scholarly journals Percutaneous K-Wires Fixation of Displaced Intra-articular Calcaneal Fractures (A Novel Technique)

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Mohamed Mesregah
Keyword(s):  
Soft Tissue ◽  
Closed Reduction ◽  
Articular Surface ◽  
Calcaneal Fractures ◽  
Type Iv ◽  
Subtalar Arthritis ◽  
The Mean ◽  
K Wires ◽  
Pin Tract Infection ◽  
Periosteal Elevator

Category: Hindfoot Introduction/Purpose: The operative treatment of calcaneal fractures has been a controversial topic. Open reduction and internal fixation is associated with a high incidence of postoperative soft tissue complications. Closed reduction and percutaneous K-wires fixation was used to preserve soft tissue. The aim of our study is to evaluate the outcome of closed reduction and percutaneous K-wires fixation of displaced intra-articular calcaneal fractures. Methods: Twenty two displaced intra-articular calcaneal fractures were treated by closed reduction and percutaneous K-wires fixation. The clinical evaluation was based on Maryland Foot Score. According to Sander’s Classification, Eleven fractures were type II, nine were type III and two were type IV. Bimanual compression across the calcaneus was applied to reduce the calcaneal width. A Schanz screw was inserted into the calcaneal tuberosity and was forcibly pushed downwards to elevate the depressed fragment. Two parallel 2 mm K-wires were placed from the posterior inferior corner of the calcaneus across the posterior facet and into the talar body. The reduction of the articular surface was maintained by two crossing subchondral 2 mm K-wires. If the reduction was not satisfactory, a 1-2 cm long transverse incision was used just below the tip of the lateral malleolus. A small tipped periosteal elevator was introduced to elevate the depressed fragment before K-wire fixation. Results: The mean follow up period was 7.68 months. The clinical outcome revealed 18 fractures (81.8%) of satisfactory (14 excellent and 4 good), and 4 patients (18.2%) of unsatisfactory results (4 fair and 0 poor). The mean time of radiological union was 11.86 (range 10 – 14) weeks. One patient had pin tract infection. One patient developed heel widening. Conclusion: Closed reduction and percutaneous K-wires fixation of calcaneal fractures minimizes the soft tissue complications and postoperative scar formation. The mini approach for elevation of the depressed posterior facet restores the articular surface and decreases late subtalar arthritis.

Treatment of Calcaneal Fractures with Closed Reduction and the Endobutton-Assisted Technique

2015 ◽  
Vol 105 (1) ◽  
pp. 33-41
Author(s):  
Halil Atmaca ◽  
Kaya Memisoglu ◽  
Tuncay Baran ◽  
Cumhur Cevdet Kesemenli
Keyword(s):  
Soft Tissue ◽  
Closed Reduction ◽  
Soft Tissue Injuries ◽  
Mean Value ◽  
Calcaneal Fractures ◽  
Aofas Score ◽  
Minimally Invasive Osteosynthesis ◽  
The Mean ◽  
American Orthopaedic

Background Closed reduction and percutaneous pinning, open reduction and internal fixation, and primary arthrodesis are procedures used in the surgical treatment of calcaneal fractures. This study presents short-term clinical and radiologic results of patients with calcaneal fractures treated by closed indirect reduction with Endobutton-assisted minimally invasive osteosynthesis. Methods Twenty-one feet of 18 patients (four women and 14 men) with calcaneal fractures were retrospectively analyzed. Böhler and Gissane angles were measured from the preoperative, postoperative, and latest follow-up lateral radiographs of the feet. American Orthopaedic Foot and Ankle Society (AOFAS) scores were used for the 6-month and latest follow-up clinical assessments. Results The mean preoperative Böhler angle of 17.1° was corrected to a mean of 20.4° postoperatively. The mean value of this angle measured at the time of latest follow-up was 21.3°. The mean preoperative and postoperative Gissane angles were 116° and 117.8°, respectively. The mean value of this angle measured at the time of latest follow-up was 117.4°. The mean 6-month postoperative AOFAS score was 59.8 points. The mean AOFAS score at the time of latest follow-up (79.1 points) was significantly higher than the mean score 6 months postoperatively (P < .001). Regarding the latest follow-up AOFAS scores, four were poor, four were moderate, ten were good, and three were excellent. Conclusions With a low learning curve and satisfactory clinical outcomes, this technique can be used in acute, edematous cases with soft-tissue injuries to avoid calcaneal enlargement, infection, and soft-tissue problems.

