MANAGEMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES WIILIZAROV RING FIXATIO

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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Subtalar arthroscopy and fluoroscopy in percutaneous fixation of intra-articular calcaneal fractures

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684995 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668499 ◽

Cited By ~ 2

Author(s):

Gin Way Law ◽

Nicholas Eng Meng Yeo ◽

William Yeo ◽

Kevin Koo ◽

Keen Wai Chong

Keyword(s):

Functional Outcomes ◽

Subtalar Joint ◽

Time Frame ◽

Percutaneous Fixation ◽

Calcaneal Fractures ◽

Anatomical Reduction ◽

Intraoperative Fluoroscopy ◽

Böhler’S Angle

Introduction: Percutaneous fixation of intra-articular calcaneal fractures is traditionally assisted only by intraoperative fluoroscopy. Previous studies have demonstrated that the additional use of subtalar arthroscopy in anatomical reduction of the posterior calcaneal facet of the subtalar joint for less complex calcaneal fractures yielded positive results up to 2-year follow-up. This study aims to investigate long-term outcomes of these patients using similar evaluation parameters. We hypothesized that this novel technique with dual-imaging can provide sustainable, long-term benefits with good functional outcomes and significant restoration of the Bohler’s angle. Methods: We performed a retrospective study of 15 Sanders II, AO-OTA 83-C2 intra-articular calcaneal fractures in 14 patients who underwent subtalar arthroscopy and fluoroscopy guided percutaneous fracture fixation with a minimum follow-up of 5 years. Outcome measures were assessed using the ankle and hindfoot NPRS, AOFAS ankle–hindfoot score, and SF-36 Physical Function subscale preoperatively and at 3 months, 6 months, 1 year, 2 years and 5–8 years postoperatively. The Bohler’s angle was measured preoperatively, immediately postoperatively and at 5–8 years postoperatively. Results: We report excellent functional outcomes in all scores as well as continued improvements in the majority of patients across all time points with minimal subsidence of the corrected Bohler’s angle over our study time frame. Conclusion: Subtalar arthroscopy with intraoperative fluoroscopy in anatomical reduction of the posterior calcaneal facet of the subtalar joint is most useful in Sanders type II, AO-OTA 83-C2 fractures with excellent functional outcomes and good preservation of the corrected Bohler’s angle on long-term follow-up.

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Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684722 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668472 ◽

Cited By ~ 5

Author(s):

Süleyman Semih Dedeoğlu ◽

Yunus İmren ◽

Haluk Çabuk ◽

Murat Çakar ◽

Samet Murat Arslan ◽

...

Keyword(s):

Functional Outcomes ◽

Clavicle Fracture ◽

Rehabilitation Program ◽

Minimal Invasive ◽

X Rays ◽

Distal Clavicle ◽

Distal Clavicle Fracture ◽

Shoulder Scores ◽

Coracoclavicular Fixation

Aim: We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle. Material and methods: 22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1. Results: Mean age was 39 (range: 21–60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30–55 min). Mean union time was found to be 14 weeks (range: 7–21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9–88.3) and 82.2 (71–100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays. Conclusion: This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes.

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Functional outcome of calcaneal locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20181805 ◽

2018 ◽

Vol 4 (3) ◽

pp. 493

Author(s):

George Thomas ◽

Jinny John

Keyword(s):

