A PROSPECTIVE STUDY OF RADIOLOGICAL,CLINICALAND FUNCTIONAL OUTCOMES OF CALCANEAL FRACTURE FIXATION USING CONVENTIONAL CALCANEAL PLATES

THIS STUDY AIMS TO DETERMINE THE RADIOLOGICAL,CLINICAL AND FUNCTIONAL OUTCOMES OF CALCANEAL FRACTURES FIXED USING CONVENTIONAL CALCANEAL PLATES. THE STUDY WAS CONDUCTED BETWEEN MAY 2017 AND APRIL 2020 FOR A PERIOD OF 36 MONTHS IN SREE BALAJI MEDICAL COLLEGE HOSPITAL, CHROMEPET. THIS STUDY COMPRISES 36 PATIENTS WHO SUSTAINED INTRA ARTICULAR FRACTURES OF CALCANEUM AND UNDERWENT PLATE FIXATION WITH OR WITHOUT BONE GRAFTING . PATIENTS WERE RETRIEVED FROM MAY 2017 TO APRIL 2019 . THE MINIMUM FOLLOW UP PERIOD WAS 12 MONTHS. THE PATIENTS FOLLOWUP WAS DONE BASED ON BOHLER’S ANGLE(RADIOLOGICAL OUTCOME) , AOFAS (CLINICAL AND FUNCTIONAL OUTCOME ) .THE OUTCOMES WERE GROUPED INTO WORSE , FAIR AND GOOD PROGNOSIS .SURGICAL TECHNIQUES AND POSTOPERATIVE COMPLICATIONS WERE GIVEN METICULOUS IMPORTANCE. OF THE 36 PATIENTS,THE OUTCOME WAS BETTER IN ALL DISPLACED INTRAARTICULAR CALCANEAL FRACTURES TREATED WITH ORIF PLATE OSTEOSYNTHESIS.

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Functional outcome of operatively treated displaced intra-articular calcaneal fractures using two parallel contoured reconstruction plates

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i1.3215 ◽

1970 ◽

Vol 8 (1) ◽

pp. 12-17

Author(s):

S Lakhey ◽

RR Manandhar ◽

RL Pradhan ◽

BK Pandey ◽

S Sharma ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Scoring System ◽

Surgical Techniques ◽

Calcaneal Fracture ◽

Lateral Approach ◽

Complication Rates ◽

Calcaneal Fractures ◽

Articular Fractures ◽

Intraarticular Fractures

Introduction: The treatment of displaced intra-articular calcaneal fracture is controversial. Conventionally, they were treated non-operatively. However, some surgeons are now operatively treating these fractures because of continuing dissatisfaction with the outcome of conservative treatment of these fractures and improvements that have occurred in surgical techniques and complication rates. Objective: The aim of this study was to determine the functional outcome of operatively treated displaced intra-articular calcaneal fractures using two parallel contoured reconstruction plates. Materials and methods: 12 patients with 14 displaced intra-articular calcaneal fractures involving the subtalar joint were included in the study conducted between July 2005 and December 2008. The fracture site was exposed using extended lateral approach. Internal fixation was done by two nearly parallel 3.5mm reconstruction plates and screws contoured to form a gentle curve in all cases with the first plate fixed just below the articular surface. At the end of follow up, the patients' foot function was assessed by Calcaneal Fracture Scoring System of Kerr et al. Patients were also enquired about their satisfaction with their treatment outcome. Results: The patients were followed up for duration of 12 to 24 months (mean 15.64 months). The outcome score as measured by Calcaneal Fracture Scoring System ranged from 48 to 94 (mean 83.64). 11 of 12 patients (91.6 %) were satisfied with the treatment. Conclusion: Displaced intra-articular fractures treated by open reduction and internal fixation, using two nearly parallel, contoured reconstruction plates through an extensile lateral approach and following the principles of treatment of intraarticular fractures, have good functional results with high patient satisfaction rate. Key words: displaced intra-articular calcaneal fractures; operative treatment. DOI: 10.3126/kumj.v8i1.3215 Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 12-17

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A Novel Minimally Invasive Reduction Technique by Balloon and Distractor for Intra-Articular Calcaneal Fractures: A Report of 2 Cases

Case Reports in Orthopedics ◽

10.1155/2018/7909184 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

M. Prod’homme ◽

S. Pour Jafar ◽

P. Zogakis ◽

P. Stutz

Keyword(s):

