Treatment of Calcaneal Fractures with Closed Reduction and the Endobutton-Assisted Technique

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 < .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.

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Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

Foot & Ankle International ◽

10.1177/10711007211013012 ◽

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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An evaluation of the efficacy of the locked plate with bone grafting in Sanders type III and IV intra-articular calcaneus fractures

SAGE Open Medicine ◽

10.1177/20503121211040954 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110409

Author(s):

Ali Varol ◽

Yunus Oc ◽

Bekir Eray Kilinc

Keyword(s):

Bone Grafting ◽

Plate Osteosynthesis ◽

Locking Plates ◽

Foot And Ankle ◽

Calcaneal Fractures ◽

Type Iii ◽

Heel Height ◽

The Mean ◽

American Orthopaedic

Objective: To demonstrate the efficacy of locking plate osteosynthesis performed by an L-shaped lateral approach in patients with Sanders type III and IV intra-articular calcaneal fractures with posterior facet displacement. Methods: Fifty-three patients with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and additional bone grafting were included in the study. Böhler and Gissane angles, and heel height values were measured on the radiological examinations. Clinical results of the patients were evaluated using the American Orthopaedic Foot and Ankle Society and Maryland evaluation criteria. The presence of arthrosis was investigated with Broden’s view. Preoperative and postoperative values were evaluated. Results: The mean Gissane angle was 119.32°, the mean Böhler angle was 9.47° and the mean heel height was 40.82 mm on radiographs at initial presentation of the patients. The mean Gissane angle was 114.63°, the mean Böhler angle was 23.33° and the mean heel height was 47.84 mm on the early postoperative radiographs of the patients. In patients, a mean 4.69° recovery was achieved in the Gissane angle, 13.86° in Böhler angle and 7.02 mm in heel height. On the most recent follow-up, Böhler angle was 21.49°, Gissane was 114.88° and the mean heel height was 46.95 mm. The mean American Orthopaedic Foot and Ankle Society score and Maryland score were 86.91 and 86.53, respectively, on the last follow-up. Conclusion: Internal fixation and grephonage using low-profile locking plates provides good functional results to patients since it facilitates anatomic restoration of the subtalar joint and correction of calcaneal height, width and varus/valgus heel.

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The effect of a modified chevron osteotomy for hallux valgus patients: A five-year follow-up study

10.21203/rs.3.rs-929642/v1 ◽

2021 ◽

Author(s):

Shiyong Zhang ◽

Xue Wang ◽

Tiannan Chen ◽

Chengwei Wang ◽

Jie Wang

Keyword(s):

Hallux Valgus ◽

Analog Scale ◽

Aofas Score ◽

Intermetatarsal Angle ◽

Follow Up Study ◽

Chevron Osteotomy ◽

Vas Scores ◽

The Mean ◽

American Orthopaedic

Abstract Purpose This study aimed to detect the effect of a modified chevron osteotomy on hallux valgus (HV) deformity at five-year follow up. Methods Twenty patients with symptomatic HV who underwent modified chevron osteotomy between June 2014 and January 2016 were included in the present study. The follow-up duration was more than five years. Each patient was evaluated preoperatively, six weeks postoperatively and five years postoperatively using the visual analog scale (VAS) pain score, the American Orthopaedic Foot & Ankle Society (AOFAS) score and cosmetic and radiological outcomes. Results The AOFAS score improved from 54.40 (± 4.58) preoperatively to 94.30 (± 2.15) six weeks postoperatively (p < 0.001) and 96.95 (± 1.54) five years postoperatively (p < 0.001). The VAS scores decreased from 6.30 (± 1.17)preoperatively to 0.15 (± 0.37) five years postoperatively (p < 0.001). The mean intermetatarsal angle improved from 16.00° (± 2.20°) preoperatively to 4.15° (± 1.22°) six weeks postoperatively (p < 0.001) and 4.40° (± 1.39°) five years postoperatively (p < 0.001). The mean HV angle also improved, from 32.70° (± 5.34°) preoperatively to 4.80° (± 1.40°) six weeks postoperatively (p < 0.001) and 5.20° (± 1.32°) five years postoperatively (p < 0.001). The cosmetic results were either excellent or good in 19 patients (95%). There was no recurrence in this study during the five postoperative years. Conclusion A modified chevron osteotomy can achieve successful correction of moderate-to-severe HV, with excellent outcomes at five-year follow up.

