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.

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.

Treatment of Osteoporotic Stable Burst Fracture with Percutaneous Vetebroplasty

PURPOSE: To evaluate the result of percutaneous vertebroplasty in the treatment of osteorporotic stable burst fracture that has not neurologic symptom. MATERIALS AND METHODS: A retrospective review was conducted in 37 vertebrae of 33 patinets with osteoporotic stable burst fracrure treated by percutaneous vertebroplasty from February 2000 to May 2003. Stable burst fracture was classified by McAfee. The operation was performed in the patient without neurologic symptom, BMD T-score was below -2.5 and hot uptake was seen in (99m)Tc bone scan. The operation was held from post-traumatic 7 to 32 days, average 17 days. Follow up period was from 5 months to 38 months, average 11 months. The result of the treatment was assesed by clinical finding (pain scale and work status by Denis) and radiologic findings (percentage height restored and change of kyphotic angle). RESULTS: In clinical assessment, 27 had a satisfactory pain scale below the P3, 25 had a satisfactory work status below the W3. In the radiologic findings, percentage height restore was increased from 0% to 62%, average 23.3%. The preop. kyphotic angle was from -20 degree to 42 degree, average 8.9 degree. The postop. kyphotic angle was from -20 to 42 degree, average 6.5 degree. The kyphotic angle was decreased average 2.4 degree after operation. CONCLUSION: Treatment of osteoporotic stable burst fracture with percutaneous vertebroplasty is the minimal invasive treatment that has satisfactory pain relief and reduction of fracture.

Treatment of Displaced Transverse Patellar Fractures with Cannulated Screws and Figure-Eight Wiring

PURPOSE: To evaluate the radiographic and clinical results of displaced transverse patellar fractures using a tensioned anterior figure-eight wire placed through two cannulated screws MATERIALS AND METHODS: 9 patients with displaced transverse patellar fractures treated with cannulated screws and figure-eight wiring were analyzed retrospectively. The mean age was 53 years (range, 22 to 68 years). Controlled passive range of motion exercise were started on the first postoperative day. Full weight bearing was allowed as tolerated. The patients were evaluated with radiographs, clinical examination and Levack's scoring system. RESULTS: All fractures healed and mean time elapsed for union was 9.4 weeks (range, 8 to 12 weeks). All patients regained full knee range of motion. Clinical results according to the Levack's scoring system were excellent in 8 cases and good in 1 case. We found no complications like loss of reduction and soft tissue irritation caused by the wire and screw, loosening or migration of hardware. CONCLUSION: Anterior figure-eight wiring through paired cannulated screws is appropriate for transverse patellar fractures, is possible early knee motion exercise and weight bearing.