Soft Tissue ◽

Minimally Invasive ◽

Soft Tissues ◽

Weight Bearing ◽

Calcaneal Fracture ◽

Invasive Technique ◽

Calcaneal Fractures ◽

Early Weight Bearing ◽

Articular Fractures ◽

Minimally Invasive Reduction

Treatment of displaced intra-articular fractures of the calcaneus remains a challenge for the orthopaedic surgeon. Conservative therapy is known to produce functional impairment. Surgical approach is plagued by soft-tissue complications and insufficient fracture reduction. We describe a minimally invasive technique that will hopefully improve these issues. We want to present our first experience through two cases. The first was a 46-year-old man who presented with a Sanders type IIBC calcaneal fracture, and the second was a 86-year-old woman with a type IIIBC calcaneal fracture. We introduced 2 Schanz screws in the talus and the calcaneus. After distraction, we introduced an inflatable balloon inside the calcaneus. By inflating the balloon, the articular surface was reduced by lifting it up. Then bone cement was injected in order to maintain the reduction. Additional screw fixation was used in the young patient. Postoperative imaging showed good congruence of the subtalar joint without leakage of cement, for the two cases. After 2 months, the patients had no pain and were without soft-tissue complications. We advocate this technique to perform a minimally invasive reduction and fixation of intra-articular calcaneal fractures because it preserves soft-tissues and provides good clinical results with early weight-bearing.

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Plate on Plate Osteosynthesis : A Novel Method For Periplate Fracture Fixation

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00043 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0004

Author(s):

Jagjoth Singh ◽

Kamarul Arifin Abdul Razak ◽

Terence Michal Dass ◽

Tan Weng Liang ◽

Yogeshwarran Nadeson ◽

...

Keyword(s):

Distal Femur ◽

Locking Plate ◽

Plate Osteosynthesis ◽

Plate Fixation ◽

X Rays ◽

Locking Plate Fixation ◽

Simple Method ◽

Invasive Approach ◽

Novel Method ◽

A Prospective Study

Periplate fractures may occur after plate fixation, especially in osteoporotic and non-united bones. We present a case of locking plate fixation over an existing plate for such fractures. Case Presentation: 58 years old man slipped and fell in sitting position 8 months post left distal femur LCP. He sustained pain and swelling of the left hip. The left thigh was externally rotated and shorter than the normal side. X-rays revealed a periplate fracture extending to the subtrochanteric region. A reverse right distal femur LCP was planned. A minimally invasive approach was used. Proximal screws were removed from the original plate and new screws were inserted through both plates which were of similar material, Titanium. Discussion: Elderly population makes a large subgroup of the cases due to osteoporosis and rigidity of the LCP construct2. This fixation provides a simple method to reduce surgical time, bleeding, and preserving more blood supply to enhance fracture healing, as opposed to using nails supplemented with cerclage/cable wires. Care should be taken to use the pre-existing screw holes in the overlapping segment of the two plates, as well as similar plate materials to avoid stress risers and reduce corrosion1. Conclusion: Plate on plate osteosynthesis is a novel method that may prove valuable due to the increasing population age and unique types of fractures. Further research is needed to determine any complications related to this type of fixation. References: Georgios Arealis et. al Plate On Plate Osteosynthesis For The Treatment Of Non Healed Periplate Fractures, Hindawi Publishing Corporation, Volume 2014, Article 367490 S. Ruchholtz, et al., “Less invasive polyaxial locking plate fixation in periprosthetic and peri-implant fractures of the femur—a prospective study of 41 patients,” Injury, vol. 44, no. 2, pp. 239–248, 2013

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Clinico-radiological and functional outcomes of distal tibia extra-articular fractures (AO 43A1-A3) managed by minimal invasive plate osteosynthesis in a tertiary care hospital: a series of 21 patients

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211000 ◽

2021 ◽

Author(s):

Pankajvir Singh ◽

Abdul Ghani ◽

Simran Preet Singh ◽

Amarjeet Singh

Keyword(s):

Soft Tissue ◽

Blood Supply ◽

Scoring System ◽

Functional Outcomes ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Minimal Invasive ◽

Soft Tissue Coverage ◽

Care Hospital ◽

Articular Fractures

Background: The fractures around distal tibia are challenging injuries due to limited soft tissue coverage, precarious blood supply and subcutaneous nature of the tibia. Minimal invasive plating for distal tibia fracture is a very good option for treatment, as this does not disrupt the blood supply and cause very little insult to soft tissue.Methods: 21 patients with extra-articular fractures of distal tibia were operated using minimally invasive plate osteosynthesis (MIPO) technique of plating. They were followed up to six months in terms of radiological union and functional outcomes, and complications. Functional outcome was assessed using Olerud Molander scoring system.Results: Good to excellent results were obtained in almost all the patients using Olerud and Molander scoring system, mean score being 80. These results were in comparison with the studies done earlier.Conclusions: Our study concluded that clinico-radiological and functional outcomes of distal tibia extra-articular fracture managed by MIPO technique of plating are satisfactory with minimal complications.

