NSNSinus tarsi approach with percutaneous screw fixation for intra-articular calcaneal fractures

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 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.

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Optimum Screw Configuration for the Fixation of Sanders Type IIC Tongue-Type Fractures?

Journal of the American Podiatric Medical Association ◽

10.7547/16-140 ◽

2018 ◽

Vol 108 (1) ◽

pp. 20-26

Author(s):

Tayfun Bacaksız ◽

Cemal Kazimoglu ◽

Ali Reisoglu ◽

Ali Turgut ◽

Erdem Kumtepe ◽

...

Keyword(s):

Minimally Invasive ◽

Screw Fixation ◽

Axial Loading ◽

Load Test ◽

The Other ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Calcaneal Fractures ◽

Percutaneous Screw Fixation ◽

Fracture Displacement

Background: The minimally invasive technique (percutaneous screw fixation) is one of the options for treating tongue-type IIC fractures successfully. The aim of this study was to assess the biomechanics of four different screw configurations used for the fixation of tongue-type IIC calcaneal fractures. Methods: Identical osteotomies, recapitulating a type IIC injury, were created in synthetic calcaneus specimens using a saw. The specimens were randomly assigned to one of the four fixation groups (n = 7 per group): two divergent screws, two parallel screws, two parallel screws plus one screw axially oriented toward the sustentaculum tali, and three parallel screws. A load test was performed on all of the groups, and the specimens were then tested using offset axial loading until 2, 4, and 5 mm of fracture displacement occurred. Results: Mean force values for the three–parallel screw construct at 2-, 4-, and 5-mm fracture displacements were found to be significantly higher compared with those for the other groups. Conclusions: The use of a three–parallel screw construct seems to provide more stability in the treatment of tongue-type IIC fractures.

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