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

2021 ◽  
pp. 107110072110130
Author(s):  
Kyeong-Hyeon Park ◽  
Chang-Wug Oh ◽  
Joon-Woo Kim ◽  
Hee-June Kim ◽  
Dong-Hyun Kim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Kirschner Wire ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Simple Method ◽  
Wire Fixation ◽  
The Mean ◽  
Radiographic Union

Background: Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. Methods: We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. Results: The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of −22 degrees (range, −109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. Conclusion: Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. Level of Evidence: Level IV, retrospective case series.

scholarly journals A Novel Technique for Closed Reduction and Fixation of Paediatric Calcaneal Fracture Dislocation Injuries

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Radwane Faroug ◽  
Paul Stirling ◽  
Farhan Ali
Keyword(s):  
Soft Tissue ◽  
Functional Outcome ◽  
Closed Reduction ◽  
Calcaneal Fracture ◽  
Fracture Dislocation ◽  
Bony Union ◽  
Calcaneal Fractures ◽  
Simultaneous Application ◽  
Soft Tissue Envelope ◽  
Good Functional Outcome

Paediatric calcaneal fractures are rare injuries usually managed conservatively or with open reduction and internal fixation (ORIF). Closed reduction was previously thought to be impossible, and very few cases are reported in the literature. We report a new technique for closed reduction using Ilizarov half-rings. We report successful closed reduction and screwless fixation of an extra-articular calcaneal fracture dislocation in a 7-year-old boy. Reduction was achieved using two Ilizarov half-ring frames arranged perpendicular to each other, enabling simultaneous application of longitudinal and rotational traction. Anatomical reduction was achieved with restored angles of Bohler and Gissane. Two K-wires were the definitive fixation. Bony union with good functional outcome and minimal pain was achieved at eight-weeks follow up. ORIF of calcaneal fractures provides good functional outcome but is associated with high rates of malunion and postoperative pain. Preservation of the unique soft tissue envelope surrounding the calcaneus reduces the risk of infection. Closed reduction prevents distortion of these tissues and may lead to faster healing and mobilisation. Closed reduction and screwless fixation of paediatric calcaneal fractures is an achievable management option. Our technique has preserved the soft tissue envelope surrounding the calcaneus, has avoided retained metalwork related complications, and has resulted in a good functional outcome.

The ‘clicky hip’

2018 ◽  
Vol 100-B (9) ◽  
pp. 1249-1252 ◽  
Author(s):  
S. Humphry ◽  
D. Thompson ◽  
N. Price ◽  
P. R. Williams
Keyword(s):  
Service Provision ◽  
Closed Reduction ◽  
Developmental Dysplasia ◽  
Ultrasound Screening ◽  
Ultrasound Scan ◽  
Type Iv ◽  
Referral Practices ◽  
Adductor Tenotomy ◽  
The Mean ◽  
Dysplasia Of The Hip

Aims The significance of the ‘clicky hip’ in neonatal and infant examination remains controversial with recent conflicting papers reigniting the debate. We aimed to quantify rates of developmental dysplasia of the hip (DDH) in babies referred with ‘clicky hips’ to our dedicated DDH clinic. Patients and Methods A three-year prospective cohort study was undertaken between 2014 and 2016 assessing the diagnosis and treatment outcomes of all children referred specifically with ‘clicky hips’ as the primary reason for referral to our dedicated DDH clinic. Depending on their age, they were all imaged with either ultrasound scan or radiographs. Results There were 69 ‘clicky hip’ referrals over the three-year period. This represented 26.9% of the total 257 referrals received in that time. The mean age at presentation was 13.6 weeks (1 to 84). A total of 19 children (28%) referred as ‘clicky hips’ were noted to have hip abnormalities on ultrasound scan, including 15 with Graf Type II hips (7 bilateral), one Graf Type III hip, and three Graf Type IV hips. Of these, ten children were treated with a Pavlik harness, with two requiring subsequent closed reduction in theatre; one child was treated primarily with a closed reduction and adductor tenotomy. In total, 11 (15.9%) of the 69 ‘clicky hip’ referrals required intervention with either harness or surgery. Conclusion Our study provides further evidence that the ‘clicky hip’ referral can represent an underlying diagnosis of DDH and should, in our opinion, always lead to further clinical and radiological assessment. In the absence of universal ultrasound screening, we would encourage individual units to carefully assess their own outcomes and protocols for ‘clicky hip’ referrals and tailor ongoing service provision to local populations and local referral practices. Cite this article: Bone Joint J 2018;100-B:1249–52.

