Surgical Outcome of Percutaneous Fixation for Calcaneal Fractures in Adults (original) (raw)
Related papers
Percutaneous fixation of displaced intra-articular calcaneal fractures
Journal of Orthopedics, Traumatology and Rehabilitation
Introduction: The calcaneus is the most frequently injured tarsal bone. Many calcaneal fractures are work-related, as they result from a fall from height, especially in males age 35-45 years. These fractures frequently result in long-term disability with potentially severe economic impact on the patient. Operative treatment of displaced calcaneal fractures has been a controversial due to tissue condition and wound infection. In this study our objective is to investigate the outcome of percutaneous fixation of displaced calcaneal fractures with cannulated cancellous screws. Materials & methods: A retrospective review of 14 patients with 16 calcaneal fractures who had percutaneous reduction and screw fixation for displaced fracture of calcaneus was done. The patients were assessed with plain radiography. In developing countries like India cost of medical treatment is often a concern so CT scan was not done as most of the patients were poor and did not afford the treatment. The fractures were classified according Essex Lopresti classification system. Functional assessment involved use of Calcaneal Fracture Scoring System of Kerr et al16 and the Maryland foot scoring. Results: The age of the patients ranged from 23 to 62 years (mean: 34 yrs).Time to union averaged 13 weeks (range 11 to16). The treatment outcome as measured by Calcaneal Fracture Scoring System ranged from 63 to 94 (mean 79). The mean Calcaneal Fracture score was 87 (72-91/100) for the tongue shaped group and 73 (52-83/100) for the joint depression group (p=0.0034). The mean Maryland Foot Score was 73/100, with 86% of patients achieving fair to excellent results. The mean functional score was 83 (42-91/100) for the tongue shaped group and 61 (52-73/100) for the joint depression group (p=0.002). Conclusion: Percutaneus fixation of fracture calcaneum, offer the prospect of fewer complications and better outcome especially in Essex-Lopresti tongue type fracture.
Journal of clinical and diagnostic research : JCDR, 2016
Calcaneal fractures have posed a challenge to orthopaedic surgeon for many years. The major problem is to reconstruct the fracture and improve healing of the fracture and also the surrounding tissues. Anatomic restoration of the three-dimensional anatomy of the calcaneum is the goal of surgical management of calcaneal fractures. Over the years, various techniques have been developed to accomplish this goal. To determine the functional outcome in displaced tongue-type calcaneal fracture treated by percutaneous screw fixation. A prospective study was conducted from October 2012 and September 2014. A total of 23 patients with intra-articular 'tongue type' calcaneal fractures were included in the study. Complete clinical and radiological evaluation was done. The surgical procedure encompassed closed reduction and fixation with two criss-cross 6.5 mm cannulated cancellous across the fracture site under fluoroscopic guidance. Postoperatively, on day three ankle and toe mobilizatio...
IOSR Journals , 2019
Background: The treatment of displaced calcaneum fractures has been a subject of intense discussion. Displaced intra-articular calcaneum fractures gives poor result with conservative treatment and requires reduction and internal fixation for favourable long term results. Open procedures are more prone to complications regarding wound healing. Percutaneous fixation offers a middle pathway in treating simpler variety of displaced calcaneal fractures. The aim of the study was to access the functional outcome of intra articular fracture calcaneum managed with closed reduction by Essex-Lopresti technique and percutaneous screw fixation. Methods: This study was done in department of Orthopaedics Jubilee Mission Medical College , Thrissur , Kerala from January 2015 to January 2018. 26 intra-articular calcaneal fractures treated with closed reduction and percutaneous screw fixation under image intensifier. Results: 25 cases evaluated (one patient had lost follow-up), all fractures were united, average time of union was 8 weeks. The mean AOFAS score was 80 (range from 45 to 96), 9 patients had excellent, 12 patients had good, 3 patients had fair and one patient had poor result for that subtalar arthrodesis was done after one year of follow-up. Average Bohler’s angle 24.5 and Gissane angle was 120 degree. No clinically significant varus or valgus in any case (less then 5 degree). Conclusions: Treatment of intra-articular fractures of calcaneum is challenging but close reduction and internal fixation with 6.5 cannulated cancellous screws yields favorable outcome in majority of cases.
Functional outcome of percutaneous screw fixation of intra-articular calcaneum fractures
International Journal of Research in Orthopaedics, 2018
Background: The treatment of displaced calcaneum fractures has been a subject of intense discussion. Displaced intra-articular calcaneum fractures gives poor result with conservative treatment and requires reduction and internal fixation for favourable long term results. Open procedures are more prone to complications regarding wound healing. Percutaneous fixation offers a middle pathway in treating simpler variety of displaced calcaneal fractures. The aim of the study was to access the functional outcome of intra articular fracture calcaneum managed with closed reduction by Essex-Lopresti technique and percutaneous screw fixation.Methods: This study was done in department of Orthopaedics Jhalawar medical college and SRG Hospital Jhalawar, Rajasthan from January 2015 to January 2018. 26 intra-articular calcaneal fractures treated with closed reduction and percutaneous screw fixation under image intensifier.Results: 25 cases evaluated (one patient had lost follow-up), all fractures w...
