Calcaneal intra-articular fracture osteosynthesis: Clinical and radiological prospective study of 31 cases (original) (raw)
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International Journal of Orthopaedics Sciences, 2019
Introduction: A calcaneal fracture is a break of the calcaneus. Symptoms may include pain, bruising, trouble walking, and deformity of the heel. It may be associated with breaks of the hip or back. It usually occurs when a person lands on their feet following a fall from a height or during a motor vehicle collision. Diagnosis is suspected based on symptoms and confirmed by X-rays or CT scan. If the bones remain normally aligned treatment may be by casting without weight bearing for around eight weeks. If the bones are not properly aligned surgery is generally required. Materials and Methods: This is a prospective study of 20 cases of displaced intra-articular calcaneal fractures managed both surgically and conservatively. Patients were selected according to inclusion and exclusion criteria mentioned below.10 patients were treated surgically and 10 patients who were not willing for surgery were treated conservatively after taking proper consent. Results: The mean age was 26.5 years (10-49), 40% of the cases were in the age group of 20-29 in conservative whereas surgical cases constitutes of 43% (20-29) with the mean age of 26.88. Mode of injury was fall from height in 100% of cases in conservative whereas in surgical 90% cases are in fall from height and rest 10% can be seen in road traffic accident. In conservative 20% of results were excellent, 70% were good and 10% of the cases were fair. Whereas in surgical 60% of the cases were excellent and 40% were good. Occupational rehabilitation to the patient's pre injury state was achieved in 60% of cases in conservative and 90% of cases in surgical. Conclusion: Intra articular calcaneal fractures are better managed surgically compared to conservative management by understanding the fracture anatomy and restoration of Bohler's angle and angle of Gissane. Delayed surgical intervention had better results than early intervention for surgery.
Injury, 2007
Aim: To report the 15-year follow-up of displaced intra-articular calcaneal fractures from a randomised controlled trial of conservative versus operative treatment published in 1993. Patients and methods: Of the initial study, 46 patients (82%) were still alive at a mean of 15 years post injury and 26 patients (57%) agreed to review. The patients had been randomly allocated to either conservative or operative treatment in the original study. Clinical [American orthopaedic foot and ankle society hindfoot scale (AOFAS), foot function index (FFI) and calcaneal fracture score] and radiological (Böhler's angle and calcaneum height) outcome measures were used. The grade of osteoarthritis was also assessed at long-term follow-up. Results: At long-term follow-up, the clinical outcomes were not different between conservative versus operative treatment. AOFAS hindfoot scale: conservative = 78.5 and operative = 70, p = 0.11; FFI: conservative = 24.4 and operative = 26.9, p = 0.66; calcaneal fracture score: conservative = 70.1 and operative = 63.5, p = 0.41. The radiological outcomes were also not different between both groups. Böhler's angle: conservative = 10.48 and operative 16.98, p = 0.07; height of calcaneum: conservative = 37.2 mm and operative = 38.2 mm, p = 0.57; grade of osteoarthritis of the subtalar joint: p = 0.54. There was no correlation between Böhler's angle and the outcome measures in either group.
2019
The management protocol modality of calcaneal fracture has under gone a drastic change over the years. Since the 1900's when Cotton and Wilson proposed the importance of reduction of lateral wall through closed dis-impaction, the calcaneal fracture still remains the most challenging fracture for the orthopaedic surgeon to manage effectively (1). Displaced intraar cular fractures represent 60% to 75% of all calcaneal fractures (2). This study compares two modalities of management of intraarticular calcaneal fractures. Non-Operative management consisting of slab, elevation and casting; and operative management consisting of Minimally Invasive Surgery (MIS) or Open Reduction Internal Fixation (ORIF) Plating. In the recent years there has been an increased trend for operative management of Calcaneal fractures with even recent studies proclaiming similar benefits. Even in the operative methods, the debate exists on the outcome of closed method versus open (2, 3). However, very few studies exist comparing the functional outcome of all three managements for intraarticular calcaneal fractures. This study aims to come to a decision on whether operative methods are superior in terms of functional outcome at 1 year.
