The Operative Treatment using Porous Hydroxyapatite for Intraarticular Calcaneal Fractures of Joint Depression Type / 대한족부족관절학회지

PURPOSE: This study was performed to evaluate the clinical outcomes of operative treatment using porous hydroxyapatite for intraarticular calcaneal fracture of joint depression type. MATERIALS AND METHODS: Twenty patients with intraarticular calcaneal fracture were followed up for more than 1 year. The period to union was calculated to evaluate the osteoconductivity of porous hydroxyapatite used as bone graft substitute. The measurement of Bohler angle, Gissane angle and the degree of articular surface depression was performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). RESULTS: Bohler angle and Gissane angle had improved significantly from preoperative average 10.4degrees, 117.8degrees to average 22.6degrees, 113.5degrees immediate postoperatively, and had maintained to average 21.2degrees and 114.4degrees at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 4.8 mm to 1.5 mm at the last follow-up. All cases achieved bone union, and the interval to union was average 12.8 weeks. AOFAS score was average 85.2 points at last follow-up. There were 7 excellent, 10 good, and 3 fair results according to the CNHF scale. Therefore, 17 cases (85%) achieved satisfactory results. CONCLUSION: Plate fixation using porous hydroxyapatite seems to be one of effective treatment methods for intraarticular calcaneal fracture of joint depression type, because of supporting the reduction of subtalar articulation by augmenting bony defect and facilitating bone formation. Further evaluation about long-term radiological changes and histological analysis on hydroxyapatite implantation site should be required.

The Result of Closed Reduction and Percutaneous Screw Fixation for Intra-articular Calcaneal Fracture of Joint Depression Type / 대한족부족관절학회지

PURPOSE: To evaluate the results of treatments by percutaneous Acutrak screw fixation for intra-articular joint depression type fracture of calcaneus. MATERIALS AND METHODS: Thirteen cases with intra-articular joint depression type fracture of calcaneus, from September 2004 to March 2006, were reviewed. There were 9 males and 4 females with 52.5 years old mean age (range: 31~74 years old). The average follow-up period was 18 months (range: 8~32 months). Steinmann pins and Freers were used for closed reduction. After closed reduction, Acutrak screws and K-wires were inserted. The patients were evaluated with Creighton-Nebraska health foundation assessment sheet for calcaneal fracture, the extent of recovery of Bohler angle, fragment size, and state of subtalar joint. RESULTS: Clinical results according to Creighton-Nebraska health foundation assessment sheet for calcaneal fracture were excellent in 6 cases (46%), good in 4 cases (30%), fair in 2 cases (15%), and poor in 1 case (7%). Average preoperative Bohler angle was 7.6degrees (range: 2degrees~13degrees). Average postoperative Bohler angle was 24.4degrees (range: 4degrees~33degrees). There were no soft tissue complications. There were one mild subtalar arthritis and one moderate subtalar arthritis. CONCLUSION: We think that closed reduction and percutaneous Acutrak screw fixation with or without K-wire is a good option for joint depression type fracture of calcaneus.

Joint Depression Type of Intraarticular Calcaneal Fractures Treated with Essex-Lopresti Method

PURPOSE: To evaluate the result of joint depression type of intraarticular calcaneal fractures treated with Essex-Lopresti method. MATERIALS AND METHODS: From March 2001 to February 2005, Thirty two patients' joint depression type of intraarticular calcaneal fractures which treated with Essex-Lopresti method were clinically and radiographically evaluated retrospectively. RESULTS: According to Creighton-Nebraska Health Foundation Assessment Score (C-N score), there were 5 excellent, 11 good, 6 fair and 10 poor results. Böhler angle was corrected from 10.3 degrees to 24.5 degrees. There was a positive correlation between size of depressed fragment and C-N score (p<0.01). CONCLUSION: Essex-Lopresti method can substitute open reduction methods in joint depression type of intraarticular calcaneal fractures which have relatively large depressed joint fragments.