Outcome Determining Factors for displaced Intra-articular Calcaneal Fractures treated operatively

Introduction: Calcaneal fractures are caused by high energy trauma and mostly are intra-articular fractures. Nondisplaced intra-articular calcaneal fracture (IACF) can be treated non-operatively. However, displaced intra-articular need to be reduced and fixed anatomically to facilitate early ankle rehabilitation and minimize functional impairment. This study was done to find out the outcome of the IACF patients who underwent operative treatment. Methods: 62 patients with IACF were selected in this study and had been followed up from June 2009 to May 2013. They were placed into two groups; the operative treated and non-operative treated groups. Bilateral ankle lateral view plain radiographs were taken for comparison of the Bohler and Gissane angles. Both groups of patients were assessed by the Maryland Foot Score (MFS) and the SF-36v2 general health survey questionnaire. The ability of the patients to perform activity of daily living (ADL) and /or return to work (RTW) was assessed as well. Results: The operative treatment group of displaced IACF patients achieved no significant better scores in the mean MFS and SF-36v2 mean scores as compared to non operated cases. There was no difference in RTW between the 2 groups, but earlier ADL was recorded in the operated group. However, this study had found 5 associated factors which causes major effect to the patients’ outcome to treatment. Conclusions: The patient’s compliance with post-operative rehabilitation regimen were found to be significantly related with the outcomes.

Surgical Outcomes of Intra-articular Fractures of Calcaneus using AO Calcaneal Plate / 대한족부족관절학회지

PURPOSE: To evaluate the outcomes of intra-articular calcaneal fractures treated using AO calcaneal plate surgically. MATERAILS AND METHODS:Total 15 cases of intra-articular calcaneal fracture that treated with open reduction and internal fixation using AO calcaneal plate were evaluated. The patients were followed over a mean period of 19.8 months. The mean age was 41.6 years. By Sanders classification, there were 2 cases of type II, 10 cases of type III, and 3 cases of type IV. We evaluated radiological outcomes by Bohler angle, Gissane angle, calcaneal hight, calcaneal width and clinical outcomes by Creighton-Nebraska health foundation score. RESULTS:All fractures united at a mean duration of 13.3 weeks. Radiologically, the mean preoperative Bohler angle was 8.5 degrees and restored to 23.3 degrees . The mean preoperative Gissane angle was 118.7 degrees and restored to 124.2 degrees . The mean preoperative calcaneal hight was 30.8 mm and restored to 38.9 mm. The mean preoperative calcaneal width was 41.3 mm and restored to 35.3 mm. 10 cases had excellent and good clinical outcomes and 5 cases having fair outcome. Conculsion: In our study, open reduction and internal fixation using AO calcaneal plate showed good results with anatomical restoration of articular surface and stable fixation without late collapse

Subtalar Distraction Bone Block Arthrodesis (Five Cases) / 대한족부족관절학회지

PURPOSE: To determine the efficacy of the SDBBA (Subtalar distraction bone block arthrodesis) procedure on patients with late complication of intra-articular calcaneal fractures including subtalar joint arthritis and anterior ankle impingement syndrome. MATERIALS AND METHODS: Five cases in which the SDBBA procedure was implemented were followed for more than one year. All five patients were male with an average age of 56. Clinically, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the pain score were assessed. Radiographically, the talocalcaneal height and the talar inclination angle were determined. RESULTS: All five patients achieved subtalar joint fusion. The average pre-operative AOFAS score was 22.8 scores (range, 8-32 scores). At last follow-up, these scores improved to an average of 72.4 scores (range, 64-82 scores). The average pre-operative pain score was 8.2 scores (range, 7-10 scores). At last follow-up, these scores improved to an average of 13.2 (range, 12-15 scores). The average pre-operative talocalcaneal height was 72.8 mm (range, 70-77 mm), average post-operative talocalcaneal height improved to 79.8 mm (range, 78-84 mm). At final follow-up, these measurement was slightly decreased to average 78.6 mm (range, 74-83 mm). The average pre-operative talar inclination angle was 13.2 degrees (range, 12-15 degrees), average post-operative talar inclination angle improved to 19.2 degrees (range, 15-24 degrees). At final follow-up, these measurement was slightly decreased to average 18.6 degrees (range, 12-24 degrees). Four patients achieved successful outcomes. One patient developed a wound infection with subsequent sural neuropathy as well as collapse of the bone graft. CONCLUSION: This study shows that the SDBBA procedure successfully restores the talocalcaneal height and tibio-talar relationship. This procedure is useful in surgically managed patients with talo-calcaneal height loss and anterior ankle impingement syndrome due to the late complications of calcaneal intra-articular fractures.

