Operative Treatment of Tongue Type Intra-articular Calcaneal Fractures: Comparison of the Open Reduction and Essex-Lopresti Technique / 대한족부족관절학회지

PURPOSE: To analyze the clinical and radiological results of operative treatment in patients with tongue type intra-articular calcaneal fracture, and to compare the open reduction and Essex-Lopresti technique. MATERIALS AND METHODS: We examined a consecutive series of 42 patients who received surgical treatment for tongue type calcaneal fracture (24 cases of the open reduction and 18 cases of the Essex-Lopresti technique) and the postoperative data was compared with a minimum 1 year follow-up. The clinical outcome was analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and Salama's criteria. The preoperative, postoperative, and last follow-up changes in the Bohler angle was radiologically analyzed. RESULTS: There were no significant differences between the two groups in terms of the clinical and radiological results at the last follow-up. However, for the Sander's type 3 and 4 fractures, the open reduction group showed more improvement of AOFAS score and less reduction loss in the Bohler angle. CONCLUSION: Although the clinical results were good irrespective of surgical technique, the open reduction and internal fixation can improve clinical outcome and reduce the reduction loss as compared with the Essex-Lopresti technique in the comminuted tongue type calcaneal fracture.

Percutaneous Acutrak Screw Fixation of Intra-articular Tongue Type Fracture of Calcaneus / 대한족부족관절학회지

PURPOSE: To evaluate the results of treatments by percutaneous Acutrak screw fixation for intra-articular tongue type fracture of calcaneus, especially in elderly patient or patients with underlying disease including diabetes mellitus. MATERIALS AND METHODS: Seven cases with intra-articular tongue type fracture of calcaneus, from November 2003 to February 2005, were reviewed. There were 6 males and 1 female with 65 years old mean age (range: 61~71 years old). The average follow-up period was 16 months (range: 10~25 months). Two Steinmann pins were used for closed reduction. After closed reduction was done like Essex-Lopresti's method, two Acutrak screws were inserted. The third Acutrak screw was inserted at the sustentaculum tali away from sinus tarsi to fix the primary fracture line. The patients were evaluated with Salama scale, the extent of recovery of Bohler angle, state of subtalar joint. RESULTS: Clinical results according Salama scale were excellent in 5 cases, and good in 2 cases. Average preoperative Bohler angle was 13 degrees (range: 12~15 degrees). Average postoperative Bohler angle was 31o (range: 23 degrees - 40 degrees). There were no soft tissue complications. There were two mild subtalar arthritis. CONCLUSIONS: We think that percutaneous Acutrak screw fixation is a good option for tongue type fracture of calcaneus in elderly patient or patients with underlying disease including diabetes mellitus.