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A comparative study of operative and conservative treatment of intraarticular displaced calcaneal fractures

Scientific Reports ◽

10.1038/s41598-021-83636-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

K. Ramachandra Kamath ◽

Sharan Mallya ◽

Atmananda Hegde

Keyword(s):

Operative Treatment ◽

Calcaneal Fracture ◽

Calcaneal Fractures ◽

American Orthopaedic ◽

One Year ◽

A Prospective Study ◽

Operative And Conservative Treatment ◽

Böhler’S Angle ◽

Better Than

AbstractThe treatment of intra-articular displaced calcaneal fracture is debatable. We conducted a prospective study to compare operative and non-operative treatment for intra-articular displaced calcaneal fractures. Patients were assigned to two groups based on the treatment given (operative and nonoperative) and were regularly followed for a period of 1 year. The outcome measures were assessed by Modified Rowe’s Score (MRS), Visual Analogue e Scale (VAS) and The American Orthopaedic Foot and Ankle Society (AOFAS) scale. The outcome related to patient’s job was noted after one year and compared with pre-injury status. Fifty five patients with 61 calcaneal fractures were studied. Thirty of them were operated and 31 were treated conservatively. Out of 30 operated cases, Bohler’s angle was restored in 25 cases and these had good results with all three outcome scores at 1 year follow up and remaining 5 cases showed fair results (Mean MRS: 74.783, VAS: 3.348, AOFAS: 78.783). Thirty one cases treated with cast also showed fair results (Mean MRS: 57.368, VAS: 4.944, AOFAS: 71.211). The overall outcome of operated cases were better than non-operated cases (unpaired T test MRS: 5.807 p < 0.001, VAS: 4.387 p < 0.001, AOFAS: 2.728 p = 0.008) . Operative treatment of displaced intra-articular calcaneal fractures gave good results at one year follow up, provided Bohler’s angle was restored to normal range. Non operative treatment gave fair results. Complications were seen both with operative and non-operative treatment.

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Mid-term outcomes of minimally invasive plate osteosynthesis for fresh and old calcaneal fractures with locked plate

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00224 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0022

Author(s):

Tatsuji Fujiwara

Keyword(s):

Minimally Invasive ◽

Plate Osteosynthesis ◽

Weight Bearing ◽

Calcaneal Fracture ◽

Minimally Invasive Plate Osteosynthesis ◽

Calcaneal Fractures ◽

Locked Plate ◽

Early Weight Bearing ◽

The Mean

Category: Trauma Introduction/Purpose: Since the mid-1990s, open reduction and internal fixation via an extended L-shaped lateral approach has been considered the gold standard for surgical treatment of displaced intraarticular calcaneal fractures. However, postoperative wound healing complications, including wound infection, skin edge necrosis, wound breakdown, and hematoma, remain a major concern. To minimize the incidence of and offer rigid stabilization of the calcaneal fracture fragments, we have performed minimally invasive plate osteosynthesis (MIPO) with locked plate for fresh and old calcaneal fractures. This study aims to assess the clinical and radiological mid-term outcomes in surgical treatment of the fresh and old calcaneal fractures using a minimally invasive technique and a locking plate to permit early weight bearing. Methods: A total of 29 fractures in 24 patients were found that met our inclusion criteria. 23 foots were fresh calcaneal fractures with an average age of 53.9 years (range, 17-80 years). We defined calcaneal fractures more than 6 weeks old as old calcaneal fracture. 6 foots were old calcaneal fractures with an average age of 43 years (range,35-52 years). Patients with fresh calcaneal fracture had been followed up for an average of 25.8 months (range, from 18-65 months). Patients with old calcaneal fracture had been followed up for an average of 29.4 months (range, from 24-48 months). The mean interval between injury and operation was 8.9 days (3-19 days) in fresh calcaneal fractures and 97 days (43-154 days) in old calcaneal fractures. There were 19 foots Sanders type II fractures, 9 foots Sanders type III and one Sanders type IV. Results: For fresh calcaneal fractures, the mean change in Böhler’s angle and width of the calcaneus from immediately after surgery to final follow-up were 0.5° and 0.7 mm, respectively. For old calcaneal fractures, the mean change in Böhler’s angle and width of the calcaneus from immediately after surgery to final follow-up were 3.4° and 1.7 mm, respectively. The reduction was graded as nearly anatomical (less than 2 mm residual articular displacement) in all fractures. One of the 22 foots had a blister. There were no events of osteomyelitis or infection or nonunion. Eight foots had revision surgery for symptomatic hardware removal. At final follow up the average American Foot and Ankle Society Score (AOFAS) were 82.8 for fresh calcaneal fractures and 83.2 for old calcaneal fractures. Conclusion: This study is first report to show that MIPO with locked plate and early weight bearing can be effectively treated for displaced intra-articular calcaneal fractures. Surgical preparation, reduction maneuvers, and fixation techniques can take time to master; however, with experience, all types of calcaneus fractures can be treated with this technique.

