rate (p 0.947), infection (p 0.659, operative time (p 0.688), anesthesia time (p 0.522) and wound complications (p 0.773). CONCLUSION Surgical restoration of the Bohler's and Gissane's angles with the patient placed in the lateral decubitus position remains superior to the prone position with no difference in the complication rate between the two groups.
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Affiliation(s)
- Hammam Kayali
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Isam Moghamis
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Radi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Omar Baroudi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Toubasi
- School of Medicine, University of Jordan, Amman, Jordan
| | - Mazen A Foodoul
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Alkhayarin
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
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Checa-Betegón P, Valle-Cruz J, Llanos-Sanz S, Miguel-Miguel C, Sánchez-Del-Saz J, García-Coiradas J. External fixation in intra-articular fractures of the calcaneus: Is it a valid option as definitive treatment? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:201-208. [PMID: 37402889 DOI: 10.1007/s00590-023-03621-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/11/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION The therapeutic management of calcaneal fractures is currently a major source of controversy in the literature. There is no consensus on the need to treat these injuries conservatively or surgically, nor on the criteria for deciding one option or the other. Although the gold standard has classically been the open approach and osteosynthesis, there are currently minimally invasive techniques that also report good results. Our objective is to present our results and experience with the MBA® Orthofix external fixator in a series of cases of calcaneal fractures. METHODS We performed a retrospective observational study in our center, between the years 2019 and 2021, of Sanders types II-IV calcaneal fractures operated with MBA® Orthofix external fixator. We recorded a total of 38 patients, 42 fractures. We registered demographic information, intraoperative, postoperative, radiological and functional parameters, using the American Orthopedic Foot and Ankle Society (AOFAS), Manchester-Oxford Foot Questionnaire (MOXFQ), EQ-5D and VAS scales. RESULTS A total of 26 men and 12 women were included, and the median age was 38 years. Mean follow-up was 24,4 months (6, 8-40, 1). The average time to surgery was 7 days and partial loading was started at 2.5 weeks after external fixation, which was removed at 9.2 weeks. The average Böhler angle correction was 7, 4°, Gissane - 12,2°, length 2 mm and calcaneal width was reduced by 5 mm. We recorded two superficial infections, one peroneal entrapment and three subtalar arthrodesis due to post-traumatic osteoarthritis. The AOFAS obtained was 79.1 + / - 15.7 points, MOXFQ 20.1 + / - 16.1 points, EQ-5D 0.84 + / - 0.2 and VAS 3.3 + / - 1.9. CONCLUSION The external fixator is an excellent surgical alternative for complex articular fractures of the calcaneus, obtaining clinical and radiological results comparable to other osteosynthesis techniques and significantly reducing soft tissue complications.
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Affiliation(s)
- P Checa-Betegón
- Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain.
- Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain.
| | - J Valle-Cruz
- Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain
| | - S Llanos-Sanz
- Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain
| | - C Miguel-Miguel
- Complejo Hospitalario de Navarrra., C. de Irunlarrea, 3, 31008, Pamplona, Spain
| | - J Sánchez-Del-Saz
- Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain
| | - J García-Coiradas
- Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain
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Mao J, Li D, Yin S, Wu P, Gao M, Wen S, Xu Q. Management of calcaneus fractures by a new “Below-the-ankle” ilizarov frame: A series of 10 cases. Niger J Clin Pract 2022; 25:1143-1148. [DOI: 10.4103/njcp.njcp_1762_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Muir RL, Forrester R, Sharma H. Fine Wire Circular Fixation for Displaced Intra-Articular Calcaneal Fractures: A Systematic Review. J Foot Ankle Surg 2019; 58:755-761. [PMID: 31130477 DOI: 10.1053/j.jfas.2018.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Indexed: 02/03/2023]
Abstract
Intra-articular calcaneal fractures represent an ongoing challenge for the orthopedic community, with the benefits of the previous "gold standard" treatment of open reduction and internal fixation having been called into question in several large randomized controlled trials. Fine wire circular fixation may represent a useful alternative treatment for these injuries, combining minimally invasive application with rigid fixation, which allows the possibility of early weight bearing We performed a systematic review of published studies that used circular fixation for calcaneal fractures and recorded functional outcomes at follow-up. In a total of 11 studies with 255 calcaneal fractures for which there was follow-up, our inclusion criteria were met: 8.2% of fractures were bilateral, 11.9% of fractures were open fractures, and 12.6% of patients had multiple orthopedic injuries. Functional outcomes were assessed with the use of a variety of tools across the different studies, but outcomes compared favorably with those seen with open reduction and internal fixation. Although pin site infections were common (22.6%), serious complications, including deep infection (0.8%), wound infection (1.6%), and complex regional pain syndrome (0.8%), were exceedingly rare. The results suggest that this is a viable alternative treatment for calcaneal fractures, but higher-quality randomized controlled trials are required before the technique can enter mainstream use.