Evaluation of the short-term results of closed reduction and percutaneous K-wires fixation of displaced intra-articular calcaneal fractures (DIACF)

The Foot ◽  
2020 ◽  
Vol 45 ◽  
pp. 101740
Author(s):  
Ibrahim Mahmoud Morsi ◽  
Ahmed A. Khalifa ◽  
Mohamed Abdelmoneim Hussien ◽  
Ahmed Abdellatef ◽  
Hesham Refae
Keyword(s):  
Closed Reduction ◽  
Calcaneal Fractures ◽  
Short Term ◽  
K Wires

scholarly journals Complications in surgical management of calcaneal fractures with anatomical plates

2021 ◽  
Vol 8 (1) ◽  
pp. 94
Author(s):  
Asfia Quadri ◽  
M. Zeeshan Vasif
Keyword(s):  
Surgical Management ◽  
Articular Surface ◽  
Deep Infection ◽  
Calcaneal Fractures ◽  
Anatomical Reduction ◽  
Superficial Skin ◽  
Subtalar Arthritis ◽  
A Prospective Study ◽  
Essex Lopresti

<p class="abstract"><span lang="EN-US">Calcaneal fractures, irrespective of their types, are treated non-operatively, one of the reasons being fear of complications. But conservatively managed fractures can result in equally problematic complications. Incidence of subtalar arthritis in such cases is reported to be 16.9% compared 3.3% in cases treated surgically. With surgical treatment aimed at achieving anatomical joint reduction, regaining calcaneal height, its length and width, successful attempts at curtailing the long-term complications can be made. This was a prospective study of 20 cases of calcaneal fractures, admitted to MNR Medical College and Hospital, Sangareddy from August 2020 to September 2021 were treated with ORIF with non-locking anatomical calcaneal plates using Fernandez’s approach, without use of bone graft. Essex Lopresti and Sander’s classification were used. Intra-operative assessment of reduction and articular surface reconstruction was done under fluoroscopic guidance. Regular follow up was done for assessment of fracture union and complications, assessment of late collapse. Among the 20 cases, 73% were men and 27% women. On typing the fractures based on Essex-Lopresti classification, intra-articular tongue type constituted 13% and 87% were of joint depression. Near normal anatomical reduction was obtained in all cases except in one where it was difficult due to comminution noted during surgery. 2 cases developed superficial skin necrosis at the surgical site, 1 case of deep infection and abscess formation and 3 cases of subtalar arthritis. This study showed that the incidence of long-term complications can probably be minimized by restoring the altered anatomy through surgical means; hence we advocate surgical management and accurate anatomical reduction in cases of displaced and comminuted calcaneal fractures with proper surgical principles. </span></p>

scholarly journals Outcome of Supracondylar Fractures of the Humerus in Children Treated by Closed Reduction and Percutaneous Pinning

2008 ◽  
Vol 47 (170) ◽  
Author(s):  
Pramod Devkota ◽  
JA Khan ◽  
BM Acharya ◽  
NMS Pradhan ◽  
LP Mainali ◽  
...  
Keyword(s):  
Tract Infection ◽  
Closed Reduction ◽  
Percutaneous Pinning ◽  
Supracondylar Fractures ◽  
Treatment Results ◽  
Wire Fixation ◽  
Ulnar Nerve Injury ◽  
K Wires ◽  
Pin Tract Infection

Supracondylar fractures of humerus in children are common injuries. Displaced fractures areinherently unstable. Conservative treatment results in malunion. Open reduction and internalfixation (ORIF) is more invasive and recovery is prolonged. From September 2004 to September 2005, 102displacedsupracondylarfractures of humerus, agedbetween one andhalf yearto 13 years, weretreated using close reduction and percutaneous Kirschner (K) wire fixation under c-arm fluoroscopy. Seventy nine patients were treated by cross K-wires and in twenty three cases lateral two K-wireswereput.Above elbow plaster ofparis back slab was appliedinall cases for atleastfour weeks.Backslab,K-wireswere removedafterfourweeks andelbowrangeofmotionexercisewas started.Resultswere analyzed using Flynn’s criteria. All patients were followed up to 14th week postoperatively. Incross K-wire group(N=79) 70.8% had excellent, 22.7% good, 3.8% fair and 2.5% had poor results at eight weeks follow up which was improved to 91.1% excellent, 6.3 good, 1.2% fair and 1.26% poor results at 14 weeks follow up. In lateral K-wire group (N=23) 70% had excellent, 21.7% good, 4.3% fair and 4.3% had poor result at eighth week which was improved to 91.3% excellent, 4.3% good, 4.3% fair and no poor result at 14th week follow up. Eight patients got superficial pin tract infection and seven patients sustained ulnar nerve injury post operatively.We recommend this procedure fordisplacedsupracondylarfractures inchildrenas itis safeandcost effectiveprocedurewithacceptablecomplication rates.Key words: closed reduction, humerus, percutaneous pinning, supracondylar fracture

scholarly journals Use of an aiming drill guide and ankle arthroscopy for reduction of depressed articular surface in posterior malleolar fractures

