Percutaneous Surgery Provides Better Functional Outcomes for Displaced Intra-Articular Calcaneal Fractures

<h3> </h3>Background: To analyze the outcome percutaneous surgeries in fractures of the calcaneum.Methods: 20 patients admitted in a tertiary care center in Ahmedabad were followed up from admission to until 2 years post operatively and functional outcomes in them following operative intervention were analyzed using AOFAS and Maryland scoring system.Results: Majority of patients have excellent or good outcome following percutaneous surgery in fractures of the calcaneum. The results were evaluated for 22 people with intraarticular calcaneum fractures using the Maryland foot score and AOFAS score. The mean AOFAS score was 86. There were 6 excellent, 12 good and 4 fair results.Conclusions: Percutaneous fixation in fractures of the calcaneum is a middle path in treatment of calcaneum fracture having the benefit of better reduction of ORIF plating and lesser soft tissue injury or chances of infection of conservative management.

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Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures

EFORT Open Reviews ◽

10.1302/2058-5241.3.170043 ◽

2018 ◽

Vol 3 (7) ◽

pp. 418-425 ◽

Cited By ~ 3

Author(s):

Haroon Majeed ◽

James Barrie ◽

Wendy Munro ◽

Donald McBride

Keyword(s):

High Risk ◽

Minimally Invasive ◽

Internal Fixation ◽

Functional Outcomes ◽

Open Reduction ◽

Risk Of Bias ◽

Cochrane Library ◽

Percutaneous Fixation ◽

Calcaneal Fractures ◽

Minimally Invasive Reduction

The aim of this article is to systematically identify and analyse research evidence available to compare the outcomes of minimally invasive reduction and percutaneous fixation (MIRPF) versus open reduction and internal fixation (ORIF) for displaced intra-articular calcaneal fractures. Articles from 2000 to 2016 were searched through MEDLINE (PubMed), Cochrane Library, Embase, ScienceDirect, Scopus and ISI Web of Knowledge using Boolean logic and text words. Of the 570 articles identified initially, nine were selected including three randomized controlled trials and six retrospective comparative studies. All nine studies had a total of 1031 patients with 1102 displaced intra-articular calcaneal fractures. Mean follow-up was 33 months. Of these, 602 (54.6%) were treated with MIRPF and 500 (45.4%) were treated with ORIF. Overall incidence of wound-related complications in patients treated with MIRPF was 4.3% (0% to 13%) compared with 21.2% (11.7% to 35%) in the ORIF group Functional outcomes were reported to be better in the minimally invasive group in all studies; however, the results did not reach statistical significance in some studies. All the studies had methodological flaws that put them at either ‘unclear’ or ‘high’ risk of bias for multiple domains. Overall quality of the available evidence is poor in support of either surgical technique due to small sample size, flaws in study designs and high risk of bias for various elements. Individual studies have reported minimally invasive techniques to be an effective alternative with lower risk of wound complications and better functional outcomes. Cite this article: EFORT Open Rev 2018;3:418-425. DOI: 10.1302/2058-5241.3.170043

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MANAGEMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES WIILIZAROV RING FIXATIO

10.36106/6403030 ◽

2021 ◽

pp. 40-43

Author(s):

Nirottam Singh ◽

Jagdish Jagdish ◽

Hemant Jain ◽

Kishore Raichandani

Keyword(s):

Functional Outcomes ◽

Operating Time ◽

Anatomic Reconstruction ◽

X Rays ◽

Calcaneal Fractures ◽

Type Iv ◽

Fall From Height ◽

Pin Tract Infection ◽

Böhler’S Angle

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

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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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Gait characteristics and functional outcomes during early follow-up are comparable in patients with calcaneal fractures treated by either the sinus tarsi or the extended lateral approach

Gait & Posture ◽

10.1016/j.gaitpost.2019.03.007 ◽

2019 ◽

Vol 70 ◽

pp. 190-195 ◽

Cited By ~ 2

Author(s):

Andreas Brand ◽

Isabella Klöpfer-Krämer ◽

Moritz Böttger ◽

Inga Kröger ◽

Leander Gaul ◽

...

Keyword(s):

Functional Outcomes ◽

Lateral Approach ◽

Calcaneal Fractures ◽

Gait Characteristics ◽

Sinus Tarsi ◽

Extended Lateral Approach

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Long-term results and physiotherapeutic determination in operative treatment of intra-articular calcaneal fractures

Rehabilitacja Medyczna ◽

10.5604/01.3001.0009.2791 ◽

2016 ◽

Vol 20 (1) ◽

pp. 5-11

Author(s):

Piotr Golec ◽

Krzysztof Tomaszewski ◽

Sebastian Nowak ◽

Zbigniew Dudkiewicz

Keyword(s):

Minimally Invasive ◽

Functional Outcome ◽

Functional Outcomes ◽

Long Term Results ◽

Calcaneal Fractures ◽

Intraarticular Fractures ◽

Type Fracture ◽

Additional Stabilization ◽

Invasive Techniques

The authors present their own observations of the surgical treatment of articular calcaneal fractures using a minimally invasive percutaneous fixation in combination with the unifi ed self-developed physiotherapy program. The analyzed techniques include the Westhues’ technique and its modifi cation with additional stabilization of the bone fragments with Kirschner wires, as well as transdermal stabilization by Rąpała. The research material comprises 82 patients with intraarticular fractures - 68 men (83%) and 14 women (17%) treated surgically between 1990 and 2012. The analyzed calcaneus fractures were divided by Essex–Lopresti scale and evaluation of functional outcome at follow-up was based on the Creighton–Nebraska criteria. Men with the “tongue type” fracture treated using the Westhues’ technique had good functional outcomes in 12 cases (17.6%) and acceptable in 7 cases (10.3%). Women with the “tongue type” fracture treated using the Westhues’ technique had good functional outcomes in 2 cases (14.3%) and in one case, poor (7.1%). After analysis of the material, the authors claim that minimally invasive techniques are not really minimally invasive, taking the observed complications into consideration in most of the patients, which lead to the poor functional outcome at long term follow-ups.

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Radiographic and functional outcomes after displaced intra-articular calcaneal fractures: a comparative cohort study among the traditional open technique (ORIF) and percutaneous surgical procedures (PS)

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-016-0426-6 ◽

2016 ◽

Vol 11 (1) ◽

Cited By ~ 16

Author(s):

Carlo Biz ◽

Elia Barison ◽

Pietro Ruggieri ◽

Claudio Iacobellis

Keyword(s):

Cohort Study ◽

Surgical Procedures ◽

Functional Outcomes ◽

Open Technique ◽

Calcaneal Fractures ◽

Comparative Cohort Study

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

10.36106/ijsr/0820397 ◽

2020 ◽

pp. 1-2

Author(s):

Aravind Ravichandran ◽

Kushwanth. E

Keyword(s):

Functional Outcomes ◽

Plate Osteosynthesis ◽

Plate Fixation ◽

Surgical Techniques ◽

Calcaneal Fracture ◽

Good Prognosis ◽

Calcaneal Fractures ◽

College Hospital ◽

Articular Fractures ◽

A Prospective Study

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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