Short term outcome of open reduction and internal fixation with plating in displaced intra articular calcaneal fractures

Background: Calcaneum fractures constitute the majority of the tarsal bone fractures worldwide. There is no gold standard consensus as of now for the management of the displaced intra articular calcaneal fractures. Open reduction and internal fixation with plating is one of the management options available.Methods: Authors studied the results of open reduction and internal fixation with plating in 22 calcaneal fractures in a study with a minimum follow up of 6 months. Outcome was studied using Maryland foot score.Results: Authors observed excellent results in 5 patients (22.72%), good results in 12 patients (54.54%), fair results in 4 patients (18.18%) and poor result in 1 patient (04.54%). Authors encountered wound infection in 1 patient (4.54%), heel varus in 1 patient (4.54%), heel broadening in 1 patient (4.54%), reduced range of motion at ankle in 2 patients (9.9%) and persistent heel pain in 1 patient (4.54%).Conclusions: Open Reduction and Internal Fixation (ORIF) with calcaneum plating, through an extensive lateral approach, for displaced intra articular fractures of the calcaneum is an effective treatment modality with very good results in experienced hands.

Calcaneal fractures: a management dilemma-minimally invasive approach for intra and extra articular calcaneal fractures

Background: Calcaneal fractures which constitutes 2% of total fractures are frequent and very debilitating if not treated properly. Calcaneal fractures generally affect younger population leading to significant man-days loss(around 2-5 years3) and in-turn leading significant economic burden on the society. The goal of treatment for calcaneal fractures is elimination of pain and restoration of normal foot shape, biomechanics, and walking ability. Wound related complications are common with open surgeries. After open reduction internal fixation with perimeter plates for displaced calcaneal fractures, wound edge necrosis is commonly observed with the extended lateral approach. Because of such high incidence of wound complications in open reduction of calcaneum fractures, minimally invasive approach takes priority over open reduction of these fractures.Methods: The study aimed to evaluate the results of minimally invasive approach for calcaneal fractures. To reduce the operative complications, 30 patients were treated with minimally invasive methods in both extra articular and intra-articular calcaneal fractures and the results were evaluated. All patients were evaluated clinically , functionally and radiologically 3D- CT reconstruction images.Results: All cases were followed up for 2 years at specified intervals. The outcome measures were evaluated by AOFAS scores10 with excellent result in 13 cases and good to fair results in the rest. Operated patients had no wound infection, no skin necrosis, 5 patients had mild subtalar arthrosis and 3 patients complained slight difficulty in wearing shoes. None of them have any gait abnormalities.Conclusions: Our study suggests that the minimally invasive methods will reduce the operative complication rates. The minimally invasive surgical intervention in an expert hand can yield better results with less complication rates.

Minimally invasive tarsal sinus incision combined with manipulative reduction and internal fixation for calcaneal fractures of Sanders typeⅡ and Ⅲ / 中华外科杂志

Objective@#To evaluate the method and curative effect of plate fixation or percutaneous screws for the treatment of calcaneal fractures of Sanders type Ⅱ and Ⅲ via a minimally invasive sinus tarsi incision combined with a variety of manipulative reduction methods.@*Methods@#Twenty-one patients with closed calcaneal fractures treated in the Department of Orthopedics, the First Affiliated Hospital of Nanchang University from January 2014 to January 2016 were collected. There were 15 men and 6 women, with an average age of 39.3 years(from 25 to 63 years). According to the Sanders classification, 16 cases were type Ⅱ and 5 were type Ⅲ.All cases were treated with internal fixation with plate and percutaneous screws via the mini-open sinus tarsi approach following reduction of the posterior articular surface of the subtalar joint and calcaneal length, width and height.Statistical analysis was performed on calcaneal width and Böhler angle, Gissane angle preoperatively and postoperatively (3 days and 3 months). All data were analyzed by ANOVA, functional recovery was evaluated according to the Ankle and Hind-foot Score of American Orthopedic Foot and Ankle Society (AOFAS).@*Results@#Twenty one patients were followed up for a mean duration of 13.4 months(6 to 24 months). All cases gained primary incision healing, without complications such as skin necrosis, wound infection, tenosynovitis of peroneus longus and brevis muscles, or fracture displacement and hardware failure.Bone union was achieved at an average of 10.5 weeks(9 to 11 weeks). No obvious malunion occurred by the last follow-up. Compared to preoperative, calcaneal width(F=25.62, 38.90) were significantly improved 3 days and 3 months after surgery, Böhler angle(F=440.24, 272.42) and Gissane angle(F=91.86, 43.74) were normal, the differences were statistically significant (all P<0.05). Compared to 3 days after surgery, calcaneal width, Böhler angle and Gissane angle kept normal 3 months after surgery, there were no statistically differences (F=0.26, 1.35, 2.60, all P>0.05). By the AOFAS scoring, 10 cases were rated as excellent, 7 were good and 4 were fair.@*Conclusions@#Fixation with plate and percutaneous screws via the mini-open sinus tarsi approach is an effective treatment for Sanders types Ⅱ and Ⅲ calcaneal fractures, which with the advantages of small wound, simple operation, reliable fixation, no incision complication, especially suitable for elderly patients and the patients with severe injury of local soft tissue.

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