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A modified minimally invasive technique for treatment of intra-articular fractures of the calcaneus. Mid-term results and review of the literature

  • Original Article
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European Orthopaedics and Traumatology

Abstract

Background

The goal of therapy for calcaneal fractures is elimination of pain and restoration of normal foot shape and walking ability. The occurrence of wound complications is a serious concern in treating calcaneal fractures.

Purpose

The purpose of the present study was to describe and evaluate the mid-term results of a modified minimally invasive technique for treatment of intra-articular fractures of the calcaneus.

Materials and methods

Fifty-two patients with 61 closed, intra-articular fractures of the calcaneus were enrolled in a prospective cohort study. They were treated with a minimally invasive technique combining a limited lateral approach and percutaneous screws. Clinical and radiographic data were analyzed. The minimum follow-up period was 2 years.

Results

Combining the anatomical and functional results, an overall rating of good, fair, and poor was assigned to each fracture. The results were good in 51 feet (83.6 %), fair in 6 feet, and poor in 4 feet.

Conclusion

The results of the current study were comparable to the results achieved using other minimally invasive techniques while avoiding the serious soft tissue complications encountered with open surgery. Thus, the described technique seems to be an effective and safe alternative for intra-articular calcaneal fracture fixation.

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References

  1. Bajammal S, Tornetta P 3rd, Sanders D, Bhandari M (2005) Displaced intra-articular calcaneal fractures. J Orthop Trauma 19:360–364

    PubMed  Google Scholar 

  2. Walde TA, Sauer B, Degreif J, Walde HJ (2008) Closed reduction and percutaneous Kirschner wire fixation for the treatment of dislocated calcaneal fractures: surgical technique, complications, clinical and radiological results after 2–10 years. Arch Orthop Trauma Surg 128:585–591

    Article  PubMed Central  PubMed  Google Scholar 

  3. Abidi NA, Dhawan S, Gruen GS, Vogt MT, Conti SF (1998) Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures. Foot Ankle Int 19:856–861

    Article  CAS  PubMed  Google Scholar 

  4. Benirschke SK, Sangeorzan BJ (1993) Extensive intra-articular fractures of the foot. Surgical management of calcaneal fractures. Clin Orthop 292:128–134

    PubMed  Google Scholar 

  5. Harvey EJ, Grujic L, Early JS, Benirschke SK, Sangeorzan BJ (2001) Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int 22:868–873

    CAS  PubMed  Google Scholar 

  6. Zwipp H, Tscherne H, Thermann H, Weber T (1993) Osteosynthesis of displaced intra-articular fractures of the calcaneus. Results in 123 cases. Clin Orthop 290:76–86

    PubMed  Google Scholar 

  7. Stephenson JR (1987) Treatment of displaced intra-articular fractures of the calcaneus using medial and lateral approaches, internal fixation, and early motion. J Bone Joint Surg Am 69:115–130

    CAS  PubMed  Google Scholar 

  8. Folk JW, Starr AJ, Early JS (1999) Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma 13:369–372

    Article  CAS  PubMed  Google Scholar 

  9. Rammelt S, Zwipp H, Schneiders W, Dürr C (2013) Severity of injury predicts subsequent function in surgically treated displaced intraarticular calcaneal fractures. Clin Orthop Relat Res 471:2885–2898. doi:10.1007/s11999-013-3062-z

    Article  PubMed Central  PubMed  Google Scholar 

  10. Forgon M (1992) Closed reduction and percutaneous osteosynthesis: technique and results in 265 calcaneal fractures. In: Tscherne H, Schatzker J (eds) Major fractures of the pilon, the talus and the calcaneus. Springer-Verlag, Berlin, pp 207–213

    Google Scholar 

  11. Sanders R, Fortin P, Di Pasquale T, Walling A (1993) Operative treatment in 120 displaced intra-articular calcaneal fractures: results using a prognostic computed tomography scan classification. Clin Orthop 290:87–95

    PubMed  Google Scholar 

  12. Bezes H, Massart P, Delvaux D, Fourquet JP, Tazi F (1993) The operative treatment of intra-articular calcaneal fractures. Indications, technique, and results in 257 cases. Clin Orthop 290:55–59

    PubMed  Google Scholar 

  13. Levin LS, Nunley JA (1993) The management of soft tissue problems associated with calcaneal fractures. Clin Orthop 290:151–156

    PubMed  Google Scholar 

  14. Magnan B, Bortolazzi R, Marangon A, Marino M, Dall’Oca C, Bartolozzi P (2006) External fixation for displaced intra-articular fractures of the calcaneum. J Bone Joint Surg (Br) 88:1474–1479

    Article  CAS  Google Scholar 

  15. McGarvey WC, Burris MW, Clanton TO, Melissinos EG (2006) Calcaneal fractures: indirect reduction and external fixation. Foot Ankle Int 27:494–499

    PubMed  Google Scholar 

  16. Stulik J, Stehlik J, Rysavy M, Wozniak A (2006) Minimally-invasive treatment of intra-articular fractures of the calcaneum. J Bone Joint Surg (Br) 88:1634–1641

    Article  CAS  Google Scholar 

  17. Talarico LM, Vito GR, Zyryanov SY (2004) Management of displaced intra-articular calcaneal fractures by using external ring fixation, minimally invasive open reduction, and early weight bearing. J Foot Ankle Surg 43:43–50

