Complications in surgical management of calcaneal fractures with anatomical plates

Authors

  • Asfia Quadri Department of Orthopedics, MNR Medical College and Hospital, Sanagreddy, Telangana, India
  • M. Zeeshan Vasif Department of Orthopedics, MNR Medical College and Hospital, Sanagreddy, Telangana, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20214969

Keywords:

Intra-articular calcaneal fractures, Complications, Plate fixation

Abstract

Calcaneal fractures, irrespective of their types, are treated non-operatively, one of the reasons being fear of complications. But conservatively managed fractures can result in equally problematic complications. Incidence of subtalar arthritis in such cases is reported to be 16.9% compared 3.3% in cases treated surgically. With surgical treatment aimed at achieving anatomical joint reduction, regaining calcaneal height, its length and width, successful attempts at curtailing the long-term complications can be made. This was a prospective study of 20 cases of calcaneal fractures, admitted to MNR Medical College and Hospital, Sangareddy from August 2020 to September 2021 were treated with ORIF with non-locking anatomical calcaneal plates using Fernandez’s approach, without use of bone graft. Essex Lopresti and Sander’s classification were used. Intra-operative assessment of reduction and articular surface reconstruction was done under fluoroscopic guidance. Regular follow up was done for assessment of fracture union and complications, assessment of late collapse. Among the 20 cases, 73% were men and 27% women. On typing the fractures based on Essex-Lopresti classification, intra-articular tongue type constituted 13% and 87% were of joint depression. Near normal anatomical reduction was obtained in all cases except in one where it was difficult due to comminution noted during surgery. 2 cases developed superficial skin necrosis at the surgical site, 1 case of deep infection and abscess formation and 3 cases of subtalar arthritis. This study showed that the incidence of long-term complications can probably be minimized by restoring the altered anatomy through surgical means; hence we advocate surgical management and accurate anatomical reduction in cases of displaced and comminuted calcaneal fractures with proper surgical principles.

Author Biographies

Asfia Quadri, Department of Orthopedics, MNR Medical College and Hospital, Sanagreddy, Telangana, India

Postgraduate,Dept of othopaedics

M. Zeeshan Vasif, Department of Orthopedics, MNR Medical College and Hospital, Sanagreddy, Telangana, India

Assistant professor,Dept of othopaedics

References

Csizy M, Buckley R, Tough S, Leighton R, Smith J, McCormack R, et al. Displaced intra-articular calcaneal fractures: variables predicting late subtalar fusion. J Orthop Trauma. 2003;17(2):106-12.

Sanders R, Fortin P, Pasquale T, Walling A. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res. 1993;(290):87-95.

Murphy A. Fractures and Dislocations of the Foot. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, PA: Mosby/Elsevier; 2008: 4833-4848.

Randle JA, Kreder HJ, Stephen D, Williams J, Jaglal S, et al. Should calcaneal fractures be treated surgically? A meta-analysis. Clin Orthop Relat Res. 2000;(377):217-27.

Rammelt S, Zwipp H. Calcaneus fractures: facts, controversies and recent developments. Injury. 2004;35(5):443-61.

Thornes BS, Collins AL, Timlin M, Corrigan J. Outcome of calcaneal fractures treated operatively and non-operatively. the effect of litigation on outcomes. Ir J Med Sci. 2002;171(3):155-7.

Dooley P, Buckley R, Tough S, McCormack B, Pate G, Leighton R, et al. Bilateral calcaneal fractures: operative versus nonoperative treatment. Foot Ankle Int. 2004;25(2):47-52.

Parmar HV, Triffitt PD, Gregg PJ. Intra-articular fractures of the calcaneum treated operatively or conservatively: a prospective study. J Bone Joint Surg. 1993;75:932-7.

Bajammal S, Tornetta P, Sanders D, Bhandari M. Displaced intra-articular calcaneal fractures. J Orthop Trauma. 2005;19(5):360-4.

Eastwood DM, Langkamer VG, Atkins RM. Intra-articular fractures of the calcaneum. Part II: open reduction and internal fixation by the extended lateral transcalcaneal approach. J Bone Joint Surg. 1993;75:189-95.

Paul M, Peter R, Hoffmeyer P. Fractures of the calcaneum: a review of 70 patients. J Bone Joint Surg. 2004;86:1142-5.

Magnan B, Bortolazzi R, Marangon A, Marino M, Dall'Oca C, Bartolozzi P. External fixation for displaced intra-articular fractures of the calcaneum. J Bone Joint Surg Br. 2006;88(11):1474-9.

Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, et al. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2002;84(10):1733-44.

Koval KJ, Sanders R. The radiologic evaluation of calcaneal fractures. Clin Orthop Relat Res. 1993;(290):41-6.

Thermann H, Krettek C, Hüfner T, Schratt HE, Albrecht K, Tscherne H. Management of calcaneal fractures in adults. Conservative versus operative treatment. Clin Orthop Relat Res. 1998;(353):107-24.

Downloads

Published

2021-12-24