scholarly journals Aesthetic Treatment of Tillaux-Chaput fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0022
Author(s):  
Shi-Ming Feng
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Weight Bearing ◽  
Ankle Arthroscopy ◽  
X Rays ◽  
The Mean ◽  
American Orthopaedic ◽  
Ankle Function ◽  
Primary Healing

Category: Arthroscopy Introduction/Purpose: This study aim to investigate the clinical result of treating Tillaux-Chaput fractures using the all-inside ankle arthroscopy technique. Methods: We retrospectively evaluated 23 Tillaux-Chaput fractures patients who underwent all-inside ankle arthroscopy technique and were follow-up from May 2013 to June 2016. There were 15 males and 8 females, with the mean age of 30.4 years (range, 10-57 years). Right ankle was involved in 15 patients and left ankle in 8 patients. Eighteen patients had single Tillaux-Chaput fractures and 5 patients had combined proximal fibular fractures. While 20 cases were diagnosed by X-rays and 3 cases by CT. Ankle arthroscopy was used through the anterolateral and anteriormedal approaches for closed reduction and internal fixation using Herbert screw(s). The joints function was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot scale score. Results: Operative incisions of 23 cases were primary healing without complications of nerve, vessel and tendon injuries. The period of follow-up was 19.6 months (range, 12-25 months) and the time of Fracture union was 23.3 weeks (range, 12-36 weeks). At the time of last follow-up, none of the patients had any restriction in the ankle function and range of motion, with the ankle pain and weight-bearing walking pain. AOFAS score was changed from preoperative 53.3 points to 92.1 points, with the excellent-good rate of 100%. Conclusion: All-arthroscopy teatment by the anterolateral and anteriormedal approaches is a precise and effective method for closed reduction and internal fixation of Tillaux-Chaput fractures and deserves clinical application.

A flexion osteotomy for correction of a distal tibial recurvatum deformity

2019 ◽  
Vol 101-B (6) ◽  
pp. 682-690 ◽  
Author(s):  
P. Scheidegger ◽  
T. Horn Lang ◽  
C. Schweizer ◽  
L. Zwicky ◽  
B. Hintermann
Keyword(s):  
Ankle Joint ◽  
Analogue Scale ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Radiological Outcome ◽  
Ankle Arthroplasty ◽  
Kellgren And Lawrence ◽  
The Mean ◽  
American Orthopaedic

Aims There is little information about how to manage patients with a recurvatum deformity of the distal tibia and osteoarthritis (OA) of the ankle. The aim of this study was to evaluate the functional and radiological outcome of addressing this deformity using a flexion osteotomy and to assess the progression of OA after this procedure. Patients and Methods A total of 39 patients (12 women, 27 men; mean age 47 years (28 to 72)) with a distal tibial recurvatum deformity were treated with a flexion osteotomy, between 2010 and 2015. Nine patients (23%) subsequently required conversion to either a total ankle arthroplasty (seven) or an arthrodesis (two) after a mean of 21 months (9 to 36). A total of 30 patients (77%), with a mean follow-up of 30 months (24 to 76), remained for further evaluation. Functional outcome, sagittal ankle joint OA using a modified Kellgren and Lawrence Score, tibial lateral surface (TLS) angle, and talar offset ratio (TOR) were evaluated on pre- and postoperative weight-bearing radiographs. Results Postoperatively, the mean score for pain, using a visual analogue scale, decreased significantly from 4.3 to 2.5 points and the mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly from 59 to 75 points (both p < 0.001). The mean TLS angle increased significantly by 6.6°; the mean TOR decreased significantly by 0.24 (p < 0.001). Radiological evaluation showed an improvement or no progression of sagittal ankle joint OA in 32 ankles (82%), while seven ankles (18%) showed further progression. Conclusion A flexion osteotomy effectively improved the congruency of the ankle joint. In 30 patients (77%), the joint could be saved, whereas in nine patients (23%), the treatment delayed a joint-sacrificing procedure. Cite this article: Bone Joint J 2019;101-B:682–690.