Functional Outcome ◽

Plantar Flexion ◽

Lateral Approach ◽

Lateral View ◽

Locking Compression Plate ◽

X Rays ◽

Calcaneal Fractures ◽

Compression Plate ◽

American Orthopaedic ◽

Böhler’S Angle

Background: The calcaneus is the frequently injured tarsal bone.75% of calcaneal fractures are intraarticular. Treating calcaneal fractures is a challenge for orthopaedic surgeon due to complex fracture pathology. Our aim is to evaluate the functional outcome of calcaneum Locking compression plate in patients with intraarticular calcaneal fractures with Bohler’s angle <20 degree who are admitted in the department of Orthopaedics, Government Medical College, Kottayam.Methods: In this study, 41 patients with 42 intraarticular calcaneal fractures were operated on with locking compression plate through lateral approach during the period of July 2015 to December 2016. Radiological evaluation done with X-rays. Bohler’s angle was measured from lateral view and those patients with angle <200 were selected for study. Patients were followed up clinically and radiologically for 24 weeks. Radiological assessment was done by Bohlers angle. Functional outcome was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) scale.Results: At 24 weeks follow up, 90.5% of the study population had excellent to good functional outcome and 9.5% had fair and none had poor result. All patients had stable hind foot with all having good dorsiflexion and plantar flexion. But some patients had limited inversion and eversion. The mean postoperative Bohler’s angle was 30.02±3.97.Conclusions: Open reduction and internal fixation with locking compression plate gives sound functional outcome, if the surgery is well timed. Anatomical articular reduction especially of the posterior facet to be achieved and restoration of Bohler’s angle to normal range to be attempted.

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Functional Outcomes of Revision Osteosynthesis after Failure of Surgical Treatment of Patellar Fractures

The Journal of Knee Surgery ◽

10.1055/s-0039-1692673 ◽

2019 ◽

Vol 34 (01) ◽

pp. 080-086 ◽

Cited By ~ 2

Author(s):

Elena Caroline Müller ◽

Karl-Heinz Frosch

Keyword(s):

Revision Surgery ◽

Functional Outcomes ◽

Surgical Techniques ◽

Fracture Dislocation ◽

Anatomic Reconstruction ◽

Secondary Fracture ◽

Complete Extension ◽

Early Revision ◽

Patellar Fractures

AbstractPatellar fractures account for approximately 1% of all skeletal fractures. These fractures are rare; however, because of the crucial function of the patella in the extensor mechanism of the knee, they may lead to serious impairment. New data are revealing functional impairment remains common even with improved surgical techniques. The aim of this study was to assess the functional outcomes of patients after revision surgery in cases of secondary fracture dislocation or persistent articular incongruity. This study included 16 patients with a mean age of 51.8 years (range: 16–85 years) with a mean follow-up of 35.1 months. According to the AO/OTA classification, 15 patients had a C-type fracture, including 10 patients with C3 fracture. Thirteen patients were initially treated with tension band wiring via K-wires or cannulated screws. Revision surgery was performed because of persistent articular incongruity in five patients and secondary fracture dislocation or refracture in 11 patients. We analyzed pain (visual analog scale [0–10]), satisfaction, range of motion (ROM), Böstman's score, Lysholm's score, and knee injury and osteoarthritis outcome score (KOOS) after revision surgery and could extract follow-up data from 15 patients. Mean pain score at rest was 0.57 (range: 0–3.5) and on exertion 2.79 (range: 0–8). The measurement of the ROM of the affected knee compared with that of the opposite knee revealed complete extension. Mean flexion was 123 degrees, in the corresponding knee it was 136 degrees (p = 0.05). The mean postoperative Böstman's and Lysholm's scores were 25.11 (good, maximum: 30) and 78.67 (moderate, maximum: 100), respectively. KOOS was as follows: symptoms, 66.8 points; pain, 77.55 points; activity of daily living (ADL), 75.67 points; and quality of life, 56.25 points. The results of this study suggested that early revision surgery after failure of primary osteosynthesis with secondary anatomic reconstruction and good radiological results leads to satisfactory functional outcomes with persistent functional deficits.

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OVERLOAD STUDY ON ADJACENT DISC AFTER ARTHRODESIS IN THORACOLUMBAR FRACTURES

Coluna/Columna ◽

10.1590/s1808-185120161504147198 ◽

2016 ◽

Vol 15 (4) ◽

pp. 314-316

Author(s):

GUSTAVO SERRA REINAS ◽

FERNANDO ZANI GARCIA ◽

RÉGIS SILVEIRA TEIXEIRA ◽

EMILIO CEZAR MAMEDE MURAD ◽

RUY YOSHIAKI OKAJI ◽

...

