Surgical Treatment of Calcaneal Fractures with Use of β-Tricalcium Phosphate Ceramic Grafting

2008 ◽  
Vol 29 (10) ◽  
pp. 1015-1019 ◽  
Author(s):  
Sheng-Dan Jiang ◽  
Lei-Sheng Jiang ◽  
Li-Yang Dai
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Tricalcium Phosphate ◽  
Open Reduction ◽  
Clinical Results ◽  
Statistical Correlation ◽  
Calcaneal Fractures ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
The Mean

Background: The treatment of calcaneal fractures is challenging. Internal fixation and grafting with sintered β-tricalcium phosphate (β-TCP) ceramic is alternative to bone grafting in the treatment of calcaneal fractures. Methods: Seventy-four patients with intraarticular calcaneal fractures were treated with open reduction, internal fixation and grafting with sintered β-TCP ceramic. Followup was performed using the Maryland foot score as well as plain radiography. Results: All patients were followed for 15 (range, 12 to 26) months. Clinical results as assessed by the Maryland foot score were excellent in 40 of 74 cases (54.1%), good in 28 (37.8%), and fair in 6 (8.1%). Immediately after surgery, the mean Böhler angle was improved by 23 degrees, and 1 year after surgery, the mean Böhler angle decreased by 4 degrees. A similar change was also seen in Gissane angles and the height and width of the calcaneus. There was no statistical correlation between the severity of fracture and functional outcome in this series. All fractures healed. Conclusion: These findings suggest that use of β-TCP combined with open reduction and internal fixation is an effective and safe method for the surgical treatment of intra-articular calcaneal fractures. Level of Evidence: IV, Retrospective Case Study

scholarly journals Limited Open Reduction and Internal Fixation of Calcaneal Fractures

2019 ◽  
Vol 41 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Anne K. Bremer ◽  
Lukas Kraler ◽  
Lars Frauchiger ◽  
Fabian G. Krause ◽  
Martin Weber
Keyword(s):  
Wound Healing ◽  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
Functional Results ◽  
High Rate ◽  
Calcaneal Fractures ◽  
Retrospective Case ◽  
Level Of Evidence

Background: The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique. Methods: Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months). Results: The mean AOFAS score was 87 ± 13 (range, 32-100). “Excellent” and “good” results, as well as hindfoot motion with “normal/mild” and “moderate” restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%). Conclusion: The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal. Level of Evidence: Level IV, retrospective case series.

scholarly journals Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation

2020 ◽  
Vol 09 (02) ◽  
pp. 141-149
Author(s):  
Pooja Prabhakar ◽  
Lauren Wessel ◽  
Joseph Nguyen ◽  
Jeffrey Stepan ◽  
Michelle Carlson ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Scaphoid Fracture ◽  
Receiver Operating Curve ◽  
Scaphoid Nonunion ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Fracture Location ◽  
Scaphoid Fractures ◽  
Time From Injury

Abstract Background Nonunion after open reduction and internal fixation (ORIF) of scaphoid fractures is reported in 5 to 30% of cases; however, predictors of nonunion are not clearly defined. Objective The purpose of this study is to determine fracture characteristics and surgical factors which may influence progression to nonunion after scaphoid fracture ORIF. Patients and Methods We performed a retrospective case–control study of scaphoid fractures treated by early ORIF between 2003 and 2017. Inclusion criteria were surgical fixation within 6 months from date of injury and postoperative CT with minimum clinical follow-up of 6 months to evaluate healing. Forty-eight patients were included in this study. Nonunion cases were matched by age, sex, and fracture location to patients who progressed to fracture union in the 1:2 ratio. Results This series of 48 patients matched 16 nonunion cases with 32 cases that progressed to union. Fracture location was proximal pole in 15% (7/48) and waist in 85% (41/48). Multivariate regression demonstrated that shorter length of time from injury to initial ORIF and smaller percent of proximal fracture fragment volume were significantly associated with scaphoid nonunion after ORIF (63 vs. 27 days and 34 vs. 40%, respectively). Receiver operating curve analysis revealed that fracture volume below 38% and time from injury to surgery greater than 31 days were associated with nonunion. Conclusion Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid. Level of Evidence This is a Level III, therapeutic study.