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Displaced Intra-articular Calcaneal Fracture Treated Surgically with Limited Posterior Incision

Foot & Ankle International ◽

10.1177/107110070002100303 ◽

2000 ◽

Vol 21 (3) ◽

pp. 195-205 ◽

Cited By ~ 41

Author(s):

In-Heon Park ◽

Kyung-Won Song ◽

Sung Shin ◽

Jin-Young Lee ◽

Tae-Gyun Kim ◽

...

Keyword(s):

Functional Recovery ◽

Calcaneal Fracture ◽

Calcaneal Fractures ◽

Cast Immobilization ◽

Articular Fractures ◽

Short Period ◽

Comminuted Fractures ◽

Cancellous Screws ◽

Displaced Fracture

The incidence of calcaneal fracture has been slowly increasing; however, the ideal treatment for displaced intra-articular fracture is not available yet, even though the fracture brings frequent complication and disability. Between April 1991 and March 1998, we treated 103 displaced intra-articular calcaneal fractures of 92 patients surgically with limited posterior incision, modified Gallie approach. There were thirty-seven tongue-type fractures, fifteen tongue-type fractures with moderate comminution, nineteen joint-depression fractures, twenty-nine joint-depression fractures with moderate comminution, and three extensively comminuted fractures. The fracture fragments were fixed mainly with partly threaded small cancellous screws or Steinmann pins without any bone graft. Ankle and subtalar motion was permitted immediately if fixation were stable enough. Otherwise, a short period of cast immobilization was utilized. With a mean follow-up of 28 months (range, 12 to 66 months), eighty six percent of feet had no pain or only occasional pain not requiring medication. Using American Orthopedic Foot and Ankle Society hindfoot score system for assessment, ninety percent of feet rated as good to excellent. We used “Circle draw test” for evaluation of subtalar motion during follow-up visitation and found eight-seven percent of feet showed good to excellent correlation with the functional recovery. We recommend a limited posterior incision for reduction and internal fixation of displaced intra-articular calcaneal fractures. For displaced intra-articular fractures with three or four large fragments without further comminution and without a displaced fracture of the calcaneal cuboid joint, this method is particularly useful. We also recommend a Circle draw test for evaluation of subtalar joint motion as well as an indicator of functional recovery after displaced calcaneal fractures.

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An illustrative case report emphasizing the biological plating of a comminuted intra-articular fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201048 ◽

2020 ◽

Vol 6 (3) ◽

pp. 652

Author(s):

Vignesh V. ◽

J. K. Giriraj Harshavardhan

Keyword(s):

Road Traffic ◽

Plate Osteosynthesis ◽

Plate Fixation ◽

High Energy ◽

Minimal Invasive ◽

Illustrative Case ◽

Left Femur ◽

Articular Fractures ◽

Comminuted Fractures ◽

Minimal Invasive Plate Osteosynthesis

Comminuted intra-articular fractures are very common in high energy traumas, conventional open reduction and plate fixation has been associated with many complications as they disturb the fracture biology and hence minimally invasive plating came into existence. We are reporting a 17 year old boy who met with road traffic accident sustained an AO type 33C2 injury to left femur with severe metaphyseal comminution treated by minimal invasive plate osteosynthesis technique who achieved full radiological union at the end of 4 months and full functional recovery at 8 months follow-up. This case emphasizes the need for preservation of fracture biology which is of paramount importance in healing of comminuted fractures.