scholarly journals Early Weight Bearing on Weber C Fractures with Retained Syndesmotic Screws

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Cristian Ortiz ◽  
Andres Keller Díaz ◽  
Pablo Mococain ◽  
Pablo Wagner ◽  
Ruben Radkievich ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
X Rays ◽  
Aofas Score ◽  
Early Weight Bearing ◽  
Clear Space ◽  
Screw Breakage ◽  
The Mean

Category: Ankle, Sports, Trauma Introduction/Purpose: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged, or the clinical result depending on the screw status, which can be intact, broken or loose. Our objective was to evaluate the radiographic and clinical parameters of patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Our hypothesis was that no difference would be observed on syndesmotic reduction or clinical function depending on the screw status. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). Radiologically we measured medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS), talar shift (TS) and screw condition (intact, broken, loose). Clinical function was measured with the AOFAS score and stratified by the screw condition. Statistical analysis was performed with the SPSS software and a non-inferiority confidence interval for the mean was calculated. Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p>0,05). Relative to clinical function, the mean AOFAS score was 95 points. No difference was found between the clinical scores of patients stratified by the screw condition (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographic or clinical consequences regarding ankle joint function. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We suggest that routine removal of syndesmotic screws is not necessary in these group of patients.

Kết quả nắn kín và kết hợp xương bên trong sử dụng đinh nội tủy đầu trên xương đùi trong điều trị gãy liên mấu chuyển xương đùi

2021 ◽  
Author(s):  
Viet Hung Tran
Keyword(s):  
Blood Loss ◽  
Internal Fixation ◽  
Closed Reduction ◽  
Weight Bearing ◽  
Proximal Femoral Nail ◽  
Minimally Invasive Surgical ◽  
Femoral Nail ◽  
Incision Size ◽  
The Mean ◽  
Intertrochanteric Femur Fracture