Functional outcome of displaced intra-articular calcaneal fractures
Journal of Trauma and Acute Care Surgery, 2012
BACKGROUND: The purpose of this study is to assess the clinical results of a minimally invasive treatment featured the concept of internal compression, including an anatomic plate and multiple compression bolts compared with open reduction and internal fixation for displaced intra-articular calcaneal fractures (DIACFs). METHODS: We retrospectively analyzed 329 patients (383 feet) who were identified from trauma inpatient database in our hospital for DIACFs from January 2004 to December 2009. Of them, 148 patients (170 feet) were treated with open reduction and internal fixation (OR group), which involved using a traditional L-shaped extended lateral approach, and fractures were fixed by plate and screws from January 2004 to December 2006; 181 patients (213 feet) were treated with a minimally invasive approach featured the concept of calcaneal internal compression (CIC group), which was achieved by an anatomic plate and multiple compression bolts through a small lateral incision from January 2007 to December 2009. Postoperative complications were recorded. During follow-up, pain and functional outcome were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) scores and compared between the two groups. Subsequent subtalar arthrodesis and early implant removal were performed when indicated. Routine hardware removal was scheduled for all patients at 1-year follow-up. RESULTS: There were no significant differences in sex, age, and fracture classification (Sanders classification) between the two groups. Wound healing complications were 4 of 213 (1.88%) in CIC group and 20 of 170 (11.76%) in OR group. Subtalar arthrodesis had to be performed in one case in OR group. Four cases in CIC group and four cases in OR group had the hardware removed earlier due to complications. The average time after surgery to start weight-bearing exercise is 5.64 weeks in CIC group and 9.38 weeks in OR group (p G 0.001). The mean AOFAS score is higher in CIC group than in OR group, although the difference is not statistically significant (87.53 vs. 84.95; p = 0.191). The overall results according to the AOFAS scoring system were good or excellent in 185 of 213 (86.85%) in CIC group and 144 of 170 (84.71%) in OR group. The subjective portion of the AOFAS survey answered by patients showed statistically significant difference in activity limitation and walking surface score (7.31 vs. 7.02 and 3.72 vs. 3.42; p G 0.05) but not in pain and walking distance between the two groups (32.72 vs. 32.29 and 4.37 vs. 4.42; p 9 0.05). CONCLUSION: The study results suggest that this minimally invasive approach featured the concept of the calcaneal internal compression can achieve functional outcome as good as, if not better than the open techniques. It is proved to be an effective alternative treatment for DIACFs. (
Predicting loss of height in surgically treated displaced intra-articular fractures of the calcaneus
International Orthopaedics, 2015
Purpose The goal of calcaneal fracture surgery is to restore its anatomy and good foot function. However, loss of height of the subtalar joint can occur post-operatively, as expressed by a decrease in Böhler's angle (BA). The aim of this study was to identify potential factors associated with a post-operative decrease in BA. Methods All consecutive adult patients treated with open reduction and internal fixation (ORIF) by an extended lateral approach (ELA) between 2000 and 2013 were retrospectively included. Primary outcome was the occurrence of a calcaneal collapse, defined as a postoperative decrease of ≥10°in BA. The BA was measured pre-operatively, directly following surgery and at one year follow-up. Patient characteristics (body mass index, diabetes mellitus, smoking/alcohol/substance abuse, American Society of Anaesthesiologist classification), fracture classification and treatment characteristics: peroperative increase in BA and occurrence of post-operative wound infection (POWI) were collected. Results A total of 262 patients with 276 calcaneal fractures were included. A calcaneal collapse occurred in 46 cases (17 %). The median preoperative BA, per-operative increase in BA and post-operative decrease in BA were, respectively, 2°, 27°and 4°. A calcaneal collapse was seen more often following a per-operative increase of >25°in BA, but no significant association was found (p=0.056). Uni-and multivariate analysis showed that patients with substance abuse and those with POWI had significantly more calcaneal collapse (p<0.05). No association was found between substance abuse and the occurrence of POWI (p=0.293). Conclusions In nearly one in six patients with an intraarticular calcaneal fracture treated with ORIF by an ELA, a post-operative collapse of ≥10°was found during follow-up. Calcaneal collapse was correlated with the occurrence of a POWI and substance abuse.