Egyptian Journal of Orthopedic Research
Background: Treatment of displaced intra-articular calcaneal fractures (DIACFs) remains controversial and challenging to orthopaedic surgeons. Several procedures were used to treat DIACFs. There is no single approach that is universally applicable to all DIACFs. Objective:-The aim of this prospective study was to evaluate functional and radiographic outcomes of closed reduction and percutaneous cannulated screws fixation in treatment of Sanders type II & III DIACFs. Patients and methods: A prospective study was conducted on 14 patients (17 feet) with Sanders' type II or III DIACFs, treated by closed reduction and fixation using cannulated screws, at orthopedics department of Sohag university hospital, between June 2020 and April 2022. Functional assessment was done by AOFAS score and VAS for pain. Radiographic assessment was done by measurement of three calcaneal angles (Gissane, Böhler's and posterior facet inclination angles) and three calcaneal distances (height, length and width of calcaneus). Results: The mean age of patients at time of operation was 34.8 years. Vast majority of patients were males (78.6%). Involvement of right side was 57.1%. Mean operative time was 57 minutes. Mean AOFAS score was 85.9 points. Mean time of radiographic union was 8.9 weeks. Conclusion: The technique avoided wound complications associated with ORIF with advantage of shorter hospital stay. Patients are satisfied and had lower rate of subtalar arthritis.
Percutaneous Reduction and Fixation of Intraarticular Calcaneal Fractures
Operative Orthopädie und Traumatologie, 2008
Objective Percutaneous reduction by distraction and subsequent percutaneous screw fixation to restore calcaneal and posterior talocalcaneal facet anatomy. The aim of this technique is to improve functional outcome and to diminish the rate of secondary posttraumatic arthrosis compared to conservative treatment and, secondly, to reduce infectious complications compared to open reduction and internal fixation (ORIF).
Percutaneous Reduction and Screw Fixation of Displaced Intra-articular Fractures of the Calcaneus
Foot & ankle international, 2016
Extensile open approaches to reduce and fix intra-articular calcaneal fractures are associated with high levels of wound complications. To avoid these complications, a technique of percutaneous reduction and fixation with screws alone was developed. This study assessed the clinical outcomes, radiographs, and postoperative CT scans after operative treatment with this technique. 153 consecutive patients with 182 intra-articular calcaneal fractures were reviewed. All patients were assessed for early postoperative complications at 3 months from the injury. The clinical results were assessed for patients seen at a minimum of 1 year after surgery (mean follow-up of 2.6 years; 90 patients, 106 feet). In patients who had both preoperative and postoperative CT scans (50 patients, 60 feet), the articular reduction was quantitatively analyzed. At the 3-month follow-up, there were 1% superficial infections and 1% rate of screw irritation. The complications at a minimum of 1 year after injury in...
European Journal of Orthopaedic Surgery & Traumatology, 2017
The management of displaced, intra-articular calcaneal fracture represents a surgical challenge to even an experienced orthopedic surgeon. Plate osteosynthesis using an extended lateral approach is complicated by soft tissue problems, while those treated by closed reduction and percutaneous pinning cannot address all the intra-articular fragments sufficiently. The objective of our study is to evaluate restoration of subtalar joint and long-term functional outcomes in intra-articular displaced calcaneal fractures treated with transverse subcondral screws through a small incision on lateral aspect of calcaneus and percutaneously placed axial screws through the calcaneal tuberosity. Forty-five intra-articular calcaneal fractures were managed with this minimally invasive technique. Calcaneal height, width, length, Bohler's angle, and Gissane angle were measured preoperatively and last followup visit. Functional outcomes were assessed on the basis of American Orthopedic Foot and Ankle Society (AOFAS) ankle/hind foot score. Preoperative calcaneal length, height, width, Bohler's angle, and Gissane angle were improved from 68.62 ± 2.64 to 72.44 ± 2.63 mm, 39.28 ± 2.72 to 32.37 ± 2.65 mm, 47.04 ± 2.56 to 49.55 ± 2.45 mm, 12.66°± 2.86°to 26.93°± 2.57°, 123.91°± 3.13°to 96.06°± 3.92°, respectively, after surgery with P value \0.001. There were 21 (46.7%) excellent, 17 (37.8%) good, 4 (8.8%) fair, and 3 (6.7%) poor outcomes based on AOFAS ankle/hindfoot scores. Time to unite the fracture was 11.06 ± 1.82 weeks (range 8-16 weeks), and all fractures were united without major complications. Minimally invasive technique through a small incision on lateral aspect of calcaneus gives a moderately good exposure for anatomical restoration of Sander's type II and III calcaneal fractures fixed with both transverse and axial screws under fluoroscopic guidance. Keywords Axial and transverse screws Á Calcaneal fracture Á Minimally invasive technique Á Soft tissue complications Á Wound healing
Percutaneous fixation of fractures of the calcaneus and its functional outcomes
International Journal of Orthopaedics Sciences, 2019
Background: Closed fractures of the calcaneum are common fractures of the lower limb and which usually result from by high velocity axial loading of the calcaneum. Open reduction and internal fixation methods have formed the mainstay of their treatment. However the associated wound complications have made the management of such injuries more difficult. Percutaneous fixation techniques provide an effective method of closed treatment of these fractures and can help avoid wound related complications. Methods: Twenty-four patients with fractures of the calcaneum were treated with percutaneous reduction with Essex-Lopresti technique and fixation with Steinman pin and K-wires, followed by immobilization with a slab. The American orthopaedic foot and ankle score (AOFAS) was calculated at the final follow up. Also the heel width (with a vernier caliper) and the heel height (from lateral malleolus to the ground surface) were recorded at the final follow up. Results: Of the total patients 8 had excellent, 10 had good and 6 had fair results. None of the patients had heel widening or loss of calcaneal height of more than 1 cm as compared to the contralateral limb. Complications seen were superficial pin tract infections (3) which were treated with early implant removal and appropriate antibiotics. The Bohler's angle at follow up was at a mean 30 degrees. Conclusion: The percutaneous reduction of closed fractures of the calcaneum provides good functional results as per AOFAS score. It also helps avoid wound related complication seen in open techniques. The Essex-Lopresti technique of reduction of such fractures has a short learning curve and can be reproduced at most operative setups. Long term follow up studies and bigger sample sizes can help support our conclusions.