Mục tiêu: Trước đây điều trị gãy liên mấu chuyển (LMC) xương đùi chủ yếu là nắn mở và kết hợp xương (KHX) bên trong bằng DHS, nẹp khóa … đòi hỏi sự bộc lộc rộng rãi và mở ổ gãy, sẽ dẫn đến tình trạng mất máu, đau, hạn chế vận động sau mổ và sẽ dẫn đến các biến chứng. Đối với những trường hợp gãy mất vững, tổn thương thành ngoài nhiều thì việc điều trị bằng DHS, nẹp khóa thường dẫn đến di lệch thứ phát và thất bại trong quá trình điều trị. Với sự ra đời của đinh nội tủy Gamma, PFNA, Reconstruction và thế hệ đinh mới nhất hiện nay InterTAN, với kỹ thuật mổ xâm nhập tối thiểu, không mở ổ gãy rút ngắn thời gian phẫu thuật và lượng máu mất, kết hợp xương vững về mặt cơ học, giúp bệnh nhân vận động sớm sau mổ giúp ngăn ngừa các biến chứng do nằm lâu. Báo cáo này nhằm đánh giá kết quả điều trị gãy liên mấu chuyển với kỹ thuật nắn kín trên bàn chỉnh hình và KHX bên trong bằng đinh nội tủy đầu trên xương đùi. Phương pháp: Chúng tôi thực hiện mổ nắn kín trên bàn chỉnh hình có sử dụng C arm, kỹ thuật mổ áp dụng theo AO trên 58 trường hợp gãy liên mấu chuyển xương đùi. Ghi nhận độ dài đường mổ, thời gian phẫu thuật, ước tính lượng máu mất, đánh giá thang điểm đau VAS, thời gian nằm viện, các biến chứng, kết quả điều trị, chức năng khớp háng theo thang điểm Harris ở thời điểm 3 tháng, 6 tháng và 12 tháng. Kết quả: Phương tiện đinh PFNA 41 trường hợp, đinh Gamma 5 trường hợp, đinh Reconstruction 12 trường hợp. Tuổi trung bình 78,86 ± 11,67 (38 - 97), nữ chiếm 72,4%. Thời gian mổ trung bình 70,34 ± 20,5 phút (45 - 135), kích thước vết mổ 6,70 ± 1,09 cm (5 - 10), ước tính lượng máu mất trung bình 257,1 ± 163,04 mL. Điểm đau VAS trước mổ và sau mổ trung bình lần lượt là 7,26 và 2,79. Thời gian nằm viện trung bình 13,37 ± 4,38 (5 - 24). Biến chứng trong phẫu thuật ghi nhân 1 trường hợp gãy rạn thân xương đùi và một trường hợp nắn kín thất bại. X quang liền xương ghi nhận ở tất cả trường hợp bệnh nhân tái khám, 4 trường hợp có can lệch. Điểm Harris ở thời điểm 3,6,12 tháng lần lượt là 76,42 ± 13,01, 85,96 ± 6,36, 90,25 ± 2,63. Kết luận: KHX bằng đinh nội tủy đầu trên xương đùi cho thấy kỹ thuật mổ xâm nhập tối thiểu giúp giảm mất máu, kích thước vết mổ nhỏ, bệnh nhân tỳ lực sớm và phục hồi sớm sau mổ. ABSTRACT THE RESULTS OF CLOSED REDUCTION AND INTERNAL FIXATION SINGPROXIMAL FEMORAL NAIL IN TREATMENT OF INTERTROCHANTERIC FEMUR FRACTURE Objective: In the past, treatment of intertrochanteric fractures was mainly to open reduction and internal fixation with DHS, locking plate … require extensive exposure, open fractures, will lead to blood loss, pain, and limited mobility postoperatively and lead to complications.In cases of unstable fractures with large external wall injuries treatment with DHS, locking plate often lead to secondary displacement and failure of treatment. With the introduction of intramedullary nails Gamma, PFNA, Reconstruction, and the latest generation of nails InterTAN, with minimally invasive surgical technique, without opening the fracture, shorter surgery time and blood loss, mechanically more stable, helping patients to move and weight bearing early after surgery and prevent complications due to prolonged lying down. This report aims to evaluate the results of treatmentintertrochanteric fractures with closed reduction technique on the orthopedic table and internal fixation with the proximal femoral nail. Material and method: We perform closed reduction on the orthopedic table using C Arm. And using surgical techniques applied according to AO on 58 cases of intertrochanteric fracture. Record the length of incision, surgery time, estimated blood loss, VAS pain score, hospital stay, complications, treatment results, hip function according to Harris scale. at 3 months, 6 months and 12 months. Results: The mean age was 78.86 ± 11.67 (38 - 97), female accounted for 72.4%. Means of nailing PFNA 41 cases, Gamma nails 5 cases, Reconstruction nails 12 cases. Average operative time 70.34 ± 20.5 minutes (45 - 135), incision size 6.70 ± 1.09 cm (5 - 10), estimated average blood loss 257.1 ± 163, 04 mL. The mean preoperative and postoperative VAS pain scores were 7.26 and 2.79, respectively. Average length of hospital stay was 13.37 ± 4.38 (5 - 24). Intraoperative complications recorded 1 case of femoral shaft fracture and 1 case of failure of closed manipulation. X-ray of bone healing was recorded in all patients at follow - up examination, 4 cases with fracture deformity. Harris score at 3,6,12 months is 76.42 ± 13.01, 85.96 ± 6.36, 90.25 ± 2.63, respectively. Conclusions: Treatment with a proximal femoral nail (PFN) showed that minimally invasive surgical technique, reduced blood loss, small incision size, allows early full weight bearing and postoperative recovery. Keywords: Proximal femoral nail, intertrochanteric femur fracture.

scholarly journals Successful Closed Reduction of Atlantoaxial Rotatory Fixation in Children—A Retrospective Study of 30 Patients