The epidemiology and trends in the surgical management of calcaneal fractures in England between 2000 and 2017

2019 ◽  
Vol 101-B (2) ◽  
pp. 140-146 ◽  
Author(s):  
J. A. Humphrey ◽  
A. Woods ◽  
A. H. N. Robinson
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Calcaneal Fracture ◽  
Recent Change ◽  
Calcaneal Fractures ◽  
Female Ratio ◽  
The United Kingdom ◽  
The Mean ◽  
The Uk ◽  
Male To Female

Aims This paper documents the epidemiology of adults (aged more than 18 years) with a calcaneal fracture who have been admitted to hospital in England since 2000. Secondary aims were to document whether publication of the United Kingdom Heel Fracture Trial (UK HeFT) influenced the proportion of patients admitted to hospital with a calcaneal fracture who underwent surgical treatment, and to determine whether there has been any recent change in the surgical technique used for these injuries. Patients and Methods In England, the Hospital Episode Statistics (HES) data are recorded annually. Between 2000/01 and 2016/17, the number of adults admitted to an English NHS hospital with a calcaneal fracture and whether they underwent surgical treatment was determined. Results During this 17-year period, 62 858 patients were admitted to hospital with a calcaneal fracture. The male-to-female ratio was 2.66:1. The mean annual incidence was 10.5/100 000 for men and 3.8/100 000 for women. The results of the UK HeFT were published in July 2014. The percentage of patients admitted with a calcaneal fracture undergoing internal fixation was 7.31% (3792/51 859) before and 7.38% (534/7229) after its publication. This difference was not statistically significant (p = 0.94). Since 2015, there has been a significant increase in the percentage of calcaneal fractures treated by closed reduction and internal fixation, as opposed to open reduction and internal fixation, from 7.7% (292/3792) to 13.29% (71/534) (p < 0.001). Conclusion This study documents the epidemiology and trends in surgical treatment of calcaneal fractures in England. We established that surgeons did not change their practice in terms of offering surgery to these patients in response to the results of the UK HeFT. There has been a significant (p < 0.001) increase in the number of calcaneal fractures being treated surgically using less invasive procedures.

Repair of Femoral Capital Physeal Injuries in Cats -14 Cases

1996 ◽  
Vol 09 (04) ◽  
pp. 182-185 ◽  
Author(s):  
A. P. Black ◽  
K. F. Lorkin ◽  
W. A. Bradley ◽  
J. A. Culvenor
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Surgical Technique ◽  
Internal Fixation ◽  
Head And Neck ◽  
Open Reduction ◽  
Functional Result ◽  
Clinical Results ◽  
Non Union ◽  
Physeal Fractures

SummaryFemoral capital physeal fractures (CPF) are common injuries in the immature cat. Fractures of the femoral head and neck have been classified by Daly (1) as capital, physeal, subcapital and transcervical. Physeal fractures may also be classified according to Salter (2) and those covered in this paper are Salter I and II.Perez-Aparicio and Fjeld (2) found that many cats become functional without surgical treatment although most developed malunion or non-union. Some of the untreated cats had persistent lameness.While femoral head and neck ostectomy (3), is often recommended and will usually lead to a functional result, particularly in the cat, open reduction and internal fixation is preferred (5, 6) as is recommended in the dog (8, 21).Fourteen femoral capital physeal fractures in 13 cats were repaired with fine pins. The surgical technique and clinical results are described. The authors feel that the ease of the technique and the clinical results make this the treatment of choice for injuries of this type in cats.

Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) of the Fifth Metatarsal for Bunionette Correction

2018 ◽  
Vol 39 (4) ◽  
pp. 450-457 ◽  
Author(s):  
Kar Hao Teoh ◽  
Kartik Hariharan
Keyword(s):  
Minimally Invasive ◽  
Callus Formation ◽  
Case Series ◽  
Clinical Results ◽  
Osteotomy Site ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Average Improvement ◽  
The Mean