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RELATIONSHIP BETWEEN THE KNEE AND HINDFOOT AXES IN PATIENTS WITH SEVERE KNEE OSTEOARTHRITIS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220202805231351 ◽

2020 ◽

Vol 28 (5) ◽

pp. 229-232 ◽

Cited By ~ 1

Author(s):

HENRIQUE MANSUR ◽

FELIPE ALMEIDA ROCHA ◽

PEDRO GUILME TEIXEIRA DE SOUSA FILHO ◽

ISNAR MOREIRA DE CASTRO JUNIOR

Keyword(s):

Mean Value ◽

Foot And Ankle ◽

Moderate Correlation ◽

Varus Knee ◽

Aofas Score ◽

Level Of Evidence ◽

The Mean ◽

American Orthopaedic ◽

Ankle Function ◽

Angular Deformities

ABSTRACT Objective: To evaluate the correlation between knee axis and hindfoot axis in patients with advanced gonarthrosis, and the association between ankle function and angular deformities. Methods: 72 patients were enrolled in the study: 66% were women, and mean age was 58.7 years. The anatomical axis of the knee and hindfoot were measured by short knee radiographs and long axial view of the hindfoot. Results: Among the study group, 79.2% presented varus knee (mean 15º ± 7.69º) and 20.8% valgus (mean 15.9º ± 7.7º). 63.9% had hindfoot varus (mean 8.5º ± 6.07º) and 36.1% valgus (mean 3.9º ± 3.92º) (p < 0.05). The mean value for the American Orthopaedic Foot and Ankle Society (AOFAS) score was 74.26 points, and values were significantly higher among patients with hindfoot varus (p < 0.05). We found no correlation between gender or AOFAS score and knee and hindfoot axes, nor between deformities in the knee and hindfoot axes (p > 0.05). The subgroup genu valgum - hindfoot varus presented a moderate correlation (r = 0.564; p < 0.05). Conclusion: We found no association between the anatomical axes of the knee and hindfoot. Patients with gonarthrosis and hindfoot varus presented a better ankle function. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

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Aesthetic Treatment of Tillaux-Chaput fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00220 ◽

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.

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Behavior of Soft Tissue around Platform-Switched Implants and Non-Platform-Switched Implants: A Comparative Three-Year Clinical Study

Journal of Clinical Medicine ◽

10.3390/jcm10132955 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2955

Author(s):

Davide Farronato ◽

Mattia Manfredini ◽

Marco Farronato ◽

Pietro Mario Pasini ◽

Andrea Alain Orsina ◽

...

Keyword(s):

Soft Tissue ◽

Mean Value ◽

Crown Height ◽

Implant Abutment ◽

Group A ◽

Bone To Implant Contact ◽

Platform Switching ◽

The Mean ◽

Over Time

To verify the influence of platform-switching (PS) on soft tissue behavior by comparing the soft tissue stability around implants with and without PS, during three years of follow-up. The study included patients treated with fixed dentures supported by implants with an internal connection. The radiographic distance between the first bone-to-implant contact (FBIC) and the implant shoulder was assessed. Additionally, the presence of keratinized facial mucosa and the prosthetic crown height (TH) were monitored for three years from the delivery of the definitive crown. These parameters were measured for two different groups: platform-switched implants in the PS group and non-platform-switched (NPS) implants in the NPS group. Seventy-seven implants were considered in the statistical analysis. After three years, the overall FBIC mean value was 0.31 ± 1.00 mm. However, the mean FBIC was 0.66 ± 0.97 mm for the NPS group and −0.05 ± 0.91 mm for the PS group. Moreover, a mean recession of 0.54 ± 1.39 mm was measured for the NPS group, whereas a mean coronal migration of 0.17 ± 0.95 mm was measured for the PS group. A significant correlation was also found between the presence of PS and ΔTH (p ≤ 0.01) over the three years of follow-up. The absence or presence of platform-switching would appear to affect the tendency of the gingival buccal margin towards recession or creeping. Additionally, implant-abutment platform-switching seems to help prevent peri-implant soft tissue recession over time when compared to implants without PS.

