Local Random Pattern Flap Coverage for Implant Exposure following Open Reduction Internal Fixation via Extensile Lateral Approach to the Calcaneus

Background Skin necrosis and implant exposure most often appear at the corner of Extensile Lateral Approach for open reduction and internal fixation (ORIF) for displaced intra-articular fracture of the calcaneus. Flap transfer is often used for coverage of this implant exposure. We introduced a new simple local random pattern flap to cover the implant exposure. Methods From March 2017 to March 2020, 12 patients with implant exposure after ORIF for displaced intra-articular fracture of the calcaneus were treated with this procedure. The sizes of the defects ranged from 2 × 2 cm2 to 5 × 2 cm2. A local random pattern flap was designed according to the defect size. The lower edge of the flap was along with the wound upper edge and extended distally. The upper horizontal incision of the flap was made at the lateral malleolus level with a length of 5–7 cm depending on the wound defect. Then the random pattern flap was elevated and transferred to cover the defect area. Results The mean follow-up duration was 6.3 months (ranging 4–13 months). All 12 flaps were uneventfully healed and all patients were able to wear shoes, and no debulking procedures were required. Conclusion The local random pattern flap could be a choice for surgeons when implant exposure at the corner of Extensile Lateral Approach to the Calcaneus occurs.

Comparison of Two Surgical Approaches for Displaced Intra-Articular Calcaneal Fractures: The Modified Sinus Tarsi Approach Versus The Extensile Lateral Approach

The purpose of this study was to assess the clinical efficacy and complications of a modified sinus tarsi approach (MSTA) and the extensile lateral approach (ELA) for the treatment of displaced intra-articular calcaneal fractures. In a retrospective design, 108 patients (117 feet) with Sanders II~IV calcaneal fractures were enrolled in this study, including 52 patients (56 feet) in the MSTA group and 56 patients (61 feet) in the ELA group. The postoperative functional and radiological results showed that the average AOFAS scores and VAS scores of the MSTA group were higher than that of the ELA group (p<0.05). After surgery, the Bohler Angle, Gissane Angle, and the length, width, and height of the calcaneus were significantly improved in the MSTA group and the ELA group, but there were no statistically significant differences between the two groups. The incidences of wound healing complications and postoperative sural nerve injury were lower in the MSTA group than in the ELA group (p<0.000). In conclusion, the MSTA was able to achieve similar effects of anatomical reconstruction and function recovery as the ELA, while also effectively reducing the incidences of wound healing complications and postoperative sural nerve injury and shortening the length of hospital stay.

Evaluation of open reduction and internal fixation of displaced intra-articular fracture of calcaneum- A short term study

Introduction: Management of displaced intraarticular fracture of calcaneum is controversial. Non-operative management often have unsatisfactory result due to subtalar arthritis and abnormal foot morphology. Objective: The objective of the study was to evaluate clinical and radiological outcome of patients with displaced intra-articular fracture of calcaneum treated by open reduction and internal fixation(ORIF) with plates and screws through extensile lateral approach. Methodology: This was prospective clinical study conducted in Nobel Medical College between November 2016 to December 2019. The patients were treated by ORIF with calcaneal plates and screws through extensile lateral approach. Patients were followed up for minimal one year. Patients were evaluated clinically by using AOFAS hind foot score and radiologically by measuring Bohler’s and Gissane angle and calcaneal height and width. Results: Out of total 26 cases, fifteen were sander’s type II, eight were type III and three were type IV. The mean age of patients was 33.92 years. The mean delay of surgery due to swelling was 8.65±1.95 days. The averagefollow-up period was 17 months. The mean AOFAS hind foot score was85.08±7.67. Tenpatients (38.46%) had excellent, twelve patients(48.61%) had good and four patients(15.38%) had fair outcome.There were significant association between improvement in Bohler’s and Gissane angle and functional outcome measured by AOFAS hind foot score. Conclusion : Open reduction and internal fixation of displaced intraarticular fracture of calcaneum with calcaneal plates and screws through extensile lateral approach produce good clinical and radiological result.