Surgical management of intraarticular fractures of the calcaneus
Archives of orthopaedic and trauma surgery, 2002
In this study we evaluated the interim results of surgical management of intraarticular calcaneal fractures in 26 feet in 19 patients. The mean age of the 15 male and 4 female patients in our series was 28.3 (range 17-54) years. There were 7 bilateral and 12 unilateral fractures. We obtained anteroposterior (AP), lateral, and skyline views and computed tomography (CT) scans of all patients preoperatively. According to Sanders CT classification, we detected type II, III, and IV fractures in 12, 10, and 4 cases, respectively. We performed extended lateral incisions in all patients but one and used Sherman plate, screw, and staples to achieve anatomic reduction. The mean follow-up period was 38.2 (range 18-50) months. Patients were evaluated by X-ray, CT, and Maryland foot score. We found that anatomic reduction had been achieved in 20 cases as confirmed by X-ray and CT postoperatively. With regard to the Maryland foot score, excellent, good, fair, and poor results were obtained in 9, ...
International Journal of Orthopaedics Sciences
Intraarticular fractures of calcaneum are frequently complex injuries, requiring experience in the diagnosis and management, for favourable results. The historical aspects of calcaneal fracture treatment are difficult to appraise, secondary to varied forms of treatments, classifications, numerous retrospective studies and mixture of diagnoses and results. Significant controversy remains over the results of nonoperative treatment. Due to the lack of standardization, accurate comparisons cannot be made between reported surgical and conservative treatment modalities to precisely determine the long term and shortterm functional results between each method. Here is a cohort prospective study to compare patients of closed displaced intra-articular fracture of calcaneum. 30 patients were taken for this study out of which fifteen patients were treated operatively and fifteen patients were treated non-operatively. Patients were followed up to an average of 1 year. The functional outcome was measured by AOFAS hind foot score. It was observed that under the operative group 73.3% of the patients had excellent results, 13.3% had good result and 6.7% each had fair and poor results. Similarly, under the conservative group 53.3% of the patients had fair results, 26.7% had good result, 20% had poor result and none of the patients had excellent results. Further, it was observed that there was a significant difference in results between the two groups (p value <0.001). We through our study and reviewing the literature conclude that the operative management by Locking Calcaneal Plate being a low profile, mouldable, multiplanar with locking screw shows satisfactory results with improved functional outcome and less complications as compared to conservatively managed displaced intra articular calcaneal fracture by below knee cast.
Management of Intra-Articular Fractures of the Calcaneus
Foot and Ankle Clinics, 2008
Since Malgaigne's first description in 1843, 1 fractures of the calcaneus have presented a significant challenge to orthopedic surgeons and patients alike. In describing the dismal results of early management of calcaneal fractures, Cotton and Wilson penned, ''the man who breaks his heel bone is done.'' 2 Calcaneal fractures are the most common of tarsal bone fractures, and the majority are displaced intra-articular fractures, typically the result of falls from height or motor vehicle accidents. Calcaneal fractures affect primarily young men in their prime working years and result in a significant loss of economic productivity. 3-7 Although the development of modern imaging, surgical techniques, and fixation implants generally has improved functional outcome after these fractures, controversy continues to surround the management of these highly complex injuries. This article highlights current controversies and emphasizes treatment rationale and surgical approaches. INTRA-ARTICULAR FRACTURES Mechanism of Injury and Pathologic Anatomy Displaced intra-articular fractures of the calcaneus generally occur as a result of highenergy trauma, with general agreement as to the pathomechanics involved. 4,8-11 With One of the authors has received financial or material support (eg, equipment or services), commercially derived honoraria, or other nonresearch-related funding (eg, paid travel) from a commercial company or institution that relates directly or indirectly to the subject of this manuscript.
The Journal of Bone and Joint Surgery, 2004
We have assessed the long-term results after operative and non-operative treatment of undisplaced and displaced calcaneal fractures.
Operative Compared with Nonoperative Treatment of Displaced Intra-articular Calcaneal Fractures
Orthopedic Trauma Directions, 2010
Background: Open reduction and internal fixation is the treatment of choice for displaced intra-articular calcaneal fractures at many orthopaedic trauma centers. The purpose of this study was to determine whether open reduction and internal fixation of displaced intra-articular calcaneal fractures results in better general and diseasespecific health outcomes at two years after the injury compared with those after nonoperative management.