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Treatment of calcaneal fracture with calcaneal reduction forceps and external fixation

10.21203/rs.2.14522/v1 ◽

2019 ◽

Author(s):

Wang Jianchuan ◽

Qin Song ◽

Wang Tienan ◽

Xia Chongjun

Keyword(s):

External Fixation ◽

Closed Reduction ◽

Average Length ◽

Calcaneal Fracture ◽

Average Height ◽

Calcaneal Fractures ◽

Aofas Score ◽

Before And After ◽

Average Angle

Abstract Background:The optimal treatment of displaced intra-articular calcaneal fractures remains controversial.Conservative treatment has been proven to be ineffective for these fractures. Usually,surgical treatment methods include open reduction and internal fixation, arthroscopic-assisted reduction,balloon dilatation and plasty.However,there is no consensus on which methods are more effective.This paper reports the clinical effect of the minimally invasive treatment of calcaneal fractures by closed reduction using calcaneal plastic reduction forceps combined with threaded-pin external fixation. Method:The clinical data of 16 patients,including 14 males and 2 females,with a unilateral calcaneal fracture were analysed retrospectively.The Bohler angle,Gissane angle,and calcaneal width, height and length were measured before and after the operation.The ankle function was evaluated according to the AOFAS score at 6 and 12 months after the operation. Result:The average Bohler angle was 16.7 before the operation and 25.8 after correction; the average angle at the final follow-up was 25.2. The average Gissane angle before and after the operation was 103.6 and 120.9, respectively; the average angle measured at the final follow-up was 119.6. The average calcaneal width before and after the operation was 39.5 mm and 35.2 mm, respectively; the average width measured at the final follow-up was 36.5 mm. The average height before and after the operation was 46.9 mm and 48.5 mm; the average height measured at the final follow-up was 48.9 mm.The average length before and after the operation was 67.5 mm and 71.2 mm, respectively; the average length measured at the final follow-up was 70.9 mm. The average AOFAS score was 60.1 at 6 months after the operation and 80.6 at 12 months after the operation, which was significantly higher than the average AOFAS score at 6 months after the operation (P < 0.001).At the final follow-up, the AOFAS score was excellent, good, moderate,and poor in 11 cases, 3 cases,1 case and 1 case,respectively,with a rate of excellent and good scores of 87.5%. Conclusion:The application of closed reduction using calcaneal plastic reduction forceps combined with threaded-pin external fixation is effective for the treatment of displaced calcaneal fractures, with a simple procedure, minimal trauma, fewer skin and soft tissue complications, and satisfactory clinical results.

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Percutaneous K-Wires Fixation of Displaced Intra-articular Calcaneal Fractures (A Novel Technique)

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000293 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Mohamed Mesregah

Keyword(s):

Soft Tissue ◽

Closed Reduction ◽

Articular Surface ◽

Calcaneal Fractures ◽

Type Iv ◽

Subtalar Arthritis ◽

The Mean ◽

K Wires ◽

Pin Tract Infection ◽

Periosteal Elevator

Category: Hindfoot Introduction/Purpose: The operative treatment of calcaneal fractures has been a controversial topic. Open reduction and internal fixation is associated with a high incidence of postoperative soft tissue complications. Closed reduction and percutaneous K-wires fixation was used to preserve soft tissue. The aim of our study is to evaluate the outcome of closed reduction and percutaneous K-wires fixation of displaced intra-articular calcaneal fractures. Methods: Twenty two displaced intra-articular calcaneal fractures were treated by closed reduction and percutaneous K-wires fixation. The clinical evaluation was based on Maryland Foot Score. According to Sander’s Classification, Eleven fractures were type II, nine were type III and two were type IV. Bimanual compression across the calcaneus was applied to reduce the calcaneal width. A Schanz screw was inserted into the calcaneal tuberosity and was forcibly pushed downwards to elevate the depressed fragment. Two parallel 2 mm K-wires were placed from the posterior inferior corner of the calcaneus across the posterior facet and into the talar body. The reduction of the articular surface was maintained by two crossing subchondral 2 mm K-wires. If the reduction was not satisfactory, a 1-2 cm long transverse incision was used just below the tip of the lateral malleolus. A small tipped periosteal elevator was introduced to elevate the depressed fragment before K-wire fixation. Results: The mean follow up period was 7.68 months. The clinical outcome revealed 18 fractures (81.8%) of satisfactory (14 excellent and 4 good), and 4 patients (18.2%) of unsatisfactory results (4 fair and 0 poor). The mean time of radiological union was 11.86 (range 10 – 14) weeks. One patient had pin tract infection. One patient developed heel widening. Conclusion: Closed reduction and percutaneous K-wires fixation of calcaneal fractures minimizes the soft tissue complications and postoperative scar formation. The mini approach for elevation of the depressed posterior facet restores the articular surface and decreases late subtalar arthritis.