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Affiliation(s)
- Ross L Muir
- Specialist Registrar, Leeds General Infirmary, Leeds, United Kingdom.
| | | | - Hemant Sharma
- Professor, Hull Royal Infirmary, Hull, United Kingdom
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Intraoperative Reduction Techniques for Surgical Management of Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:269-277. [PMID: 30784536 DOI: 10.1016/j.cpm.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Fractures of the calcaneus are detrimental injuries, often caused by high-energy trauma. To best restore the functionality of a limb and allow normal ambulation, it is recommended to repair displaced intra-articular calcaneus fractures surgically. This article presents several methods of reduction and repair of the calcaneus. Traditionally, calcaneal fractures have been repaired through a lateral extensile incision that has been shown to have a high percentage of wound healing complications. In recent times, there has been a shift toward minimally invasive and sinus tarsi incisional approaches in the repair of calcaneus fractures.
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Meng Q, Wang Q, Wu X, Peng A, Yan J. Clinical application of the sinus tarsi approach in the treatment of intra-articular calcaneal fracture. Medicine (Baltimore) 2018; 97:e0175. [PMID: 29595648 PMCID: PMC5895366 DOI: 10.1097/md.0000000000010175] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To observe the clinical outcome of the sinus tarsi approach in the operative treatment of intra-articular calcaneal fractures.Forty-nine intra-articular calcaneal fractures in 45 patients were managed surgically with sinus tarsi approach. The anatomical plate and compression bolts were applied in 14 feet. The anatomical plate and screws were applied in 35 feet. Maryland foot score system was used to evaluate the function of the hindfoot at the followup.The reduction of the posterior facet was graded as nearly anatomical (less than 2 mm articular displacement) in 46 feet (93.9%). The width, height, and Böhler angle were significantly improved in all patients (P < .01). After a mean follow-up period of 18.7 months (14.5-29 months), the Maryland foot scores were: 34 feet scored 90-100 points (excellent), 6 feet scored 80-90 points (good), 6 feet scored 70-80 points (fair), and 3 feet scored 60-70 points (poor). Incision-edge necrosis occurred in 2 cases. One case suffered from incomplete medial plantar nerve injury. One case suffered from heel pad branch of the tibial nerve injury. Six cases suffered from sural nerve injury, and 4 cases sustained a lateral wound dehiscence due to a hematoma. No case suffered from lateral impingement syndrome. Up to now, no patient had to accept subtalar arthrodesis.Sinus tarsi approach provides good exposure to the subtalar joint. Open reduction and internal fixation of calcaneus fractures through a sinus tarsi approach allows adequate reduction with low risk of wound-healing complications.
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Giannini S, Cadossi M, Mosca M, Tedesco G, Sambri A, Terrando S, Mazzotti A. Minimally-invasive treatment of calcaneal fractures: A review of the literature and our experience. Injury 2016; 47 Suppl 4:S138-S146. [PMID: 27492063 DOI: 10.1016/j.injury.2016.07.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The optimal treatment of calcaneal fractures (CF) is currently controversial and is still under debate. It is well established that conservative treatment of these fractures is associated with poor results. Several surgical techniques are described in the literature; however, there is no consensus on which of these is more effective. The main goals of surgery are to restore the subtalar joint congruence, and calcaneal width, height, shape and alignment, thus avoiding medial and lateral impingement and enabling the patient to resume a normal lifestyle. ORIF is the most popular technique for these fractures, but it is associated with high rates of wound complications, hardware failure and infections. Several minimally-invasive techniques have been developed recently for the treatment of CF, with the common aim to be as simple, effective and inexpensive as possible and to reduce surgical times, complications and length of hospital stay.
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Affiliation(s)
- S Giannini
- Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - M Cadossi
- I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - M Mosca
- I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - G Tedesco
- I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - A Sambri
- I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - S Terrando
- I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - A Mazzotti
- I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy.
