Journal article
Limited Open Reduction and Internal Fixation of Calcaneal Fractures.
- Bremer AK Department of Orthopaedic Surgery, Siloah Hospital, Gümligen/Bern, Switzerland.
- Kraler L Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.
- Frauchiger L Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.
- Krause FG Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.
- Weber M Department of Orthopaedic Surgery, Siloah Hospital, Gümligen/Bern, Switzerland.
- 2019-09-04
Published in:
- Foot & ankle international. - 2020
calcaneal fracture
functional outcome
limited sinus tarsi approach
screw fixation
Adolescent
Adult
Aged
Calcaneus
Female
Fracture Fixation, Internal
Fractures, Bone
Humans
Male
Middle Aged
Open Fracture Reduction
Retrospective Studies
Surveys and Questionnaires
Young Adult
English
BACKGROUND
The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique.
METHODS
Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months).
RESULTS
The mean AOFAS score was 87 ± 13 (range, 32-100). "Excellent" and "good" results, as well as hindfoot motion with "normal/mild" and "moderate" restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%).
CONCLUSION
The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique.
METHODS
Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months).
RESULTS
The mean AOFAS score was 87 ± 13 (range, 32-100). "Excellent" and "good" results, as well as hindfoot motion with "normal/mild" and "moderate" restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%).
CONCLUSION
The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1177/1071100719873273
- PMID 31478393
- Persistent URL
- https://sonar.ch/global/documents/267999
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