Minimally-Invasive Repair of Bilateral Calcaneal Fractures with Unilateral External Fixation: A Case Report

2016 ◽  
Vol 106 (sp1) ◽  
pp. 10-10
Author(s):  
Louis V. DeFazio ◽  
Guido A. LaPorta
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Operating Room ◽  
External Fixator ◽  
Weight Bearing ◽  
Calcaneal Fracture ◽  
Calcaneal Fractures ◽  
Percutaneous Approach ◽  
Soft Tissue Envelope ◽  
Percutaneous Repair

INTRODUCTION AND OBJECTIVES: Calcaneal fractures are a serious injury with significant associated morbidity. Bilateral calcaneal fractures complicate issues even further, due to the physical disability that the patient is left with. One of the major issues with any calcaneal fracture is the risk of soft tissue compromise caused by the traumatic nature of the injury. A percutaneous approach allows the soft tissue envelope to remain viable, while still fixating the fractures. The purpose of this presentation is to highlight the use of percutaneous repair, the role of external fixation in calcaneal fractures, and lastly discuss the outcome for this particular patient. METHODS: A 26 year-old male presented to the office with bilateral calcaneal fractures, approximately 1 week after sustaining a fall from a height of 12 feet. The patient was brought to the operating room after spending approximately 2 weeks in bilateral posterior splints with Jones compressive dressings. The right calcaneal fracture was fixated percutaneously with 4 screws. The left calcaneal fracture was fixated percutaneously with 3 screws, as well as an Ilizarov external fixator. Approximately 8 weeks later, the patient returned to the operating room for removal of the external fixator and a cast application to the left lower extremity. RESULTS: The patient continued to progress and was subsequently transitioned into bilateral CAM walkers. In the following weeks, the patient was again upgraded to full weight-bearing with physical therapy. The fracture sites were completely consolidated with minimal to no pain in his bilateral heels and full ambulation. CONCLUSIONS: Percutaneous repair, along with external fixation, offers a viable alternative to ORIF for calcaneal fractures. A percutaneous approach also does not disrupt the potentially fragile soft tissue envelope in a calcaneal fracture. Although this outcome is positive, larger controlled studies are needed to confirm percutaneous approaches and external fixation in the realm of a calcaneal fracture.

scholarly journals A Novel Technique for Closed Reduction and Fixation of Paediatric Calcaneal Fracture Dislocation Injuries

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Radwane Faroug ◽  
Paul Stirling ◽  
Farhan Ali
Keyword(s):  
Soft Tissue ◽  
Functional Outcome ◽  
Closed Reduction ◽  
Calcaneal Fracture ◽  
Fracture Dislocation ◽  
Bony Union ◽  
Calcaneal Fractures ◽  
Simultaneous Application ◽  
Soft Tissue Envelope ◽  
Good Functional Outcome

Paediatric calcaneal fractures are rare injuries usually managed conservatively or with open reduction and internal fixation (ORIF). Closed reduction was previously thought to be impossible, and very few cases are reported in the literature. We report a new technique for closed reduction using Ilizarov half-rings. We report successful closed reduction and screwless fixation of an extra-articular calcaneal fracture dislocation in a 7-year-old boy. Reduction was achieved using two Ilizarov half-ring frames arranged perpendicular to each other, enabling simultaneous application of longitudinal and rotational traction. Anatomical reduction was achieved with restored angles of Bohler and Gissane. Two K-wires were the definitive fixation. Bony union with good functional outcome and minimal pain was achieved at eight-weeks follow up. ORIF of calcaneal fractures provides good functional outcome but is associated with high rates of malunion and postoperative pain. Preservation of the unique soft tissue envelope surrounding the calcaneus reduces the risk of infection. Closed reduction prevents distortion of these tissues and may lead to faster healing and mobilisation. Closed reduction and screwless fixation of paediatric calcaneal fractures is an achievable management option. Our technique has preserved the soft tissue envelope surrounding the calcaneus, has avoided retained metalwork related complications, and has resulted in a good functional outcome.

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

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.

Tarsocrural Arthrodesis: A Clinical Report Using a Circular External Fixator

1998 ◽  
Vol 11 (04) ◽  
pp. 193-196 ◽  
Author(s):  
R. M. Radasch ◽  
C. T. Trostel
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
External Fixator ◽  
Weight Bearing ◽  
Clinical Report ◽  
Early Weight Bearing ◽  
Articular Fractures ◽  
Intraarticular Fractures ◽  
Tarsal Bones ◽  
Fixation System