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Estudo comparativo entre três técnicas cirúrgicas para fraturas intra‐articulares de calcâneo: redução aberta e fixação interna com placa, fixação externa e minimamente invasiva. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Takasaka M, Bittar CK, Mennucci FS, de Mattos CA, Zabeu JLA. Comparative study on three surgical techniques for intra-articular calcaneal fractures: open reduction with internal fixation using a plate, external fixation and minimally invasive surgery. Rev Bras Ortop 2016; 51:254-60. [PMID: 27274478 PMCID: PMC4887438 DOI: 10.1016/j.rboe.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/10/2015] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate, compare and identify the surgical technique with best results for treating intra-articular calcaneal fractures, taking into account postoperative outcomes, complications and scoring in the Aofas questionnaire. Methods This was a retrospective study on 54 patients with fractures of the calcaneus who underwent surgery between 2002 and 2012 by means of the following techniques: (1) open reduction with extended L-shaped lateral incision and fixation with double-H plate of 3.5 mm; (2) open reduction with minimal incision lateral approach and percutaneous fixation with wires and screws; and (3) open reduction with minimal incision lateral approach and fixation with adjustable monoplanar external fixator. Results Patients treated using a lateral approach, with fixation using a plate had a mean Aofas score of 76 points; those treated through a minimal incision lateral approach with screw and wire fixation had a mean score of 71 points; and those treated through a minimal incision lateral approach with an external fixator had a mean score of 75 points. The three surgical techniques were shown to be effective for treating intra-articular calcaneal fractures, without any evidence that any of the techniques being superior. Conclusion Intra-articular calcaneal fractures are complex and their treatment should be individualized based on patient characteristics, type of fracture and the surgeon's experience with the surgical technique chosen.
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Affiliation(s)
- Missa Takasaka
- Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
| | - Cintia Kelly Bittar
- Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
| | - Fernando Saddi Mennucci
- Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
| | - Carlos Augusto de Mattos
- Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
| | - José Luís Amim Zabeu
- Hospital e Maternidade Celso Pierro, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
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Ramos RR, de Castro Filho CDC, Ramos RR, Bittar CK, de Cillo MSP, de Mattos CA, Zabeu JLA, Mazzuia AR. Surgical treatment of intra-articular calcaneal fractures: description of a technique using an adjustable uniplanar external fixator. Strategies Trauma Limb Reconstr 2014; 9:163-6. [PMID: 25540120 PMCID: PMC4278970 DOI: 10.1007/s11751-014-0207-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 12/16/2014] [Indexed: 12/05/2022] Open
Abstract
Several surgical techniques are available for the treatment of intra-articular calcaneal fractures. The use of a uniplanar external fixator is an option for the treatment of fractures classified as Sanders types 2 and 3. Satisfactory reduction and stabilisation of the fracture are achieved by means of mini-incisions and fixator adjustment. The advantages of this technique include less soft-tissue damage, avoidance of internal implants and early weight-bearing with the potential to improve postoperative recovery.
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Affiliation(s)
- Randal Rudge Ramos
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - Carlos Daniel Candido de Castro Filho
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - Roger Rudge Ramos
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - Cíntia Kelly Bittar
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - Mario Sérgio Paulilo de Cillo
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - Carlos Augusto de Mattos
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - José Luís Amim Zabeu
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
| | - Antenor Rafael Mazzuia
- Celso Pierro General and Maternity Hospital, Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop, s/n, Jardim Ipaussurama, Campinas, SP Brazil
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Wallin KJ, Cozzetto D, Russell L, Hallare DA, Lee DK. Evidence-based rationale for percutaneous fixation technique of displaced intra-articular calcaneal fractures: a systematic review of clinical outcomes. J Foot Ankle Surg 2014; 53:740-3. [PMID: 24795208 DOI: 10.1053/j.jfas.2014.03.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Indexed: 02/03/2023]
Abstract
Displaced intra-articular fractures of the calcaneus are complex and have a high degree of morbidity. Percutaneous fixation techniques have been advocated in an effort to minimize postoperative complications. We performed a systematic review of the clinical outcomes to describe and ascertain the different techniques and clinical outcomes for percutaneous treatment of displaced intra-articular calcaneal fractures. A review was performed using PubMed and Google Scholar, from January 2000 to December 2012, with studies ranging from case reports to prospective studies. The inclusion criteria consisted of percutaneous fixation techniques with objective findings (Sander's classification and Bohler's angle measurements) and clinical outcome scoring and complication and subtalar fusion rates. The exclusion criteria included studies with open or limited open procedures, the use of external fixation, the use of bone substitutes alone, and pathologic or open fractures. Data and evidence with a combination of objective findings and clinical outcomes are lacking. Several techniques for percutaneous fixation have been described, including Schanz pins and Kirschner wires, cannulated screws, arthroscopically guided percutaneous fixation, and application of bone substitute. A myriad of techniques are available for percutaneous intra-articular calcaneal fixation. The results from the current data appear to be promising; however, the lack of statistical power and inconsistent documentation have made it difficult to determine any superiority. The complication rates were much lower than those with open procedures, regardless of the technique. The percutaneous fixation technique appears to be a favorable option for displaced intra-articular calcaneal fractures.