Comparison of Two Surgical Approaches for Displaced Intra-Articular Calcaneal Fractures: The Modified Sinus Tarsi Approach Versus The Extensile Lateral Approach

Background: Displaced intra-articular calcaneal fractures (DIACF) can seriously affect foot function. The conventional surgical approach is the extensile lateral approach (ELA), but it has a high incidence of complications. To reduce the complications associated with ELA, many minimally invasive approaches have been suggested. The purpose of this study was to assess the clinical efficacy and complications of the ELA and a modified sinus tarsi approach (MSTA) for the treatment of DIACF.Methods: One-hundred eight patients (107 feet) with Sanders II~IV calcaneal fractures were retrospectively analysed, including 52 patients (56 feet) in the MSTA group and 56 patients (61 feet) in the ELA group. The functional and radiological results of the affected foot were analysed retrospectively. Functional evaluation included AOFAS, VAS, and SF-36. Radiological evaluation included preoperative and postoperative changes in the Bohler Angle, Gissane Angle, length, width, and height of the calcaneus. The postoperative complications were also collected and analysed. Results: The average AOFAS scores of the MSTA group and the ELA group were 80.57±7.80 and 77.34±8.29 (p=0.033), respectively. The postoperative VAS scores of the MSTA group and the ELA group were 1.66±0.98 and 2.03±0.98 (p=0.043), respectively. The postoperative SF-36-PCS score of the MSTA group was superior to that of the ELA group (77.91±5.03 vs. 74.20±5.07, p<0.000), while there was no significant difference in the SF-36-MCS score (74.84±7.77 vs 72.70±8.21, p=0.153). After surgery, the Bohler Angle, Gissane Angle, and the length, width, and height of the calcaneus were significantly improved in the MSTA group and the ELA group, but there were no statistically significant differences between the two groups. The incidence of wound healing complications in the MSTA group and the ELA group was 5.36% and 14.75% (p < 0.000). Sural nerve injury and subtalar arthritis complications were less common in the MSTA group than in the ELA group (p<0.000).Conclusion: For DIACF, the MSTA was able to achieve similar effects of anatomical reconstruction and postoperative foot function recovery as the ELA, while also effectively reducing the incidence of postoperative sural nerve injury and wound healing complications and shortening the length of hospital stay.

Compression Wrapping for Calcaneal Fractures after Extensile Lateral Approach: Results of a Retrospective Study

Category: Trauma Introduction/Purpose: Displaced intraarticular calcaneus fractures comprise the majority of all calcaneus fractures. Many are indicated for open reduction and internal fixation (ORIF) through an extensile lateral approach (ELA). Unfortunately, this approach has reported complication rates of up to 32%. Improved edema management may reduce the incidence of complications. While compression wrapping has been shown to reduce wound complications in ankle arthroplasty, it has not been well studied in lower extremity trauma. This study aimed to evaluate the benefit of compression wrapping in calcaneus fractures treated surgically with an ELA. Methods: This study included 19 patients from 2015-2018 who underwent ORIF of closed intra-articular calcaneal fractures via an ELA by two surgeons. Demographics, comorbidities, fracture characteristics, and time to surgery were recorded. Following surgery, the extremity was initially immobilized in a short leg splint with transition to serial compression wrappings on postoperative day two. Wrappings involved application of multi-layered cotton cast padding and short stretch elastic bandages to the extremity in a distal to proximal fashion. Wraps were replaced every three days by trained physiotherapists until the two- week postoperative visit. The primary outcome was development of a wound complication. A minor complication was defined as wound appearance prompting initiation of oral or IV antibiotics or local wound care. A major complication was defined as development of flap necrosis or return to the OR for debridement. Results: Mean age was 47.7 years. 3 patients (15.7%) were diabetic, and 7 patients (36.8%) were smokers. Mean BMI was 26.9 kg/m2 (SD 4.4). Mean time to surgery was 11.4 days from injury (SD 6.93). The rate of minor soft tissue complication was 4/19 (26.3%); 2 patients required oral antibiotics only, 1 local wound care only, and 1 both antibiotics and local wound care. The rate of major complication was 2/19 (10.5%), with 1 patient requiring a return to OR and another requiring both a return to the OR and IV antibiotics. Of those patients, 1 was noncompliant with the protocol. All patients progressed to eventual soft tissue healing. Statistical analysis identified diabetes as a risk factor for any complication (p=0.02, relative risk 5.3). Conclusion: Compression wrapping resulted in a low incidence of major soft tissue complications in calcaneus fractures treated with an extensile lateral approach. Compression wrapping is an effective method of post-operative soft tissue management for calcaneal fractures, and may have further applications for similar high energy foot and ankle fractures. Further studies are warranted to determine whether this novel wound care technique is superior to standard post-operative wound care.