2021 ◽  
pp. 219256822098442
Author(s):  
Ping Xu ◽  
Zhiqiang Zhang ◽  
Yiming Zheng ◽  
Junrong Meng ◽  
Chuang Qian ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Recovery Time ◽  
Average Length ◽  
Final Visit ◽  
X Rays ◽  
Total Recovery ◽  
Group I ◽  
The Mean ◽  
Delayed Time

Study Design: Retrospective cohort study. Objectives: To review our treatment experience and to investigate the process of this disease. Methods: Clinical data of AARF patients, who received closed reduction, was retrospectively reviewed. Patients were divided into 2 groups according to the length of delay (Group I: 1 month ≤ delayed time < 3 months), Group II (delayed time < 1 months). The correlation between the length of delayed time and clinical recovery (CR), radiological recovery (RR), and total recovery time were measured. The atlantodental interval (ADI), lateral mass-dens interval (LDI) and lateral joint space (LJS) were compared at admission and final follow-up. Results: 30 children (12 girls and 18 boys) with AARF had received conservative treatment. The mean age at initial treatment was 8.13-year-old, ranging from 5 to 14. The mean follow-up time was 26.93 months (range, 6-87 months). The average length of delayed time was 28.53 days (range, 2-80 days). When the LDI, LJS, and ADI differences are compared at admission and the final visit, the differences are reduced significantly on LDI and LJS. A positive correlation is observed between the length of the delay and CR time and total recovery time (r = 0.63, p = 0.00 and r = 0.47, p = 0.01) respectively. Conclusions: Pediatric AARF patients who have a delay time < 3 months can be treated with closed reduction successfully. The longer the delayed time, the longer the traction time, but the cervical collar time is almost the same. The LDI and LJS on the anteroposterior of X-rays are convenient to estimate the progress of this condition during the treatment.

scholarly journals Chronic Syndesmotic Injury: Revision and Fixation With a Suture Button and a Quadricortical Screw

2020 ◽  
pp. 193864002091612
Author(s):  
Ingrid Kvello Stake ◽  
Mette Renate Andersen ◽  
Elisabeth Ellingsen Husebye
Keyword(s):  
Case Series ◽  
Technical Note ◽  
Syndesmotic Injury ◽  
Suture Button ◽  
Computed Tomography Scans ◽  
The Mean ◽  
American Orthopaedic ◽  
Ankle Function

Background. Chronic syndesmotic injury may cause long-term pain and reduced ankle function. Today, there is no consensus about the best surgical treatment of these injuries. We present the technique and results of revision and fixation with a suture button and a quadricortical screw. Methods. Eleven patients treated for chronic syndesmotic injury were included. The patients completed questionnaires regarding ankle function, and computed tomography scans were obtained to evaluate tibiofibular distance and osteoarthritis. Complications were registered. Results. At mean 45 months follow-up, the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 87 points. There were 5 complications, including 3 hardware-related pain. The tibiofibular distance was significantly reduced with surgery. Seven patients had progression of osteoarthritis. Conclusions. Even though the majority of the patients had progression of radiological signs of osteoarthritis, the functional outcome after revision and fixation with a suture button and a quadricortical screw in chronic syndesmotic ruptures is good and comparable to the results presented in other studies. Levels of Evidence: Level IV: Case series without control, technical note

scholarly journals Treatment of Displaced Intra-articular Calcaneal Fractures with the Intramedullary Nail

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0007
Author(s):  
Julien Lucas ◽  
Antoine Fourgeaux
Keyword(s):  
Intramedullary Nail ◽  
Weight Bearing ◽  
Ct Scans ◽  
Nerve Lesion ◽  
X Rays ◽  
New Device ◽  
Subtalar Arthrodesis ◽  
Number Of Patients ◽  
The Mean

