DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20180399

A study of intra articular calcaneal fractures treated with minimally invasive cannulated screw fixation

B. Sundararaja, L. Senthil, U. Thyagarajan, D. Gokulraj

Abstract


Background: The management of displaced intra-articular calcaneal fractures (DIACFs) remains challenging and controversial. A prospective study to assess the functional outcome of patients with displaced intra-articular calcaneal fractures treated with percutaneous reduction, cannulated screw fixation.

Methods: Ultimately, 14 patients with a DIACFs, underwent. percutaneous reduction, cannulated screw fixation. Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hind foot scores. Radiological results were assessed using plain radiographs and computed tomography (CT) scans, and postoperative wound-related complications were also recorded.

Results: A total of 46 adult patients were assessed in our study. Twenty patients did not meet the inclusion criteria and were excluded. Twelve patients were excluded due to severe medical ailments (2 patients) and non-adherence to the treatment plan (10 patients). Therefore, 14 patients with an average age of 42.5 years old (range, 20 to 72 years) including 10 men and 4 women participated in the study. All patients were followed-up for 12 months averagely (range, 11 to 18 months). Complete articular reduction is achieved in 8 patients, 6 patients had articular depression of posterior facet, 3 patients had heel widening and lateral impingement. There was no wound complications in any of the patients, 2 patients developed sub talar arthritis at 2 years of follow up.

Conclusions: Surgical treatment of intra articular calcaneal fractures remains challenging task. Minimally invasive reductions remain good option to minimize wound complications. Cannulated cancellous screw fixation is good option for intra articular calcaneal fracture.


Keywords


Calcaneus, Intra-articular fractures, Minimally invasive, Percutaneous fixation

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References


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

Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am. 2000;82:225–50.

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;84:1733–44.

Howard JL, Buckley R, McCormack R, Pate G, Leighton R, Petrie D, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma. 2003;17:241–9.

Koski A, Kuokkanen H, Tukiainen E. Postoperative wound complications after internal fixation of closed calcaneal fractures: a retrospective analysis of 126 consecutive patients with 148 fractures. Scand J Surg. 2005;94:243–5.

Cavadas PC, Landin L. Management of soft-tissue complications of the lateral approach for calcaneal fractures. Plast Reconstr Surg. 2007;120:459–66.

Al-Mudhaffar M, Prasad CV, Mofidi A. Wound complications following operative fixation of calcaneal fractures. Injury. 2000;31:461–4.

Ramos RR, de Castro Filho CD, Ramos RR, Bittar CK, de Cillo MS, de Mattos CA, et al. 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.

Rammelt S, Heineck J, Barthel S, Zwipp H. Percutaneous fixation of intraarticular calcaneus fractures. Techn Foot Ankle Surg. 2009;8:70–6.

Sampath Kumar V, Marimuthu K, Subramani S, Sharma V, Bera J, Kotwal P. Prospective randomized trial comparing open reduction and internal fixation with minimally invasive reduction and percutaneous fixation in managing displaced intra-articular calcaneal fractures. Int Orthop. 2014;38:2505–12.

Schuberth JM, Cobb MD, Talarico RH. Minimally invasive arthroscopic- assisted reduction with percutaneous fixation in the management of intra-articular calcaneal fractures: a review of 24 cases. J Foot Ankle Surg. 2009;48:315–22.

Hospodar P, Guzman C, Johnson P, Uhl R. Treatment of displaced calcaneus fractures using a minimally invasive sinus tarsi approach. Orthopedics. 2008;31:112.

Schepers T. The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review. Int Orthop. 2011;35:697–703.

Zhang T, Su Y, Chen W, Zhang Q, Wu Z, Zhang Y. Displaced intra- articular calcaneal fractures treated in a minimally invasive fashion: longitudinal approach versus sinus tarsi approach. J Bone Joint Surg Am. 2014;96:302–9.

Yeo JH, Cho HJ, Lee KB. Comparison of two surgical approaches for displaced intra-articular calcaneal fractures: sinus tarsi versus extensile lateral approach. BMC Musculoskelet Disord. 2015;16:63.

Chen L, Zhang G, Hong J, Lu X, Yuan W. Comparison of percutaneous screw fixation and calcium sulfate cement grafting versus open treatment of displaced intra-articular calcaneal fractures. Foot Ankle Int. 2011;32:979–85.

Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349–53.

Radnay CS, Clare MP, Sanders RW. Subtalar fusion after displaced intra- articular calcaneal fractures: does initial operative treatment matter? J Bone Joint Surg. 2009;91:541–6.

De Boer AS, Van Lieshout EM, Den Hartog D, Weerts B, Verhofstad MH, Schepers T. Functional outcome and patient satisfaction after displaced intra-articular calcaneal fractures: a comparison among open, percutaneous, and nonoperative treatment. J Foot Ankle Surg. 2015;54:298–305.

Rak V, Ira D, Masek M. Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications. Indian J Orthop. 2009;43:271–80.

Backes M, Schepers T, Beerekamp MS, Luitse JS, Goslings JC, Schep NW. Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach. Int Orthop. 2014;38:767–73.

Wang YM, Wei WF. Sanders II type calcaneal fractures: a retrospective trial of percutaneous versus operative treatment. Orthop Surg. 2015;7:31–6.

Mulcahy DM, McCormack DM, Stephens MM. Intra-articular calcaneal fractures: effect of open reduction and internal fixation on the contact characteristics of the subtalar joint. Foot Ankle Int. 1998;19:842–8.

Song KS, Kang CH, Min BW, Sohn GJ. Preoperative and postoperative evaluation of intra-articular fractures of the calcaneus based on computed tomography scanning. J Orthop Trauma. 1997;11:435–40.

Gavlik JM, Rammelt S, Zwipp H. The use of subtalar arthroscopy in open reduction and internal fixation of intra-articular calcaneal fractures. Injury. 2002;33:63–71.