Background: Different osteotomies have been proposed for the treatment of bunionette deformity. Minimally invasive surgery is now increasingly popular for a variety of forefoot conditions. The aim of this study was to evaluate the outcome following fifth minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) for bunionette deformity. Methods: Nineteen patients (21 feet) who had symptomatic bunionette deformity and failed conservative treatment between 2014 and 2016 were included in this retrospective study. Clinical data were recorded, and pre- and postoperative Manchester-Oxford Foot Questionnaire (MOXFQ) scores and visual analog scale (VAS) pain score were collected. The mean follow-up was 28 months (range, 12-47). Results: The mean MOXFQ summary index score decreased from 71 (range, 59-81) preoperatively to 10 (range, 0-30) postoperatively. All 3 MOXFQ domains also improved. The average improvement in VAS score was 7. Forefoot swelling and some painful symptoms took an average of 3 months to settle. There were no wound or nerve complications. One patient required a dorsal cheilectomy for a symptomatic prominent dorsolateral callus formation. Conclusion: The minimally invasive fifth DMMO for bunionette deformity was a safe and effective technique. It had relatively few complications and led to good clinical results. We believe it is important to warn patients that the forefoot swelling will take months to settle compared to an osteotomy with fixation, and there is a 10% chance of a prominent callus over the osteotomy site. Level of Evidence: Level IV, retrospective case series.

scholarly journals Comparative Study of Open Reduction and Internal Fixation and Primary Subtalar Arthrodesis for Sanders Type IV Intra-articular Calcaneal Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Seunghun Woo ◽  
Hyung Jin Chung ◽  
Su-Young Bae ◽  
Tae Sik Goh
Keyword(s):  
Patient Satisfaction ◽  
Internal Fixation ◽  
Clinical Outcomes ◽  
Open Reduction ◽  
Calcaneal Fractures ◽  
Subtalar Arthrodesis ◽  
Type Iv ◽  
Significant Difference ◽  
The Mean

Category: Trauma Introduction/Purpose: To compare clinical outcome of Sanders type IV intra-articular calcaneal fracture treated with open reduction and internal fixation (ORIF) versus ORIF and primary subtalar arthrodesis (PSTA). Methods: Between March 2003 and November 2013, 22 patients with 22 Sanders type IV intra-articular calcaneal fractures were included in this study. Of these, 11 feet were treated with ORIF (ORIF group), 11 feet were treated with ORIF and PSTA (PSTA group). The mean follow-up periods was 34.6 months (range, 18-72 months). Clinical outcomes were assessed along with the American Orthopaedic Foot and Ankle Society’s Ankle-Hindfoot Scale (AOFAS score), the Visual Analog Scale Pain score (VAS score) at 6-, 12 month, and last follow-up. The patient satisfaction, returning to previous occupation and postoperative complications were also investigated. Results: Complete bone union were achieved in all patients. No statistical difference was found between the results for ORIF compared with PSTA: the mean preoperative Bohler angle were, respectively, -3.2±9.2 and -6.6±12.7 degrees (p=0.475); the mean last follow-up AOFAS scores were 73.8±14.9 and 80.5±4.6 (p=0.795); the mean VAS last follow-up VAS scores were 29.7±20.6 and 23.4±10.0 (p=0.986). Secondary subtalar arthrodesis were conducted in 5 patients (45.5%) of ORIF group due to subtalar osteoarthritis symptom within 2 years, postoperatively. Conclusion: We were unable to demonstrate a significant difference of clinical outcomes between ORIF and PSTA however, the patient satisfaction was higher in the PSTA group. PSTA may be considerable choice for patients who need fast recovery to daily activity and to prevent the need for secondary subtalar arthrodesis.

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.

Outcomes of a Cardiac Rehabilitation (CRH) Program after phase II: what about our patients almost 4 years later?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Borrego Rodriguez ◽  
C Palacios Echevarren ◽  
S Prieto Gonzalez ◽  
JC Echarte Morales ◽  
R Bergel Garcia ◽  
...  
Keyword(s):  
Phase Ii ◽  
Hospital Readmissions ◽  
Clinical Results ◽  
Level Of Evidence ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
The Mean ◽  
Acute Cardiovascular Event ◽  
Mean Time