    Article  PubMed  Google Scholar 

  18. Fernandez DL, Koella D (1993) Combined percutaneous and “minimal” fixation of displaced articular fractures of the calcaneus. Clin Orthop 290:108–116

    PubMed  Google Scholar 

  19. Burdeaux BD (1997) Fractures of the calcaneus: open reduction and internal fixation from the medial side; a 21-year prospective study. Foot Ankle Int 18:685–692

    Article  PubMed  Google Scholar 

  20. Levine DS, Helfet DL (2001) An introduction to the minimally invasive osteosynthesis of intra-articular calcaneal fractures. Injury 32(Suppl 1):SA51–SA54

    Article  PubMed  Google Scholar 

  21. Tornetta P (1998) The Essex-Lopresti reduction for calcaneal fractures revisited. J Orthop Trauma 12:469–473

    Article  PubMed  Google Scholar 

  22. Johnson EE, Gebhardt JS (1993) Surgical management of calcaneal fractures using bilateral incision and minimal internal fixation. Clin Orthop 290:117–124

    PubMed  Google Scholar 

  23. Goff CW (1938) Fresh fractures of the os calcis. Arch Surg 36:744–765

    Article  Google Scholar 

  24. Carr JB, Tigges RG, Wayne JS, Earll M (1997) Internal fixation of experimental intra-articular calcaneal fractures: A biomechanical analysis of two fixation methods. J Orthop Trauma 11:425–428

    Article  CAS  PubMed  Google Scholar 

  25. Ebraheim NA, Elgafy H, Sabry FF, Freih M, Abou-Chakra IS (2000) Sinus tarsi approach with trans-articular fixation for displaced intra-articular fractures of the calcaneus. Foot Ankle Int 2:105–113

    Google Scholar 

  26. Hospodar P, Guzman C, Johnson P, Uhl R (2008) Treatment of displaced calcaneus fractures using a minimally invasive sinus tarsi approach. Orthopedics 31:1112

    Article  PubMed  Google Scholar 

  27. Shan SL, Xu JL, Yao SZ, Yu GS, Liu YQ (2010) Minimally invasive plate internal fixation for calcaneal fractures. Chin J Traumatol 13:313–315

    PubMed  Google Scholar 

  28. Mostafa MF, El-Adl G, Hassanin EY, Abdellatif MS (2010) Surgical treatment of displaced intra-articular calcaneal fracture using a single small lateral approach. Strategies Trauma Limb Reconstr 5:87–95. doi:10.1007/s11751-010-0082-z

    Article  PubMed Central  PubMed  Google Scholar 

  29. Nosewicz T, Knupp M, Barg A, Maas M, Bolliger L, Goslings JC, Hintermann B (2012) Mini-open sinus tarsi approach with percutaneous screw fixation of displaced calcaneal fractures: a prospective computed tomography-based study. Foot Ankle Int 33:925–933. doi:10.3113/FAI.2012.0925

    Article  PubMed  Google Scholar 

  30. Xia S, Wang X, Lu Y, Wang H, Wu Z, Wang Z (2013) A minimally invasive sinus tarsi approach with percutaneous plate and screw fixation for intra-articular calcaneal fractures. Int J Surg 11:1087–1091. doi:10.1016/j.ijsu.2013.09.017

    Article  PubMed  Google Scholar 

  31. Kikuchi C, Charlton TP, Thordarson DB (2013) Limited sinus tarsi approach for intra-articular calcaneus fractures. Foot Ankle Int 34:1689–1694. doi:10.1177/1071100713510267

    Article  PubMed  Google Scholar 

  32. Abdelazeem A, Khedr A, Abousayed M, Seifeldin A, Khaled S (2014) Management of displaced intra-articular calcaneal fractures using the limited open sinus tarsi approach and fixation by screws only technique. Int Orthop 38:601–606. doi:10.1007/s00264-013-2203-z6

    Article  PubMed Central  PubMed  Google Scholar 

  33. Huang H, Zhuang XQ, Bai Y, Lu SL, Xu F (2013) Treatment of intra-articular calcaneal fractures by minimally invasive through the sinus tarsi approach and external fixation with calcaneal locking plates. Zhongguo Gu Shang 26:893–896

    PubMed  Google Scholar 

  34. Xia S, Lu Y, Wang H, Wu Z, Wang Z (2014) Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures - a randomized controlled trial. Int J Surg 12:475–480. doi:10.1016/j.ijsu.2014.03.001

    Article  PubMed  Google Scholar 

  35. Kline AJ, Anderson RB, Davis WH, Jones CP, Cohen BE (2013) Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int 34:773–780. doi:10.1177/1071100713477607

    Article  PubMed  Google Scholar 

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All authors involved in this study declare no conflict of interest.

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Correspondence to Ashraf Anbar.

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Gomaa, M.A., El Naggar, A. & Anbar, A. A modified minimally invasive technique for treatment of intra-articular fractures of the calcaneus. Mid-term results and review of the literature. Eur Orthop Traumatol 6, 305–313 (2015). https://doi.org/10.1007/s12570-015-0321-3

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  • DOI: https://doi.org/10.1007/s12570-015-0321-3

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