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Minimally invasive internal fixation of calcaneal fractures or subtalar joint arthrodesis using the Calcanail®

Minimal-invasive interne Fixierung bei Kalkaneusfrakturen oder bei subtalarer Arthrodese mit dem Calcanail®

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Abstract

Objective

A minimally invasive technique to prevent soft tissue problems using a calcaneal nail (Calcanail®, FH Orthopedics, Heimsbrunn, France) for calcaneal fractures or in subtalar joint arthrodesis is described.

Indications

Displaced extra-articular calcaneal fractures involving the tuberosity fragment and in displaced intra-articular calcaneal fractures with impression and/or displacement of the subtalar joint surface. Subtalar joint arthrodesis for posttraumatic subtalar osteoarthritis.

Contraindications

Severely displaced fractures type Sanders IV with the purpose of internal fixation; peripheral calcaneal fractures; general contraindications for operative treatment.

Surgical technique

Minimally invasive reduction of calcaneal fractures using a special distractor and a graft pusher through a calcaneal working channel. Fixation performed via the insertion of the Calcanail® and the two locking screws, optional additional screws. Subtalar joint arthrodesis with a Calcanail® used with optional three locking screws to fix the talus and calcaneus creating an angular stable construct.

Postoperative management

Mobilization and restricted weight-bearing for 6 weeks in the patient’s own shoes after fracture fixation or in a walker after arthrodesis.

Results

Preliminary results of 69 cases from three surgical centers have already been published. From 2013–2017, the technique was used in 48 of our own patients (42 calcaneal fracture reduction and fixation; 6 for subtalar joint arthrodesis). Mean postoperative hospital stay was 7 days for fracture reduction without any need of additional operations. During follow-up, 6 implant removals and 2 secondary subtalar fusions were noticed. All 6 cases of subtalar joint arthrodesis were planned in posttraumatic subtalar osteoarthritis.

Zusammenfassung

Operationsziel

Beschreibung einer minimal-invasiven Technik zur Verhinderung von Weichteilschäden mit einem Kalkaneusverriegelungsnagel (Calcanail®) bei Osteosynthese von Kalkaneusfrakturen oder subtalarer Arthrodese.

Indikationen

Dislozierte extraartikuläre Kalkaneusfrakturen unter Einbeziehung des calcaneal tuberosity, dislozierte Gelenkfrakturen des Kalkaneus mit imprimierter/dislozierter subtalarer Gelenkfläche, posttraumatische subtalare Arthrose durch Arthrodese des unteren Sprunggelenks.

Kontraindikationen

Schwer dislozierte Kalkaneusfrakturen Typ Sanders IV mit dem Ziel der Frakturosteosynthese, periphere Kalkaneusfrakturen, generelle Operationskontraindikationen.

Operationstechnik

Innere Reposition von Kalkaneusfrakturen in minimal-invasiver Technik mit speziellem Distraktor und Knochenstößel über einen kalkanearen Arbeitskanal. Osteosynthetische Stabilisierung durch den eingebrachten Calcanail® und 2 Verriegelungsschrauben, ggf. zusätzliche Kleinfragmentschrauben. Bei subtalarer Arthrodese wird der Calcanail® mit optional 3 Verriegelungsschrauben eingesetzt, um Talus und Kalkaneus winkelstabil miteinander zu fixieren.

Weiterbehandlung

Mobilisation unter Teilbelastung für 6 Wochen im patienteneigenen Schuh nach Frakturversorgung und im Walker nach Arthrodese.

Ergebnisse

Vorläufige Ergebnisse von 69 Fällen nach Kalkaneusfraktur aus drei operativen Zentren wurden publiziert. Im eigenen Patientengut wurde der Calcanail® von 2013–2017 in 48 Fällen eingesetzt (42 zur Frakturosteosynthese bei Kalkaneusfrakturen, 6 zur subtalaren Arthrodese). In der Osteosynthesegruppe betrug die mittlere postoperative Krankenhausverweildauer 7 Tage ohne Notwendigkeit zusätzlicher Operationen. Während der Nachbehandlung wurden 6 Implantate entfernt und 2 sekundäre subtalare Arthrodesen beobachtet. Alle 6 Fälle der subtalaren Arthrodesen wurden bei posttraumatischer subtalarer Arthrose geplant.

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Acknowledgements

Thanks to Mr. Thomas Wodetzki (Universitätsmedizin Rostock) for drawing Figs. 4, 12, 14b, 15 and 19.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Germany

    M. Saß,  R. Rotter &  T. Mittlmeier

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  1. M. Saß
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  2. R. Rotter
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  3. T. Mittlmeier
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Corresponding author

Correspondence to M. Saß.

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Conflict of interest

T. Mittlemeier shares the patent on the Calcanail® implant. R. Rotter has received a speaker honorarium from FH Orthopedics. M. Saß declares that he has no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Editor

S. Rammelt, Dresden

Illustrator

R. Himmelhan, Mannheim

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Saß, M., Rotter, R. & Mittlmeier, T. Minimally invasive internal fixation of calcaneal fractures or subtalar joint arthrodesis using the Calcanail®. Oper Orthop Traumatol 31, 149–164 (2019). https://doi.org/10.1007/s00064-018-0576-2

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  • DOI: https://doi.org/10.1007/s00064-018-0576-2

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