Keyword(s):

Surgical Approach ◽

Common Mechanism ◽

X Rays ◽

Thoracolumbar Fractures ◽

Mechanism Of Injury ◽

Adjacent Disc ◽

Fall From Height ◽

The Mean

ABSTRACT Objective: To analyze the degeneration of the adjacent disc after arthrodesis due to thoracolumbar fractures. Methods: Eighty-three patients who underwent posterolateral arthrodesis in thoracolumbar levels had their x-rays analyzed for degeneration of adjacent discs to the arthrodesis. The disc spaces were classified by the UCLA scale. Results: Of the 83 patients evaluated, 66 were males (79%) and 18 females (21%), with a mean age of 35.5 years. The mean follow-up period was 40 months. As the fractures 75% were between T12 and L2 (p<0.001), being of the A3 type in 65% of the cases (p<0.001). The most common mechanism of injury, accounting for 50% of the cases (p<0.001), was fall from height. Only 6% of the superior discs and 12% of the inferior ones showed some degree of degeneration. No patient underwent a new surgical approach. Conclusion: The incidence of degeneration on adjacent disc in patients after arthrodesis resulting from fractures ranged from 6% to 12% with an average follow-up of 40 months.

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Anatomic reconstruction for acromioclavicular joint injuries: a pilot study of a cost-effective new technique

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00325 ◽

2021 ◽

Vol 24 (4) ◽

pp. 209-214

Author(s):

Radhakrishnan Pattu ◽

Girinivasan Chellamuthu ◽

Kumar Sellappan ◽

Chendrayan Kamalanathan

Keyword(s):

Acromioclavicular Joint ◽

Cost Effective ◽

Anatomic Reconstruction ◽

X Rays ◽

Effective Technique ◽

Ac Joint ◽

Joint Injuries ◽

Cost Effective Technique ◽

The Mean

Background: The treatment for acromioclavicular joint injuries (ACJI) ranges from a conservative approach to extensive surgical reconstruction, and the decision on how to manage these injuries depends on the grade of acromioclavicular (AC) joint separation, resources, and skill availability. After a thorough review of the literature, the researchers adopted a simple cost-effective technique of AC joint reconstruction for acute ACJI requiring surgery.Methods: This was a prospective single-center study conducted between April 2017 and April 2018. For patients with acute ACJI more than Rockwood grade 3, the researchers performed open corococlavicular ligament reconstruction using synthetic sutures along with an Endobutton and a figure of 8 button plate. This was followed by AC ligament repair augmenting it with temporary percutaneous AC K-wires. Clinical outcomes were evaluated using the Constant Murley shoulder score. Results: Seventeen patients underwent surgery. The immediate postoperative radiograph showed an anatomical reduction of the AC joint dislocation in all patients. During follow-up, one patient developed subluxation but was asymptomatic. The mean follow-up period was 30 months (range, 24–35 months). The mean Constant score at 24 months was 95. No AC joint degeneration was noted in follow-up X-rays. The follow-up X-rays showed significant infra-clavicular calcification in 11 of the 17 patients, which was an evidence of a healed coracoclavicular ligament post-surgeryConclusions: This study presents a simple cost-effective technique with a short learning curve for anatomic reconstruction of acute ACJI. The preliminary results have been very encouraging.

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The Results of Hemivertebra Resection by the Posterior Approach in Children with a Mean Follow-Up of Five Years

Advances in Orthopedics ◽

10.1155/2017/4213413 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Ramazan Erden Erturer ◽

Bekir Eray Kilinc ◽

Bahadir Gokcen ◽

Sinan Erdogan ◽

Kursat Kara ◽

...

