Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach

PURPOSE: As the functional demands for activities in elderly patients are increasing according to their life extension, the need for surgical treatment is also increasing in elderly patients with displaced intra-articular calcaneal fractures. In addition to the extensile lateral approach (ELA), which is a surgical procedure that showed good results on intra-articular calcaneal fractures, the minimally invasive approach (MIA) also showed an outstanding result. This study compared the radiological and clinical results of intraarticular calcaneus fractures in elderly patients in two groups: ELA and MIA. MATERIALS AND METHODS: Thirty patients aged over 65 years with intra-articular calcaneus fractures, who could be followed-up more than 14 months, were included in this study. Thirteen patients of the MIA group and 17 patients of the ELA group were analyzed retrospectively using radiological and clinical assessments. RESULTS: No significant difference in union time, posterior facet reduction accuracy, subtalar osteoarthritis frequency, Bohler angle, calcaneal width, American Orthopaedic Foot and Ankle Society score, visual analogue scale score, 36-item short form survey, and foot function index was observed between the two groups. The p-value of the average height of the calcaneus correction, average length of calcaneal correction, and average loss of correction length were <0.001, 0.005, and 0.015, respectively. The incidence of complications, including soft tissue necrosis and bone infection, were 23.1% in the ELA group and none in the MIA group. CONCLUSION: The clinical outcomes were similar in the two groups. The degree of reduction of fracture showed a better result in the MIA group than the ELA group. Furthermore, there were no complications in the MIA group, whereas the ELA group showed some complications.

Treatment of Intra-articular Calcaneal Fractures Using Minimally Invasive Sinus Tarsi Approach in Diabetic Patients

PURPOSE: Wound problems occur in 5~30% of intra-articular calcaneal fractures following operation. Diabetes mellitus, large incisions and abundant dissection can increase the risk of wound problems that may require skin graft or other additional care. The authors used minimally invasive technique to treat intra-articular calcaneal fractures in diabetic patients and evaluated the results and complications of this method. MATERIALS AND METHODS: Between January 2002 and July 2005, 12 patients with intra-articular calcaneal fractures who had underlying diabetes mellitus were treated using minimally invasive technique with a modified sinus tarsi approach. The patients had an average age of 47 years (39~67) and were followed an average of 19 months (13~32). The mean period between injury and operation was 8 days (5~14). Crutch assisted partial weight bearing was advised for an average of 7.3 weeks (6~9) and full weight bearing was allowed after average of 9.3 weeks (7~11). RESULTS: According to AOFAS scale for ankle and hindfoot, patients had the following results: excellent - 1 patient (8%), good - 9 patients (75%), fair - 1 patient (8%), unsatisfied - 1 patient (8%). Bone union was achieved in all cases and there were no events of deep infection or skin necrosis. CONCLUSION: Treating intra-articular calcaneal fractures by minimally invasive technique is an excellent operative method for patients with diabetes mellitus, as this method can minimize soft tissue incision and resulting deep infection and skin necrosis.

Analysis of the Calcaneocuboid Joint Involvement in Intraarticular Calcaneal Fractures / 대한족부족관절학회지

PURPOSE: This study was performed to analyze the characteristics of calcaneocuboid joint involvement in intraarticular calcaneal fractures. MATERIALS AND METHODS: Total number of 92 patients (111 cases) who underwent operation for intraarticular calcaneal fractures between Jan. 2000 and Oct. 2005 were included in this study. The preoperative computed tomographs of the subjects were retrospectively reviewed to analyze calcaneocuboid joint involvement. RESULTS: It was revealed that 63 cases (56.8%) involved calcaneocuboid joint; 29cases (46.0%) showed type 1 (undisplaced or minimally displaced type, articular gap or =2 mm), 7 cases (11.1%) were included in type 3 (comminuted type) and 11 cases (17.5%) belonged to type 4 (fracture and dislocation). 48 out of 63 cases belonged to Sanders classification II and III that involved calcaneocuboid joint and included 25 cases (52.1%) of type 1 and 14 cases (29.2%) of type 2. Among 15 out of 63 cases included in Sanders classification IV, 4 (26.7%) showed type 1 and 6 (40.0%) belonged to type 4. According to our results, Sanders classification allowed to predict pattern of the involvement of calcaneocuboid joint (P0.05). CONCLUSION: Calcaneocuboid joint involvement in intraarticular calcaneal fractures was common and more than half showed severe injuries. We concluded that further studies on the involvement of calcaneocuboid joint should be performed prior to surgical treatment of intraarticular calcaneal fractures.