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MIPO vs. nail for extra-articular distal tibia fractures and the effect of intra-operative alignment control

British Journal of Surgery ◽

10.1093/bjs/znab202.057 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

N J Bleeker ◽

N van Veelen ◽

B van de Wall ◽

B -C Link ◽

R Babst ◽

...

Keyword(s):

Fracture Healing ◽

Plate Osteosynthesis ◽

Distal Tibia ◽

Surgical Techniques ◽

Definitive Treatment ◽

Rotational Malalignment ◽

Non Union ◽

Articular Fractures ◽

Significant Difference ◽

Tibia Fractures

Abstract Objective Definitive treatment of distal extra-articular fractures of the tibia is challenging and both minimal invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are considered feasible surgical modalities with their own implant-specific merits and demerits. This retrospective study was designed to compare MIPO versus IMN in terms of fracture healing, complications, functional and radiological outcomes and to assess the efficacy of intra-operative alignment control in order to reduce the rate of malalignment after definitive fixation of distal extra-articular fractures of the tibia. Methods All consecutive adult patients with extra-articular distal meta- or diaphyseal tibia fractures that were treated in a level 1 trauma center in Switzerland between January 2012 and September 2019 either with plating or IMN were included. Outcome measures included fracture healing, complications (infection, malalignment, subsequent sur-geries), functional and radiological outcomes. Intra-operative alignment control encompassed bilateral draping of the lower extremities. Results A total of 135 patients were included out of which seventy-two patients (53%) were treated with MIPO and 63 patients (47%) underwent IMN. There was a significantly higher incidence of non-union for fractures treated with an IMN (13 (22%) vs. 4 (6%), p = 0.037). There was no significant difference between both groups in terms of rotational malalignment (4% vs. 9%) and angular malalignment (4% vs. 5%). The incidence of malalignment in both groups was lower than reported in literature. A significantly higher rate of infection was found after MIPO (13% vs. 6%, p = 0.028). No differences were found in subsequent surgeries or functional outcomes. Conclusion Both MIPO and IMN are reliable surgical techniques. IMN is associated with higher rates of non-union whereas MIPO results in a higher risk for infection. The incidence of malalignment was surprisingly low endorsing the utility of the intra-operative alignment control.

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Pediatric and adolescent intra-articular fractures of the calcaneus

Orthopedic Reviews ◽

10.4081/or.2013.e17 ◽

2013 ◽

Vol 5 (2) ◽

pp. 17 ◽

Cited By ~ 2

Author(s):

Marcel Dudda ◽

Christiane Kruppa ◽

Jan Geßmann ◽

Dominik Seybold ◽

Thomas A. Schildhauer

Keyword(s):

Surgical Treatment ◽

Plate Osteosynthesis ◽

High Energy ◽

Open Fractures ◽

Calcaneal Fractures ◽

Invasive Approach ◽

Articular Fractures ◽

Clinical And Radiological Outcome ◽

K Wires ◽

Fractures In Childhood

Calcaneal fractures in childhood are very rare, whereas particularly intra-articular displaced fractures are not typical in skeletally immature children. Various techniques of osteosynthesis have been described. This study aimed to determine clinical and radiological outcome after surgical treatment of intra-articular calcaneal fractures. Fourteen intra-articular fractures of the calcaneus were included in this retrospective study. Eleven children (2 girls and 9 boys) aged 6-16 years (average age 11.5 years) underwent surgical treatment. One child sustained a Type II open fracture of both calcanei. All injuries occurred after a high-energy trauma; 3 patients had multiple additional fractures. The clinical and radiological postoperative follow up was an average 44 months. In 4 cases, a reduction through a minimally invasive approach and fixation with K-wires or screws could be achieved. Eleven fractures were treated with open reduction and internal fixation with plate osteosynthesis, K-wires or screws. In one case with open fractures of both heel bones, an additional external fixator was applied. The surgical treatment approach adopted enabled the pre-operative Boehler’s angle (average 16°) to be improved to an average 30°. In all cases, except for the patient with open fractures, a good functional result and outcome could be achieved. In calcaneal fractures in childhood, anatomical reduction is the determining factor, as in fractures in adults, whereas the surgical technique seems to have no influence on clinical outcome in children. The wound healing problems that have often been described were not observed in this age group.

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