SummaryArthrodesis is a well documented treatment option for comminuted intraarticular fractures, irreparable collateral ligament injuries, limb salvage for ischiatic nerve injury, and severe degenerative joint disease of the tarsocrural joint (1-6). Conservative splint or bandage application often results in a less than favorable outcome in the management of these types of injuries. Common techniques to achieve tarsocrural arthrodesis include divergent Steinmann pin placement, lag screw or compression plating and external skeletal fixation (1-5). This report describes a tarsocrural arthrodesis using a circular external fixation system to manage an open, severely contaminated, comminuted intra-articular fracture of the talus and calcaneous, with extensive soft tissue degloving injuries. The decision to use a circular external fixation system was based on its ability to (1) adequately stabilize the tibialtarsal region, (2) be applied with minimal soft tissue and vascular disruption, (3) allow adequate post-operative soft tissue wound management, and (4) be tolerated well by the patient allowing early weight bearing of the limb.Severe tarsocrural injuries were diagnosed on a four-year-old mixed breed dog including articular fractures of the tubercalcaneous, talus, fibula, multiple tarsal bones and the second metatarsal bone. A circular ring external fixator was used to arthrodese the joint. Twelve weeks following surgery the limb was functional without any mechanical gait alteration and with minimal to zero discomfort.

scholarly journals External skeletal fixation of the tibial shaft fractures

2005 ◽  
Vol 62 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Sasa Milenkovic ◽  
Milorad Mitkovic ◽  
Mile Radenkovic
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Weight Bearing ◽  
Early Mobilization ◽  
Tibial Shaft ◽  
Closed Fracture ◽  
Early Weight Bearing ◽  
Shaft Fractures ◽  
Pin Tract Infection ◽  
Tibial Shaft Fractures

Aim. To present the possibility of a successful use of external skeletal fixation in treating the open and closed tibial shaft fractures with Mitkovic?s external fixator. Methods. External fixation was used in 115 patients with 118 fresh tibial shaft fractures, 82 males (71.3%) and 33 females (28.7%), average age 43.92 years (16?84). Open tibial shaft fractures were present in 37 (31.36%). All the fractures were treated with Mitkovic?s external fixator type M 20. Results. The results of external fixation were excellent or good in 94.07% of the cases, and bad in 5.08%. Pin tract infection appeared in 7 (5.93%) patients. In only 3 cases an external fixator was removed and treatment continued with the functional braces. Nonunion occurred in 6 (5.08%) patients, of which 4 were with open fractures (2 Gustilo type IIIB, 1 Gustilo type IIIA, 1 Gustilo type II) and 2 with the segment fractures. Compartment syndrome was observed in 1 (0.85%) patient with closed fracture. Malunion was found in 2 (1.69%) patients. Conclusion. External fixation of tibial shaft fractures is a simple and effective method to enable the safe healing of fractures, early mobilization of the patients, early weight-bearing, as well as early rehabilitation. Fixation of tibial shaft fractures was unilateral with convergent pins orientation, and there was also a possibility of compression and distraction.

Ankle spanning external fixator with limited internal fixation for distal tibial extra-articular fractures

2017 ◽  
Vol 5 (10) ◽  
pp. 4355
Author(s):  
Siddharth Goel ◽  
Abhay Elhence
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Tibial Fractures ◽  
Fixation Method ◽  
Ankle Pain ◽  
Distal Tibial Fractures ◽  
Tract Infections

Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function.

scholarly journals Radiologic and Clinical Outcomes of Ollier Approach with Screw Fixation for Displaced Intra-Articular Calcaneal Fractures – Comparative Study with Extensile Lateral Approach with Lateral Plating

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004 ◽  
Author(s):  
Seunghun Woo ◽  
Su-Young Bae ◽  
Hyung Jin Chung ◽  
Tae Sik Goh
Keyword(s):  
Soft Tissue ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Lateral Approach ◽  
Functional Score ◽  
Calcaneal Fractures ◽  
Pain Scores ◽  
Extensile Lateral Approach ◽  
Lateral Plating

Category: Trauma Introduction/Purpose: This study aims to assess the detailed radiologic outcomes which used uninjured side weight-bearing radiograph as a template as well as clinical results to compare the Ollier approach with screw fixation and the extensile lateral approach with lateral plating. Methods: We performed a retrospective review of intra-articular calcaneal fractures treated operatively in our hospital from January 2009 to November 2014. Radiologic outcomes were assessed using radiologic parameters such as Böhler angle, calcaneal height, and talar sagittal angles represent calcaneal deformation by the comparison of the final follow-up bilateral weight-bearing lateral radiograph. Functional outcome was assessed through the American Orthopaedic Foot and Ankle Society (AOFAS) scores and Visual Analog Scale (VAS) pain scores. Postoperative complications were investigated. Results: Ninety-seven unilateral fractures were appeared to match our inclusion criteria: forty-six fractures were treated by using the extensile lateral approach with lateral plating (the ELP group), and fifty-one fractures were treated with the Ollier approach and screw fixation (the OS group). The operation time was significantly shorter in the OA group (p<0.05). There were no significant difference of the final follow-up radiologic parameters between two groups. The mean AOFAS scores were significantly higher in the OS group (p = 0.020) and both groups showed similarity in the VAS pain scores (p = 0.175). Overall soft-tissue complications were 28.3% in the ELP group and 9.8% in the OS group (p = 0.034). Conclusion: No difference could be shown in the postoperative and final follow-up radiological outcomes between the Ollier approach and the extensile lateral approach, but the Ollier approach had better functional score and lower soft tissue complication rate with shorter operative time.