Category: Trauma Introduction/Purpose: In 2010, a new closed reduction, internal fixation procedure for displaced intra-articular calcaneus fractures (DIACF) was developed with an intramedullary nail introduces through a channel in the calcaneal tuberosity. The goal was to reduce the rate of skin complications following principles of open reduction procedures. The aim of this prospective mono-centric study was to assess the occurrence of complications and the functional results using the AOFAS-AHS score. The secondary objectives were to assess first the restoration of the Böhler and Gissane angles on X-ray and shape of the calcaneus (Height, length, width) on CT scans, then thalamic reduction on 3D CT scans based on Goldzak’s global articular reduction classification. Methods: 26 Patients were included prospectively between 2014 and 2016 with analysis of X-rays and CT scans. Two were lost to follow-up and 2 patients sustained a secondary subtalar arthrodesis. After positioning a distractor and drilling, reduction was done with tamps and spatula. The nail was then introduced and locked with screws in the tuberosity and the constant fragment. After 3 weeks of non-weight bearing and 3 weeks with hindfoot off-loading shoe, full weight bearing was allowed. The functional outcome and restoration of the radiographic angles were evaluated postoperatively, at 3 months, 1 year and at the last follow-up. Global calcaneal shape and thalamic surface were evaluated postoperatively, at 1 year and at the last follow-up. The following early complications (delayed healing, infection, annoyed material, sural nerve lesion) and later complications (painful stiffness of the subtalar joint, hindfoot varus malalignment and calcaneofibular conflict) were recorded. Results: Mean follow up was 2.4 years. The mean AOFAS-AHS score was 79 ± 12 [100; 61] in the 22 patients examined. The mean Böhler angle rose from -1.29°± 18° [-35; 28] pre-operatively to 33°± 6° [22; 44] post-operatively. The mean calcaneal height index and length rose respectively from 0.44± 0,18 [0,12; 0,83] to 0.86± 0,22 [0,46; 1,1] and 82,4± 5,4 [72; 93] mm to 86,7mm ±4,6 [76; 97], and the width decreased from 49,8± 4,8 [38; 59] to 46,3± 3,7 [38; 55] mm. The Goldzak global articular reduction assessment was excellent in 39% of cases, good in 42% of cases and poor in 19% of cases. One case of deep infection was reported. Three patients needed device removal and two sustained a secondary subtalar arthrodesis. Conclusion: Our prospective study on this new device has the longest time of follow-up. The results confirm the effectiveness and the reliability over time of the procedure to restore the global shape and the thalamic surface with a low rate of complications and quick return to activities. It appears to be an excellent compromise between the respect of the principles of reduction as applied in the ORIF procedures, and the low cutaneous risk of percutaneous procedures. A subsequent study, with a larger number of patients, will enable analysis of the correlation between the radiological markers and the AOFAS-AHS.

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 &lt; .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.

Fractures of the Calcaneus: Open Reduction and Internal Fixation From the Medial Side a 21-Year Prospective Study

1997 ◽  
Vol 18 (11) ◽  
pp. 685-692 ◽  
Author(s):  
Billie D. Burdeaux
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Medial Approach ◽  
Medial Side ◽  
Successful Group ◽  
American Orthopaedic ◽  
System Time

Since 1974, 61 displaced fractures of the calcaneus have been treated by open reduction and internal fixation by a modified medial approach technique. Surgery was performed through a 5-cm incision posterior to the neurovascular bundle. A single threaded pin was passed longitudinally through the tuberosity and into the sustentacular fragment, giving stable fixation. Reduction of the depressed posterior facet fragments was accomplished from the medial side in 77% of cases, occasionally assisted by fluoroscopy. Postoperatively all fractures were immobilized in a cast for 4 weeks. At the end of 4 weeks the pin was removed, and full weight bearing in a walking cast was started and continued for 4 weeks. At 8 weeks after surgery, the walking cast was removed, and the patient began walking in a shoe. These cases were evaluated at a mean follow-up of 4.4 years. There were 49 successful cases (80.3%) and 12 unsuccessful cases (19.7%). A high number of superior results was found in the successful group as shown by the mean score of 94.7 (American Orthopaedic Foot & Ankle Society Scoring System). Time to return to work was a mean of 4.9 months.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

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.

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