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Affiliation(s)
- Kelly J Wallin
- Attending Surgeon, Department of Orthopaedic Surgery, Kaiser Permanente South Sacramento Medical Center, South Sacramento, CA
| | - Dana Cozzetto
- Postgraduate Year 3, Foot and Ankle Residency Program, Kaiser Foundation Hospital, Sacramento, CA
| | - Lindsay Russell
- Chief, Foot and Ankle Surgery, Department of Orthopaedic Surgery, Kaiser Permanente South Sacramento Medical Center, South Sacramento, CA
| | - Domingo A Hallare
- Chief, Orthopaedic Trauma, Department of Orthopaedic Surgery, Kaiser Permanente South Sacramento Medical Center, South Sacramento, CA
| | - Daniel K Lee
- Site Director, Foot and Ankle Surgery Residency Program, Department of Orthopaedic Surgery, Kaiser Permanente South Sacramento Medical Center, South Sacramento, CA.
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Fu TH, Liu HC, Su YS, Wang CJ. Treatment of displaced intra-articular calcaneal fractures with combined transarticular external fixation and minimal internal fixation. Foot Ankle Int 2013; 34:91-8. [PMID: 23386767 DOI: 10.1177/1071100712460364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate clinical outcomes after surgery for displaced intra-articular fractures using an external fixator and minimal internal fixation. METHODS In this retrospective observational study, a total of 39 patients (32 [82%] men and 7 [18%] women) with 48 displaced intra-articular calcaneal fractures were included. An extended lateral approach was used to stabilize fractures using multiple sagittal plane screws, axial percutaneous threaded Kirschner wires for the frontal fracture plane, and an external fixator for reduction assistance and maintenance. The following variables were assessed: preoperative and postoperative Böhler's angle; calcaneal length, height, and width; postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores; and complications. Mean duration of follow-up was 74 ± 26 months. RESULTS The mean time from surgery to external fixator removal was 12 ± 1 weeks. The mean preoperative Böhler's angle (-3 ± 21 degrees), calcaneal length (7.9 ± 0.6 cm), and calcaneal height (3.6 ± 0.5 cm) were significantly increased (P < .05) at final follow-up (28.3 ± 6.5, 8.3 ± 0.6, and 4.5 ± 0.5, respectively), whereas the mean preoperative calcaneal width (4.2 ± 0.5) was significantly decreased from the final follow-up mean (3.8 ± 0.5). There were no significant differences between any of the normal and postoperative measures. The mean AOFAS score was 82 ± 12. Complications included superficial pin tract infection (n = 7, 15%), superficial wound edge necrosis (n = 4, 8%), and deep infection (n = 2, 4%). CONCLUSION Our findings suggest that use of an external fixator with minimal internal fixation is an effective option for treating displaced intra-articular calcaneal fractures. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Te-Hu Fu
- Division of Emergency and Trauma Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Wang X, Zhou JQ, Yu GR. Comment on the new calcanail for calcaneus fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012. [DOI: 10.1007/s00590-012-1021-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stapleton JJ, Kolodenker G, Zgonis T. Internal and external fixation approaches to the surgical management of calcaneal fractures. Clin Podiatr Med Surg 2010; 27:381-92. [PMID: 20691371 DOI: 10.1016/j.cpm.2010.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Calcaneal fractures are one of the most difficult fractures to surgically manage and often require a steep learning curve to achieve consistent results. They usually occur in young individuals with labor intensive occupations and are associated with major complications. Conservative treatment of intraarticular calcaneal fractures with displacement often results in significant deformity, bone loss, and posttraumatic arthrosis. Optimally, an open approach is required in most cases to achieve anatomic reduction and successful long-term outcomes.
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Ramanujam CL, Capobianco CM, Zgonis T. Ilizarov external fixation technique for repair of a calcaneal avulsion fracture and Achilles tendon rupture. Foot Ankle Spec 2009; 2:306-8. [PMID: 20400432 DOI: 10.1177/1938640009350983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Crystal L Ramanujam
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
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