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Minimally invasive fixation for displaced intra-articular fractures of calcaneum: a short-term prospective study on functional and radiological outcome

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MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Introduction

Studies have demonstrated a decrease in the incidence of late consequences and the socio-economic burden of intra-articular fractures of calcaneum when treated by surgical fixation. Operative management of displaced intra-articular calcaneal fractures (DIACF) pose significant challenges such as technical difficulty, wound healing and long-term pain and disability.

Materials and methods

All patients presenting to the ER with DIACF over a period of 2 years and matching the inclusion criteria were enrolled in the study. Percutaneous fixation with 4 mm CC screw was undertaken with a minimally invasive sinus tarsi approach. All patients were available for a minimum follow-up of 24 months. Six radiological parameters were assessed, and functional outcome was evaluated using AOFAS score.

Results

Thirty-four patients with 42 calcaneal fractures were included in the study, and all patients were available for minimum follow-up period. All radiological parameters were attained within anatomic normal range and maintained at 24 months of follow-up. AOFAS score showed a mean value of 90.10 which is considered an excellent outcome. Superficial wound infection was seen in two patients, but no patients required a revision surgery.

Conclusion

Displaced intra-articular fractures pose a treatment dilemma, more so in cases of soft tissue complications like open injury or blisters. Percutaneous screw fixation with limited sinus tarsi incision has shown good functional and radiological outcome with minimal complications and can be undertaken without delay.

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References

  1. 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  Google Scholar 

  2. McBride DJ, Ramamurthy C, Laing P (2005) The hindfoot: calcaneal and talar fractures and dislocations part I: fractures of the calcaneum. Curr Orthop 19:94–100

    Article  Google Scholar 

  3. Lindsay WRN, Dewar FP (1958) Fractures of the os calcis. Am J Surg 95:555–576

    Article  CAS  Google Scholar 

  4. Parmar HV, Triffitt PD, Gregg PJ (1993) Intra-articular fractures of the calcaneum treated operatively or conservatively: a prospective study. J Bone Joint Surg Br 75:932–937

    Article  CAS  Google Scholar 

  5. Nouraei MH, Moosa FM (2011) Operative compared to nonoperative treatment of displaced intra-articular calcaneal fractures. J Res Med Sci 16:1014–1019

    PubMed  PubMed Central  Google Scholar 

  6. Thordarson DB, Krieger LE (1996) Operative vs. nonoperative treatment of intra-articular fractures of the calcaneus: a prospective randomized trial. Foot Ankle Int 17:2–9

    Article  CAS  Google Scholar 

  7. Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, Galpin R (2002) Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am 84A:1733–1744

    Article  Google Scholar 

  8. Agren PH, Wretenberg P, Sayed-Noor AS (2013) Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am 95:1351–1357

    Article  Google Scholar 

  9. Mitchell MJ, McKinley JC, Robinson CM (2009) The epidemiology of calcaneal fractures. Foot (Edinb) 19:197–200

    Article  CAS  Google Scholar 

  10. Csziy M, Buckley R, Tough S, Leighton R, Smith J, McCormack R et al (2003) Displaced intra-articular calcaneal fractures: variables predicting late subtalar fusion. J Ortho Trauma 17:106–112

    Article  Google Scholar 

  11. Coughlin MJ (2000) Calcaneal fractures in the industrial patient. Foot Ankle Int 21:896–905

    Article  CAS  Google Scholar 

  12. Howard J, Buckley R, McCormack R, Pate G, Leighton R, Petrie D et al (2003) Complications following management of displaced intra-articular calcaneal fractures: a prospective randomised trial comparing open reduction internal fixation with non-operative management. J Orthop Trauma 17(4):241–249

    Article  CAS  Google Scholar 

  13. Basile A (2010) Operative versus non-operative treatment of displaced intra-articular calcaneal fractures in elderly patients. J Foot Ankle Surg 49(1):25–32