2021 ◽  
Vol 29 (3) ◽  
pp. 230949902110558
Author(s):  
Hyo-Jin Lee ◽  
Sung Jae Kim ◽  
Young Uk Park ◽  
Jintak Hyun ◽  
Hyong Nyun Kim
Keyword(s):  
Soft Tissue ◽  
Articular Surface ◽  
Ankle Arthroscopy ◽  
Direct Visualization ◽  
Novel Technique ◽  
Drill Guide ◽  
Posterior Malleolus ◽  
Soft Tissue Dissection ◽  
Tissue Dissection ◽  
The Mean

Purpose We describe a novel technique that uses an aiming drill guide and ankle arthroscopy for direct visualization and reduction of the depressed articular surface located between the posterior tibia and the fractured posterior malleolus. This technique requires less soft tissue dissection to visualize and reduce the depressed articular surface. Methods Between June 2014 and May 2019, 126 patients were surgically treated for trimalleolar fractures. Among them, 11 had depressed articular fragment between the posterior tibia and the fractured posterior malleolus reduced using our novel technique. The study included six men and five women, with a mean age of 46.5 (range: 23–62) years. Results In eight (73%) cases, the articular surface was reduced, with the articular surface step-off being less than 2 mm, as noted on postoperative computed tomography (CT). Syndesmosis congruity within an anterior-to-posterior difference of less than 2 mm was confirmed in nine (82%) cases via postoperative CT. The mean 100-mm visual analog scale (VAS) and the mean Olerud-Molander ankle score at the final follow-up were 16.6 ± 14.5 and 87.7 ± 7.5, respectively. Conclusions The depressed articular fragment located between the posterior tibia and the fractured posterior malleolus can be treated using an aiming drill guide and ankle arthroscopy. Ankle arthroscopy is used for direct visualization of the depressed articular surface, and the aiming drill guide can guide the bone plunger precisely to the depressed articular surface for reduction. This technique requires less soft tissue dissection than conventional techniques to visualize and reduce the depressed articular surface.

MANAGEMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES WIILIZAROV RING FIXATIO

2021 ◽  
pp. 40-43
Author(s):  
Nirottam Singh ◽  
Jagdish Jagdish ◽  
Hemant Jain ◽  
Kishore Raichandani
Keyword(s):  
Functional Outcomes ◽  
Operating Time ◽  
Anatomic Reconstruction ◽  
X Rays ◽  
Calcaneal Fractures ◽  
Type Iv ◽  
Fall From Height ◽  
Pin Tract Infection ◽  
Böhler’S Angle

Objective: Calcaneal fractures are caused by a high velocity force to the heel, mostly in road trafc accidents or fall from height. Debate continues regarding the best management of calcaneal fractures. We aim at evaluating the radiological and functional outcomes of displaced intra-articular calcaneal fractures treated with Ilizarov ring xation. Methods: intra-articular calcaneal Eighteen consecutive patients with fractures [Sanders type II (10), Sanders type III(6), and Sanders type IV (2)] were treated with the Ilizarov ring xator from Sep 2017 to June 2020. Patients were evaluated in terms of associated injuries and x-rays of anteroposterior, lateral and axial views of the calcaneus. CT scan was done to assess the amount of comminution and articular depression. Patients were followed up clinically and radiologically at least for 1 year. Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society (AOFAS) scale. Radiological assessment was done by Bohler's angle and Gissane's angle along with measurement of calcaneal height and width. Results: At average follow-up of 18.5 months, average AOFAS score was 80.5 (range 71 to 90), with 6.25% having excellent, 75% having good, 12.5% having fair and 6.25%having poor results. All patients had stable ankle joint with all having dorsiexion and plantar exion more than 30°. All patients are able to wear their previous size shoes. The mean Bohler's angle, mean Gissane's angle, calcaneal height and width were 21.5°, 126.3°, 4.36 cm and 3.80cm respectively at nal follow-up. Four patients had supercial pin tract infection. One patient had collapse of posterior facet after removal of xator with peroneal tendinitis. All fractures united and none needed secondary bone grafting. Patients returned to work on an average of 5.5 months. Conclusion: Ilizarov external ring xation gives good functional outcomes, manifested by restoring near normal anatomic reconstruction of morphology and alignment of the calcaneus. The added advantages of these procedures are the considerably shortened operating time and hospital stay, no need of highly equipped operation theatres and the reduced risk of complications related to surgical exposure.

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