Percutaneous Cannulated Screws for Treatment of Displaced Intra-Articular Calcaneal Fractures: A Prospective Study (original) (raw)
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International Orthopaedics
Purpose Several minimally invasive procedures were used to treat displaced intra-articular calcaneal fractures (DIACFs). No agreement among different authors about either the ideal fixation method or which technique is minimally invasive. The aim of this study was to compare functional and radiographic outcomes of two minimally invasive techniques in treatment of Sanders type II and III DIACFs by using K-wires or cannulated screws without bone grafts. Methods A prospective randomized controlled study was conducted on 28 patients (34 feet) with Sanders type II or III DIACFs, treated by closed reduction and fixation using cannulated screws or K-wires, at the Orthopedics Department of Sohag University Hospital, between April 2020 and February 2022. Functional assessment was done by American Orthopedic Foot and Ankle Society (AOFAS) score and VAS for pain. Radiographic assessment was done by measurement of three calcaneal angles (Gissane, Böhler’s, and posterior facet inclination angles...
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.
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
Cannulated screw fixation for dislocated fractures of the calcaneus
Scripta Scientifica Medica, 2019
INTRODUCTION: Fractures of the calcaneus still remain some of the most challenging injuries that an orthopedic surgeon should manage. The difficulties about these fractures arise from the specific anatomy of the region, from the unique shape and morphology of the bone, and from the mechanism of the injury (in most cases high energy trauma). Despite the progress of the medical implants that can be used for fracture fixation in the last decade there are a lot of controversies, regarding the best option. AIM: The aim of the study is to present our experience with the use of cannulated screws for fixation of dislocated fractures of os calcis. MATERIALS AND METHODS: Twenty patients with dislocated fractures of os calcis using cannulated screws for fixation were operated on for a period of two years (2017-2018). The classifications used in the study included: the Essex-Lopresti x-ray classification modified by Stulik and Stehlik and the CT classification of Sanders. Two of the patients were with dislocated extraarticular fractures of tuber calcanei, three patients with "extreme beak" type fractures, the remaining 15 patients were with intraarticular fractures with more than 2 mm step off in the subtalar joint: 9 patients with tongue type and 5 patients with joint depression type. Gender distribution: 18 men, 2 women. RESULTS: Evaluation of the results was made by using the Maryland Foot Score. Satisfaction from the treatment was graded using the Visual Analogue Scale (VAS) score (mean 7,5). The reduction is evaluated by measurement of the angle of Gissane, Bohler and Preis pre-and postoperatively. Assessment of the calcaneal height, length and width was initiated on lateral, axial and Broden views. CONCLUSION: Fixation of displaced calcaneal fractures by cannulated screw is effective and reliable method. These screws are introduced by stab incisions which leads to minimal soft tissue dissection in such complex area of the hindfoot. It is an enormous advantage for fracture healing and reduces the percentage of possible complications.
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...
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...
International Journal of Research in Orthopaedics, 2019
Background: Calcaneal fractures account for 2% of all fractures with approximately 65-75% intra-articular. The aim of the present study is to determine the outcome of the patients who underwent minimally invasive screw fixation for calcaneal fracture in our institute.Methods: The present study was performed in 31 patients who underwent closed reduction and fixations with screw in this institute for the duration of 2 years were included in this study. Present study was conducted to determine the functional outcome of patients with calcaneal fractures treated with minimally invasive fixation of fractures with cancellous screws after indirect reduction with JESS or manual reduction or with Steinmen pin.Results: The average age of the patients was 44.14 years, ranging from 16 to 74 years, 28 patients were males and 3 were female. The AOFAS score at last follow up was 78.05 this improvement was also significant statistically (p<0.05). The mean Bohler angle at the last radiographic eva...
Foot & Ankle Specialist, 2021
Abstract: Background. Several minimally invasive techniques were developed for management of intraarticular calcaneal fractures. This study aimed to compare the functional and radiological outcomes of 2 minimally invasive reduction and fixation techniques using cannulated screws or Kirschner wires (K-wires) for fixation. Methods. This study was a retrospective comparative review of patients with displaced intraarticular calcaneal fractures, who were treated with cannulated screws or K-wires techniques. Clinical and radiological data were collected and compared between both groups. Functional outcomes and patient satisfaction using the Maryland Foot Score (MFS) and the visual analogue scale (VAS) of pain, in addition to the complications, were compared between both groups. Results. In total, 70 patients were included in the study: 34 in the cannulated screws group, with a mean age of 35.2 ± 4 years, and 36 in the K-wires groups, with a mean age of 33.4 ± 3 years. The operative time was shorter in the K-wires group (40.5 ± 5.6 minutes) compared to the cannulated screw group (49.5 ± 4.5 minutes), P < .001
Journal of Orthopaedic Surgery, 2018
Objective: Intra-articular displaced calcaneal fractures are common fractures and are often treated with surgical interventions. Sinüs tarsi approach provides secure access to lateral wall and joint facets. The aim of the study is to compare cannulated screw (CS) fixation and mini-plate (MP) fixation via sinus tarsi approach with Sanders types 2 and 3 fracture of calcaneus. Methods: Sixty patients with Sanders types 2 and 3 calcaneal fracture underwent surgical intervention were randomly allocated into two groups as group MP fixation and group CS fixation regarding osteosynthesis method for 5-year period. Open reduction via sinüs tarsi approach was performed in both groups. Demographic variables, time to surgery (TS), operation duration (OD), length of hospital stay (LOS), surgical complications, and reoperations were recorded. Pre- and postoperative Gissane and Böhler angles; calcaneal length, height, and width; ankle anterior-posterior (AP) and lateral X-rays; and computed tomogra...
International Journal of Research in Orthopaedics
Background: The present study aims to analyse the results of surgical outcome of the operated calcaneal fractures using either plates or cannulated cancellous screws. Recently there has been considerable shift of treatment of calcaneal fractures from conservative to operative owing to better understanding of fracture pattern. However, reduction of long-term functional outcome of such patients is always questionable and remains unanswered. Methods: A 25 fractures were operated with locking plates or cannulated screws after proper assessment. Functional assessment was done using AOFAS scoring system. Radiological outcome was assessed using restoration of Bohler and Gissane angle. Results: The results were extrapolated as excellent in 20 patients, good in 3 patient's and poor result in 2 patients. Statistical analysis revealed better outcomes in percutaneous cannulated screw fixation as compared to open plate fixation. 6 patients had to undergo implant exit of which 5 were cannula...