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Osteosynthesetechnik bei Fersenbeinfrakturen

A technique of internal fixation for os calcis fractures

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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Summary

Goal of Surgery

Healing of the fracture in optimal position. Restoration of joint surfaces and function of the subtalar and calcaneocuboid joints.

Indications

Os calcis fractures of type A2 and B2 of our classification modified after the AO classification published by Müller.

Contraindications

Poor skin and soft tissue conditions. Severely comminuted fractures, osteoporosis. Peripheral circular disturbance. Uncooperative or inactive patients.

Positioning and Anaesthesia

Supine. Tourniquet. Operating table which can be tilted and is radiolucent. General, spinal or epidural anaesthesia.

Surgical Technique

Closed reduction using an external fixator, introduced from the medial side into the calcaneal tuberosity and the first metatarsus. Open reduction of the joint surfaces with the possible use of autogeneous cancellous bone grafts and plate fixation laterally. Posterior plaster slab for the first postoperative days.

Postoperative Management

Elevation of limb. Out of cast physiotherapy of the ankle and subtalar joints starting the first postoperative day. Partial weight bearing of 20 kg using 2 canes is permitted in reliable patients after wound healing. For the other patients partial weight bearing in the plaster slab. Full weight bearing after 8 to 10 weeks depending on radiologic state of consolidation.

Results

37 os calcis fractures were thus treated between 1988 and 1991. Patient age varied between 7 and 74 years, mean age 38.9 years. 12% of the patients suffered of polytrauma. Average time to full weight bearing: 12 weeks. Follow-up of 32 patients after 15 to 64 months, mean 33 months: 24 patients returned to the same occupation, 3 patients retired, 2 patients changed their occupation and 3 are unemployed. Scoring according to the method proposed by Merle d'Aubigné. Fracture types and results are listed in Table 1. The following complications were observed: 6 haematomas needing evacuation. Injury to the dorsal cutaneous nerve in 6 patients, pain at the subtalar joint while walking over uneven ground in 22 patients, 3 patients wear orthopaedic shoes and 12 arch supports. Up to now no subtalar arthrodesis became necessary.

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Author notes

  1. Eugen Hermann Kuner

    Present address: Abteilung Unfallchirurgie der Chirurgischen Universitätsklinik, Hygstetter Straβe 55, D-79106, Freiburg/Brsg

Authors and Affiliations

  1. Abteilung für Unfallchirurgie, Universität Freiburg, Freiburg, Deutschland

    Hildegard Berwarth

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  1. Eugen Hermann Kuner
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  2. Felix Bonnaire
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  3. Hildegard Berwarth
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Kuner, E.H., Bonnaire, F. & Berwarth, H. Osteosynthesetechnik bei Fersenbeinfrakturen. Operat Orthop Traumatol 8, 295–306 (1996). https://doi.org/10.1007/BF02510192

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