    Article  Google Scholar 

  14. Tufescu TV, Buckley RE (2001) Age, gender, work capability, and worker’s compensation in patients with displaced intra-articular calcaneal fractures. J Orthop Trauma 15:275–279

    Article  CAS  Google Scholar 

  15. De Boer AS, Van Lieshout EM, Den Hartog D, Weerts B, Verhofstad MH, Schepers T (2014) Functional outcome and patient satisfaction after displaced intra-articular calcaneal fractures: a comparison among open, percutaneous, and nonoperative treatment. J Foot Ankle Surg 30:1–8

    Google Scholar 

  16. Schepers T, van Lieshout EMM, van Ginhoven TM, Heetveld MJ, Patka P (2008) Current concepts in the treatment of intra-articular calcaneal fractures: results of a nationwide survey. Int Orthop 32(5):711–715

    Article  CAS  Google Scholar 

  17. Veltman ES, Doornberg JN, Stufkens SAS, Luitse JSK, van den Bekerom MPJ (2013) Long-term outcomes of 1730 calcaneal fractures: systematic review of the literature. J Foot Ankle Surg 52:486–490

    Article  Google Scholar 

  18. Gougoulias N, Khanna A, McBride DJ, Maffulli N (2009) Management of calcaneal fractures: systematic review of randomized trials. Br Med Bull 92:153–167

    Article  Google Scholar 

  19. Rammelt S, Heineck J, Barthel S, Zwipp H (2009) Percutaneous fixation of intraarticular calcaneus fractures. Technol Foot Ankle Surg 8:70–76

    Article  Google Scholar 

  20. Kilkuchi C, Charlton TP, Thordarson DB (2013) Limited sinus tarsi approach for intraarticular calcaneus fractures. Foot Ankle Int 34(12):1689–1694

    Article  Google Scholar 

  21. 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(6):773–780

    Article  Google Scholar 

  22. Nosewicz T, Knupp M, Barg A, Maas M, Bolliger L, Goslings JC et al (2012) Mini-open sinus tarsi approach with percutaneous screw fixation of displaced calcaneal fractures: a prospective computed tomography-based study. Foot Ankle Int 33(11):925–933

    Article  Google Scholar 

  23. Weber M, Lehmann O, Sagesser D, Krause F (2008) Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. J Bone Joint Surg Br 90:1608–1616

    Article  CAS  Google Scholar 

  24. Tornetta P III (2000) Percutaneous treatment of calcaneal fractures. Clin Orthop Relat Res 375:91–96

    Article  Google Scholar 

  25. 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(12):1634–1641

    Article  CAS  Google Scholar 

  26. Park I, Song KW, Shin S, Lee JY, Kim TG, Park RS (2000) Displaced intra-articular calcaneal fractures treated surgically with limited posterior incision. Foot Ankle Int 21:195–205

    Article  CAS  Google Scholar 

  27. Schuberth JM, Cobb MD, Talarico RH (2009) Minimally invasive arthroscopic-assisted reduction with percutaneous fixation in the management of intra-articular calcaneal fractures: a review of 24 cases. J Foot Ankle Surg 48:315–322

    Article  Google Scholar 

  28. Wang Q, Chen W, Su Y, Pan J, Zhang Q, Peng A et al (2010) Minimally invasive treatment of calcaneal fracture by percutaneous leverage, anatomical plate, and compression bolts—the clinical evaluation of cohort of 156 patients. J Trauma 69:1515–1522

    Article  Google Scholar 

  29. Tomesen T, Biert J, Frolke JPM (2011) Treatment of displaced intra-articular calcaneal fractures with closed reduction and percutaneous screw fixation. J Bone Joint Surg 93:920–928

    Article  CAS  Google Scholar 

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

    Google Scholar 

  31. Griffin D, Parsons N, Shaw E, Kulikov Y, Kulikov Y, Hutchinson C, Thorogood M, Lamb SE, UK Heel Fracture Trial Investigators (2014) Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ 349:g4483