Classification of the Calcaneal Fracture Based on Computed Tomography / 대한정형외과학회잡지

The os calcis is most frequently fractured than any other tarsal bone and the displaced intraarticular fractures account for 60-75% of them. Because of complex contour of calcaneous, it is difficult to evaluate the pattern of fracture exactly by conventional roentgenograms. But recently, more detailed understanding of fracture pattern can be possible with CT scan, which is thought to be one of the most important factor in deciding method of treatment and predicting prognosis. From Jan. 1992 to Dec. 1992, intraarticular calcaneal fractures of 31 cases treated in Kyungpook university hospital were analysed preoperatively with CT scan and classified by Sanders classification system. The results were obtained as follows: 16 cases of 31 cases were classified as type II and this type were sudivided as IIA in 7 cases, IIb in 4 cases, IIC in 5 cases. Type III fractures were found in 9 cases and subdivided as III AB in 3 cases, III BC in 4 cases IIIAC in 2 cases. Type IV fractures were found in 6 cases.

Open Reduction of Intra-Articular Fractures of the Calaneus through the Lateral Approach / 대한정형외과학회잡지

Displaced intra-articular fractures of the calcaneus result in serious and prolonged disability. These injuries continue to pose a therapeutic challange and there remains a great deal of controversy regarding treatment, operative versus nonperative. The lateral approach for open reduction, popularized by Palmer, has been used by many authors, with high percentage of excellent results. We treated 21 displaced intra-articular fractures of the calvaneus in 18 patients by open reduction and internal fixation through the lateral approach from July 1990 to May 1992 and the patients have been followed from 12 to 36 months from the time of their injury. The clinical and radiographic analyses were as follows; 1. The most common cause of injury was falls from a height: 19 fractures in 16 patients(88.8%), Spine fracture was most commonly associated injury : 5 patients (27.8%). 2. Fracture was classified according to classification of Paley and Hall. Eight fractures were tongue type(no comminution 4, with comminution 4), 12 joint depression type(no comminution 8, with comminution 4), and a comminuted type. 3. The average bohler tuber-joint angle was

Percutaneous Pinning for Intra-articular Calcaneal Fracture / 대한정형외과학회잡지

Calcaneus was the most commonly involved bone among the tarsal bone fracture. Many different methods have been tried for the treatment of fractures of the calcaneus in order to search for better results. But there is no general agreement on the treatment of the fracture of the calcaneus, especially involving the subtalar joint. From Jan. 1986 to Jan. 1990, 25 feet in 20 patients of calcaneal fractures involving the subtalar joint were treated by closed reduction & percutaneous pinning at the Dept. of Orthopedic Surgery, Chosun University Hospital and the results were as follows; 1. Of these intra-articular fractures, 15 fractures were tongue type and 10 fractures were joint depression type by Essex-Lopresti classification. 2. According to the Salama unit system, the results of treatment were excellent or good in 11 cases of 15 tongue types and 6 cases of 10 joint depression types. 3. The results were excellent in which reduction is achieved near anatomical reduction. 4. Even if the joint depression type fracture which is not severely comminuted, the treatment with closed reduction & percutaneous pinning is thought to be good method.