Displaced intra-articular calcaneal fractures: is there a consensus on treatment in Germany?
Open reduction in displaced intra-articular calcaneal fractures entails a high rate of wound healing deficits and infections as well as an uncertain outcome, which leads to remaining ambiguity in treatment preferences.
Between January and July 2011, we emailed 575 German chairpersons of trauma and/or orthopaedic departments, asking them to complete a 31–question web-based survey regarding three broad domains: fracture classification, surgical treatment algorithms and risk factors for wound healing deficits.
The response rate was 47 %. With an incidence of 77 %, open reduction via an extended lateral approach and plate fixation was the main treatment option for displaced intra-articular fractures of the joint-depression-type (Sanders II or III). Percutaneous techniques were only preferred in individual cases, with mainly precarious wound situations (59 %) as well as in patients with a reduced general health condition (ASA 3 and 4; 41 %). The re-operation rate due to infections and wound healing deficits after an extended lateral approach was reported with a percentage of 0-5 % by 88 % of the respondents. Participants stated that especially a poor microcirculation of the foot, disregard of soft tissue conserving techniques, overall condition of the patient, smoking, long time-to-surgery and operation time are the main reasons for wound healing deficits.
Given the extended lateral approach as the preferred treatment option, we found minimally invasive techniques and primary arthrodesis of the lower ankle joint play a minor role in treating intra-articular calcaneal fractures in Germany. Ninety percent of our respondents stated less than 5 % of patients required re-operations due to infections and wound healing deficits.
Level of Evidence Level V, expert opinion.
KeywordsExtended lateral approach Fracture classification Intra-articular calcaneal fracture Minimally invasive techniques Treatment methods Wound healing
We would like to thank Michael Pastor for his creative and constructive ideas and especially Torsten Mueller for his support. The authors would also like to thank all the participants of this study. Without all of them this work would not have been possible.
Compliance with ethical standards
Conflict of interest
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
- 1.Bohler L (1931) Diagnosis, pathology, and treatment of fractures of the os calcis. J Bone Joit Surg 75–89Google Scholar
- 13.Femino JE, Vaseenon T, Levin DA, Yian EH (2010) Modification of the sinus tarsi approach for open reduction and plate fixation of intra-articular calcaneus fractures: the limits of proximal extension based upon the vascular anatomy of the lateral calcaneal artery. Iowa Orthop J 30:161–167PubMedPubMedCentralGoogle Scholar
- 17.Surgeons CoTotACo (2000) Resource for Optimal Care of the Injured Patient 1999. American College of Surgeons, ChicagoGoogle Scholar
- 19.Feinstein A (1987) The theory of evaluation of sensibility in clinimetrics. Yale University Press, pp 141–166Google Scholar
- 20.Lawshe C (1975) A quantitative approach to content validity. Pers Psychol 563–575Google Scholar
- 30.Jain V, Kumar R, Mandal DK (2007) Osteosynthesis for intra-articular calcaneal fractures. J Orthop Surg (Hong Kong) 15(2):144–148Google Scholar