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION CRH in patients with ischemic heart disease is recommended by the different clinical practice guidelines with an IA level of evidence, with an important role in reducing cardiovascular mortality and hospital readmissions during follow-up. OBJECTIVE The goal of this study is to show the 4-year clinical results of a population of patients who participated in an CRH program after an Acute Coronary Syndrome (ACS). METHODS Between May/2014 and September/2017, 221 patients who had recently presented an ACS completed the 12 weeks of phase II of the CRH program at our center. In May/2020 we collected epidemiological, clinical and echocardiographic information at the time of the acute cardiovascular event; and we evaluate the current vital status of the patients and the incidence of readmissions for: angina, HF, new ACS, or arrhythmic events. RESULTS Of the 221 patients, 182 were men (82%). The mean age of our population was 58.3 ± 7.8 years. 58% (129 patients) suffered from ST-elevation ACS. The mean time of hospital stay was 6.20 ± 2.9 days. An echocardiogram was performed at discharge, which showed an average LVEF of 56 ± 6%. Eight patients (4%) developed early Ventricular Fibrilation (VF) during the acute phase of ACS. Among the classic CVRF, smoking (79%) was the most prevalent, followed by dyslipidemia (53%) and hypertension (47%). The mean time from hospital discharge to the start of phase II RHC was 42 ± 16 days. The overall incidence of events was 9%: 10 patients suffered reinfarction during follow-up, and 7 were readmitted for unstable angina, all of whom underwent PCI; no patient was admitted for HF; and none of the 8 patients with early VF had a new tachyarrhythmia, registering a single admission for VT during follow-up. None of the patients had sustained ventricular tachyarrhythmias during exercise-training. At the mean 4.5-year follow-up, 218 patients were still alive (98%). CONCLUSION The incidence of CV events in the follow-up of our cohort was low, which can be explained by the fact that it is a young population, with an LVEF at low limits of normality at discharge, which is one of the most important predictors in the prognosis after an ischemic event. As an improvement, we must shorten the time until the start of phase II of the program. CRH shows once again its clinical benefit after an ACS, in consonance with the existing evidence. Abstract Figure. Outcomes of a CRH program.

Radiographic Correlation of Hallux MP Fusion Position and Plate Angle

2009 ◽  
Vol 30 (9) ◽  
pp. 873-876 ◽  
Author(s):  
J. Thaddeus Leaseburg ◽  
James K. DeOrio ◽  
Shane A. Shapiro
Keyword(s):  
Weight Bearing ◽  
Proximal Phalanx ◽  
Case Series ◽  
Statistical Correlation ◽  
Titanium Plate ◽  
Care Needs ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Lower Correlation ◽  
Proper Weight

Background: This study assessed the variability of plate bend in regard to final metatarsophalangeal (MP) fusion angles and toe-to-floor distance. We hypothesized that the final MP angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance would be dictated solely by the magnitude of the bend in the plate. Materials and Methods: This is a retrospective analysis of 35 sequential patients who underwent MP fusion with a low-contour titanium plate. Postoperative weightbearing radiographs were analyzed for plate angle, MP fusion angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance. Results: We found statistical correlation between plate angle and MP angle and between plate angle and the angle of the proximal phalanx to the floor. However, there was low correlation between plate angle and with toe-to-floor distance. In addition, we noted many outliers, which resulted in higher or lower correlation of the MP angle to the expected plate angle and, thus, a relationship between angles that was far from linear. Conclusion: Care needs to be taken when relying solely on the bend in the plate to determine the final position of the toe in MP fusions. Although the association between plate bend and MP angle and proximal phalanx to floor angle was strong, the association between the bend in the plate and weight bearing toe-to-floor distance was variable. This could result in the toe hitting the shoe or the need to vault over the toe. Therefore, the surgeon must match the plate to each patient's anatomy to ensure proper weight bearing toe-to-floor distance and not rely on plate angle exclusively. Level of Evidence: IV, Retrospective Case Series

Open Reduction and Internal Fixation of Intra-articular Calcaneal Fractures in Children

Orthopedics ◽  
2012 ◽  
Vol 35 (6) ◽  
pp. e874-e879 ◽  
Author(s):  
Guang-rong Yu ◽  
Hong-mou Zhao ◽  
Yun-feng Yang ◽  
Jia-qian Zhou ◽  
Hai-feng Li
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Calcaneal Fractures ◽  
Fractures In Children
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