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PO 18133 - Internal fixation of displaced intra-articular fractures of the hallux through a dorsomedial approach

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1016 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. S27

Author(s):

Danilo Ryuko Cândido Nishikawa ◽

Fernando Aires Duarte ◽

Augusto César Monteiro ◽

Bruno Rodrigues de Miranda ◽

Guilherme Honda Saito ◽

...

Keyword(s):

Soft Tissue ◽

Internal Fixation ◽

Range Of Motion ◽

Clinical Evaluation ◽

Interphalangeal Joint ◽

Rigid Fixation ◽

Aofas Score ◽

Articular Fractures ◽

The Mean

Introduction: Intra-articular fractures of the hallux are usually treated nonoperatively, except when the fragments are displaced and the joint is incongruent. Displaced fractures treated nonoperatively can result in degenerative arthritis of the interphalangeal joint, causing pain and range of motion limitation. The aim of this study is to present the results of the surgical treatment of displaced interphalangeal joint (IPJ) fractures of the hallux using a dorsomedial approach. It is our understanding that this approach minimizes injury to the soft tissue envelope without the need to detach or create a tenotomy of the extensor hallucis longus tendon (EHL), allowing rigid fixation and early weight bearing and range of motion. Methods: A retrospective case series was performed of 5 patients with displaced IPJ fractures of the hallux treated with the dorsomedial approach from July 2013 to October 2017. Two patients were male and three female, with a mean age of 37,4 years and a mean follow-up of 36 months. The surgical indication for open reduction and internal fixation through a dorsomedial approach of the IPJ was displaced (>2 mm) bicondylar fractures of the proximal phalanx of the hallux. The incision was performed along the medial border of the EHL tendon without the need to detach or create a tenotomy of this tendon. In the postoperative period, follow-up included clinical evaluation and radiographic exams. All patients were assessed by visual analog scale (VAS) scores for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: All patients presented bone consolidation and returned to their previous activities without limitations. At the final follow-up, the mean VAS score was 0, and the mean AOFAS score was 92,6. Clinical evaluation revealed preservation of approximately 50% of the range of motion of the IPJ compared with the contralateral side. Conclusion: We concluded that a dorsomedial approach should be considered in the surgical management of displaced intra-articular fractures of the hallux. It preserves soft tissue and most of the IPJ motion, preventing postoperative joint pain and stiffness.

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Clinical and functional outcomes of pre-contoured plate fixation in displaced intraarticular calcaneum fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200573 ◽

2020 ◽

Vol 6 (2) ◽

pp. 260

Author(s):

B. L. S. Kumar Babu ◽

Bhaskar Amarnath Bhavanasi ◽

Narreddy Jayasomeswar Reddy

Keyword(s):

Functional Outcome ◽

Plate Fixation ◽

Operative Procedure ◽

Early Mobilization ◽

Adult Patients ◽

Calcaneal Fractures ◽

Anatomical Reduction ◽

Aofas Score ◽

American Orthopaedic

Background: We evaluated the clinical and functional outcome of intra-articular calcaneal fractures treated with pre-contoured plating. The functional outcome was measured by the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system.Methods: Twenty-five adult patients with displaced intra-articular calcaneus fractures, treated with by open reduction and internal fixation using pre-contoured plates, and those who were available for follow up were evaluated for the outcomes such as operative procedure, anatomical reduction, postoperative hospital stays early mobilization and functional outcome postoperatively. Follow-up was at three, six and twelve months radiological and clinical union were also considered.Results: Twenty-five adult patients presented with calcaneal fractures were operated during the study period. The mean time for union of fracture was 12.5±1.8 weeks. When we assessed the functional outcome in those patients who had radiological and clinical union using AOFAS score, we found that 16 out of 23 (64%) had good results with mean AOFAS score of 83.5±2.0 and 7/25 (28%) had fair results with mean score of 73.3±1.3, and 2/25 (8%) had poor results with mean score of 54.0±8.5. In 2 out of 16 (12.5%) patients, with good AOFAS scores, implants were removed after one and a half year from the day of surgery after confirming complete union of the fracture.Conclusions: We believe that pre-contoured reconstruction plate fixation for displaced intraarticular calcaneus fracture is excellent in terms of the union of the fracture, attaining anatomical reduction. It gives better outcomes concerning the function and range of movements.

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