Keyword(s):

Postoperative Period ◽

Sagittal Plane ◽

Operating Time ◽

Deformity Correction ◽

Pedicle Screws ◽

Early Postoperative Period ◽

X Rays ◽

Hemivertebra Resection ◽

The Mean

Aim. To evaluate the radiologic and clinical results of patients who underwent deformity correction and stabilization for congenital spinal deformities using pedicle screws after hemivertebra resection. Material and Method. Nine patients, mean age 9.2, who underwent posterior hemivertebrectomy and transpedicular fixation for congenital spinal deformity and had longer than five years of follow-up were evaluated retrospectively. The hemivertebrae were located in the thoracic region in 4 patients and thoracolumbar transition region in 5 patients. The patients were evaluated radiologically and clinically in the postoperative period. Results. Mean length of follow-up was 64.2 months. The mean operating time was 292 minutes. The mean blood loss was 236 mL. The average hospitalization time was 7 days. The amount of correction on the coronal planes was measured as 31%. The mean segmental kyphosis angle was 45.7 degrees preoperatively and it was measured 2.7 degrees in the follow-up period. There were no statistically significant differences between the early postoperative period and final follow-up X-rays with respect to coronal and sagittal plane deformities. Conclusion. The ability to obtain a sufficient and balanced correction in the cases accompanied by long compensator curvatures that have a structural character in hemivertebra may require longer fusion levels.

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Pediatric calcaneal fractures

Orthopedic Reviews ◽

10.4081/or.2009.e9 ◽

2009 ◽

Vol 1 (1) ◽

pp. 9 ◽

Cited By ~ 11

Author(s):

Hobie Summers ◽

Patricia Ann Kramer ◽

Stephen K. Benirschke

Keyword(s):

Operative Treatment ◽

Treatment Protocol ◽

Skeletally Immature ◽

Calcaneal Fractures ◽

Articular Fractures ◽

Wound Healing Problems ◽

Operative Fixation ◽

Fracture Types ◽

Böhler’S Angle

Although operative treatment of displaced, intra-articular fractures of the calcaneus in adults is generally accepted as standard practice, operative treatment for the same fractures in the skeletally immature remains controversial, potentially because the outcome for fracture types (intra- vs. extra-articular) and severity (displaced vs. nondisplaced) have been confounded in studies of children. We review herein the results of 21 displaced, intra-articular fractures in 18 skeletally immature patients, who were treated with open reduction and internal fixation using a standard surgical approach and protocol developed for adults. The average pre-operative Böhler's angle on the injured side was -5° (range: -35 - +35) compared to 31° (range: +22 - +47) on the uninjured side, indicating substantial displacement. There were no post-operative infections or wound healing problems, and all but one patient was followed to union (average follow-up: 1.5 years; range: 0.30-4.3 years). Maintenance of reduction was confirmed on follow-up radiographs with an average Böhler's angle of 31° (range: +22 - +49). We demonstrate that results for operative fixation of displaced, intra-articular calcaneal fractures in the skeletally immature are comparable to those in adults when the treatment protocol is the same.

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Conservative Treatment Versus Repair Deltoid in SER Type IV Equivalent Ankle Fracture

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00004 ◽

2018 ◽

Vol 3 (2) ◽

pp. 2473011418S0000

Author(s):

Chamnanni Rungprai

Keyword(s):