    Article  Google Scholar 

  32. Sharr PJ, et al (2015) Current management options for displaced intra-articular calcaneal fractures: nonoperative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis: a contemporary review. Foot Ankle Surg

  33. Ibrahim T, Rowsell M, Rennie W, Brown AR, Taylor GJS, Gregg PJ (2007) Displaced intra- articular calcaneal fractures: 15 year follow-up of a randomized controlled trial of conservative versus operative treatment. Injury 38:848–855

    Article  CAS  Google Scholar 

  34. van Hoeve S, Poeze M (2016) Outcome of minimally invasive open and percutaneous techniques for repair of calcaneal fractures: a systematic review. J Foot Ankle Surg 55(6):1256–1263

    Article  Google Scholar 

  35. Harvey EJ, Grujic L, Early JS et al (2001) Morbidity associated with ORIF of intraarticular calcaneus fractures using a lateral approach. Foot Ankle Int 11:868–873

    Article  Google Scholar 

  36. Aldridge JM III, Easley M, Nunley JA (2004) Open fractures: results of operative treatment. J Orthop Trauma 18(1):7–11

    Article  Google Scholar 

  37. Arastu M, Sheehan B, Buckley R (2014) Minimally invasive reduction and fixation of displaced calcaneal fractures: surgical technique and radiographic analysis. Int Orthop 38(3):539–545

    Article  Google Scholar 

  38. Ceccarelli F, Faldini C, Piras F, Giannini S (2000) Surgical vs non-surgical treatment of calcaneal fractures in children: a long term results comparative study. Foot Ankle Int 21:825–832

    Article  CAS  Google Scholar 

  39. Thermann H, Hufner T, Schratt E, Held C, von Glinski S, Tscherne H (1999) Long-term results of subtalar fusions after operative versus non-operative treatment of oscalcis fractures. Foot Ankle Int 20(7):408–416

    Article  CAS  Google Scholar 

  40. Sanders R (2000) Current concepts review: displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am 82:225–250

    Article  CAS  Google Scholar 

  41. Buckley R, Leighton R, Sanders D, Poon J, Coles CP, Stephen D et al (2014) Open reduction and internal fixation compared with ORIF and primary subtalararthrodesis for the treatment of sanders type IV calcaneal fractures: a randomized, multicenter trial. J Orthop Trauma 28(10):577–583

    Article  Google Scholar 

  42. Giannini S, Cadossi M, Mosca M, et al (2016) Minimally-invasive treatment of calcaneal fractures: a review of the literature and our experience. Injury

  43. Loucks C, Buckley R (1999) Bohler’s angle: correlation with outcome in displaced intra-articular calcaneal fractures. J Orthop Trauma 13(8):554–558

    Article  CAS  Google Scholar 

  44. Dooley P, Buckley R, Tough S, McCormack B, Pate G, Leighton R et al (2004) Bilateral calcaneal fractures: operative versus non-operative treatment. Foot Ankle Int 25(2):47–52

    Article  Google Scholar 

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Authors and Affiliations

  1. Trauma and Arthroplasty and Foot and Ankle Surgeon, Sunshine Hospitals, Secunderabad, India

    K. R. Rachakonda & B. Kidiyur

  2. Trauma Surgeon, Sunshine Hospitals, Secunderabad, India

    A. Nugur

  3. Department of Orthopaedics, Sunshine Hospitals, Secunderabad, 500003, India

    N. A. Shekar & V. M. Joseph

  4. Trauma and Arthroplasty Surgeon, Sunshine Hospitals, Secunderabad, India

    P. Kilaru & S. Gannamani

Authors
  1. K. R. Rachakonda
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  2. A. Nugur
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  3. N. A. Shekar
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Correspondence to V. M. Joseph.

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Rachakonda, K.R., Nugur, A., Shekar, N.A. et al. Minimally invasive fixation for displaced intra-articular fractures of calcaneum: a short-term prospective study on functional and radiological outcome. Musculoskelet Surg 103, 181–189 (2019). https://doi.org/10.1007/s12306-018-0575-3

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