Skeletal Stabilisation

2020 ◽  
pp. 41-56
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixation ◽  
Surgical Procedures ◽  
External Fixator ◽  
Definitive Treatment ◽  
Mutual Understanding ◽  
Published Evidence ◽  
The Difference ◽  
Skeletal Stability

In this chapter we draw upon published evidence and the experience of the authors to provide guidance in stabilisation for open tibial fractures. Most orthopaedic surgeons have, through their training, reached higher levels of proficiency and expertise in methods of internal fixation than with external fixation. The difference reflects the greater number of fractures treated with internal fixation methods. Spanning external fixation should provide skeletal stability without impeding access for plastic surgical procedures. This combination of prerequisites has to be met through a mutual understanding of bony and soft tissue requirements at first debridement and at definitive treatment of the open fracture. Many fixator configurations used currently and even advocated for in external fixator manuals simply fail to meet these requirements. Consequently, we provide a clear rationale for the recommendations made and encourage adoption of the principles described.

External Fixation of Unstable Metacarpal and Phalangeal Fractures

1992 ◽  
Vol 17 (2) ◽  
pp. 151-155 ◽  
Author(s):  
S. W. PARSONS ◽  
J. A. W. FITZGERALD ◽  
J. R. SHEARER
Keyword(s):  
Soft Tissue ◽  
Prospective Study ◽  
External Fixation ◽  
External Fixator ◽  
Non Union ◽  
The Stability ◽  
A Prospective Study ◽  
Phalangeal Fractures

A prospective study of the management of 30 patients with 37 unstable or complex metacarpal or phalangeal fractures treated with the “Shearer” micro-external fixator was carried out over an 18-month period. The stability achieved, with minimal soft-tissue tethering, allowed early joint mobilisation with good or excellent function in 94% of metacarpal and 85% of phalangeal fractures by nine weeks. There were no cases of non-union and few complications.

Calcaneal Fracture-Dislocation with Entrapment of the Medial Neurovascular Bundle: A Case Report

Foot & Ankle ◽  
1993 ◽  
Vol 14 (7) ◽  
pp. 411-413 ◽  
Author(s):  
Arati R. Mallik ◽  
Mark D. Chase ◽  
Paul C. Lee ◽  
George P. Whitelaw
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Calcaneal Fracture ◽  
Neurovascular Bundle ◽  
Fracture Dislocation ◽  
Calcaneal Fractures ◽  
Peroneal Tendons ◽  
Tarsal Bones ◽  
The Subject

The calcaneus is the most commonly fractured of all the tarsal bones. Soft-tissue interposition, usually involving the peroneal tendons, has been reported to block reduction of calcaneal fractures and subtalar dislocations. 3 , 4 , 10 To our knowledge, no case of entrapment of the neurovascular bundle has been reported. This is the subject of our report.

scholarly journals Tibiotalocalcaneal Intramedullary Nailing for Unstable Geriatric Ankle Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932110207
Author(s):  
Elif Kulakli-Inceleme ◽  
David B. Tas ◽  
Diederik P.J. Smeeing ◽  
Roderick M. Houwert ◽  
Nicole M. van Veelen ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Postoperative Complications ◽  
Intramedullary Nailing ◽  
Weight Bearing ◽  
Primary Treatment ◽  
Ankle Fractures ◽  
Fixation Method ◽  
Soft Tissue Envelope ◽  
Patient Reported ◽  
The Mean

Background: Tibiotalocalcaneal (TTC) intramedullary nailing has been suggested as an alternative to open reduction and internal fixation (ORIF) for the primary treatment of unstable fragility ankle fractures with a poor soft tissue envelope. This study aims to investigate the clinical efficacy of TTC intramedullary nail fixation for the primary treatment of unstable ankle fractures in frail elderly patients with poor soft tissue condition, by assessing the number of postoperative complications and the patient-reported functional outcomes. Methods: A retrospective cohort study was performed including patients with an unstable ankle fracture treated between 2015 and 2019 with TTC stabilization using a retrograde intramedullary hindfoot nail that was inserted without joint preparation and allowing immediate weight-bearing postoperatively. The primary outcome was the total number of postoperative complications. Results: A total of 10 patients were included out of 365 operatively treated ankle fractures. The mean age was 85.2 years (range 66-92) with a mean follow-up of 11.2 months (range 6-16). Fracture types included AO/OTA 44-B2 (n = 1), 44-B3 (n = 6), 44-C1 (n = 2) and 44-C3 (n = 1). Postoperative complications were observed in 4 patients (40%), including 3 nonunions, 2 implant related complications and 1 wound infection. No wound healing disorder or below-the-knee amputation was observed. Four patients (40%) deceased between post-operative 6 to 16 months due to medical conditions unrelated to surgery. The mean Foot and Ankle Outcome Score was 52.6 (range 44.2-73.8). Conclusion: Hindfoot nailingis a viable treatment option in selected high-risk patients with an advanced age, unstable ankle fractures with significant bone loss, poor soft tissue condition and/or severely impaired pre-injury mobility. In a frail geriatric population, hindfoot nailing may be a safe alternative fixation method with a low risk of wound complication or major amputation. However, unprepared joint may lead to symptomatic nonunion after TTC intramedullary nailing.

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