Conservative Treatment ◽

Functional Outcomes ◽

Ankle Fracture ◽

Deltoid Ligament ◽

Medial Side ◽

Type Iv ◽

Sf 36 ◽

Fibular Fixation ◽

Return To Activity

Category: Trauma Introduction/Purpose: There remains a controversy to repair deltoid ligament in SER type IV equivalence of acute ankle fracture. Some surgeons prefer conservative treatment with casting while others prefer to repair deltoid ligament after distal fibular fixation. However, there is a little evidence to report comparative outcomes between the two methods. There remains a controversy to repair deltoid ligament in SER type IV equivalence of acute ankle fracture. Some surgeons prefer conservative treatment with casting while others prefer to repair deltoid ligament after distal fibular fixation. However, there is a little evidence to report comparative outcomes between the two methods. The purpose of this study was to report clinical and functional outcomes including complications between the two methods. Methods: A prospective, randomized collected data of 41 consecutive patients who were diagnosed with SER type IV equivalence acute ankle fracture and underwent either conservative treatment (20 patients) or deltoid repair (21 patients) between 2015 and 2017. A minimum follow up to be included in the study was 6 months (mean, 13.2 months; range, 6 to 30 months). The primary outcome was visual analogue scale (VAS), Short Form-36 (SF-36); physical and mental component scores, and FAAM; ADL and Sport. Pre- and post-operative SF-36, FAAM, and pain (Visual Analog Scale) were obtained and compared between the two groups using independent t-test. The secondary outcomes were time to return to activity of daily living, sports, work, and complications. Results: There were 41 patients (30 male and 11 female) with mean age of 29.7 years (range, 18-70 years) and mean BMI of 26.7 kg/m2 (range, 18.3-33.6 kg/m2). Both methods demonstrated significant improvement of post-operative functional outcomes (FAAM, SF-36, and VAS (p < 0.05 all)) compared to pre-operative period; however, there was no significant different between the two groups. Functional outcomes between casting and deltoid repair groups were time to return to activity of daily living (10.4 vs 11.7 weeks), works (12.1 vs 12.9 weeks), sport (25.9 vs 23.7 weeks), weight bearing medial clear space (2.9 vs 3.9 mm), and complications included medial side ankle pain (57 vs 15%) and painful scar (0 vs 15%) for cast and deltoid repair respectively. Conclusion: Both casting and deltoid repair were demonstrated significant improvement in terms of functional outcomes as measured with the FAAM, SF-36, and VAS in patients with SER IV equivalent ankle fracture. Although there was no significant difference of functional outcome in short term of follow-up, deltoid repair group was better in term of medial side ankle pain and lesser medial clear space widening.

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Calcaneal Fractures: Three-dimensional Treatment

Foot & Ankle ◽

10.1177/107110078800800403 ◽

1988 ◽

Vol 8 (4) ◽

pp. 180-197 ◽

Cited By ~ 39

Author(s):

Michael M. Romash

Keyword(s):

Three Dimensional ◽

Functional Results ◽

Three Dimensions ◽

Anatomic Reconstruction ◽

Radiographic Evaluation ◽

X Rays ◽

Calcaneal Fractures ◽

Axial Tomography ◽

Os Calcis ◽

Gait Abnormality

A series of 22 calcaneal fractures operated over 4 yr is presented. Radiographic evaluation of these fractures using axial, lateral, anteroposterior, and oblique medial projection (Broden's view) with varying tube angulation toward the head and computerized axial tomography in two planes, coronal and transverse, were done. This repeatedly demonstrated intra-articular splitting fractures along the axis of the os calcis through the posterior facet, extending to the calcaneocuboid joint. These fractures were surgically reduced as described by McReynolds with sequential medial and lateral approaches. Intraoperative X-rays demonstrate the three-dimensional nature of this injury. Bohler's angle may be reconstituted with apparent reduction of the posterior facet when projected laterally; however, Broden's and axial views show persistent widening and split of the posterior facet. The 22 patients have been followed from 12 to 46 mo. All have heels of normal width and wear standard shoes. The first two cases, done only medially, have less than anatomic reconstruction of the subtalar joint. Functional results have been encouraging. Of six active duty members so treated, three returned to full duty, a second who was medically retired as a result of other injuries had minimal heel problems, and fifth had a contralateral open pilon fracture which hampers him, and the sixth patient is now 4 mo postbilateral calcaneal fractures with return to duty anticipated. Most of the 22 have some decrease in subtalar motion without apparent gait abnormality. No cases of medial or lateral impingement or tendinitis are present. Fractures of the calcaneus are amendable to open reduction and internal fixation. Sequential medial and anterolateral exposure allow anatomic reconstruction in three dimensions, avoiding pitfalls of two-dimensional analysis and treatment.

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