Background: The treatment of displaced, intra-articular calcaneus fractures is controversial. The extensile lateral approach has been historically preferred because it provides excellent exposure and visualization for fracture reduction. However, soft tissue complications with this approach can lead to poor outcomes for patients. Recently, there has been an interest in the minimally invasive treatment of calcaneus fractures. The purpose of the present study was to determine the radiographic reduction of displaced, intra-articular calcaneus fractures and the rate of complications using a 2-incision, minimally invasive approach. Methods: A dual-incision, minimally invasive approach with plate and screw fixation was utilized for the treatment of 32 patients with displaced, intra-articular calcaneus fractures. Preoperative and postoperative calcaneal measurements were taken to assess fracture reduction. Additionally, a retrospective chart review was performed to assess for complications. Results: The mean preoperative Bohler’s angle measurement was 12.9 (range, –5 to 36) degrees and the final postoperative Bohler’s angle was 31.7 (range, 16-40) degrees. One patient (3.1%) had postoperative numbness related to the medial incision in the calcaneal branch sensory nerve distribution. Two patients (6.2%) had a wound infection treated with local wound care and oral antibiotics, while 1 patient (3.1%) had a deep infection that required a secondary surgery for irrigation and debridement. Two patients (6.2%) returned to the operating room for removal of symptomatic hardware. Conclusion: Operative fixation of displaced, intra-articular calcaneus fractures treated with a 2-incision, minimally invasive approach resulted in acceptable fracture reduction with a minimal rate of complications. Level of Evidence: Level IV, retrospective case series.
In patients with preserved triceps strength, a triceps branch of the radial nerve can be coapted directly to the axillary nerve in the absence of deltoid contraction following electrical stimulation. Functional improvements were seen in patients treated with neurolysis alone and in combination with nerve transfer, supporting the use of intraoperative axillary nerve stimulation to guide treatment.
Calcaneus fractures are severe injuries that historically have been associated with poor outcomes and debilitating consequences. To maximize functional outcome, the literature in favor of operative management encourages anatomic reduction and alignment of displaced, intra-articular calcaneus fractures, while minimizing risk to soft tissues. Because of the increased risk of soft tissue complications with extensile approaches, minimally invasive techniques have continued to gain popularity. The current technique aims to describe a minimally invasive approach to calcaneus fractures through a dual-incision, lateral (sinus tarsi) and medial, approach. This approach facilitates anatomic reduction of the calcaneal tubercle to restore calcaneal tuberosity height and length, thus facilitating anatomic reduction of the posterior facet and realignment of the anterior calcaneus while minimizing risk of soft tissue complications. The authors’ results support this technique and we recommend it as a safe and effective method for open reduction and internal fixation of displaced, intra-articular calcaneal fractures. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
The surgical correction of hallux valgus (HV) is one of the most common procedures performed by orthopedic foot and ankle surgeons. There are >100 different operations described in the literature for the management of HV, yet patient dissatisfaction following HV surgery can occur in 4% to 41% of cases. The most common outcomes leading to patient complaints include recurrence of HV, hallux varus, malunion, nonunion, osteonecrosis of the first metatarsal head, first metatarsophalangeal joint stiffness, and pain. This manuscript will present and discuss 4 cases of failed HV treated with joint-sparing secondary procedures. The goal is to use these cases as examples of treatment options available in the management of revision surgery related to previous HV reconstruction. The evaluation of patients with failed HV surgery is discussed, and an overview of the various joint-sparing surgical treatment options is presented. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Category: Trauma Introduction/Purpose: Calcaneus fractures are serious injuries that can have disabling outcomes. Achieving anatomic reduction and minimizing postoperative complications are crucial to successful treatment. Recent literature has focused on minimally invasive techniques; however, there are concerns about the ability of such techniques to reliably achieve anatomic reduction. The extensile lateral approach has demonstrated high rates of postoperative soft tissue complications. This study reviews the radiographic and clinical outcomes of a two-incision (medial and sinus tarsi), minimally invasive approach for displaced intra-articular calcaneus fractures treated by a single surgeon. We hypothesized that this technique would provide successful radiographic reduction with minimal complications. Methods: A retrospective radiographic and chart review was performed on patients with displaced intra-articular calcaneus fractures that underwent open reduction and internal fixation with a medial and sinus tarsi approach. The surgical procedure utilizes a medial incision with a push-pull technique facilitating anatomic reduction of the calcaneal tuberosity due to the stability of the medial cortex, thus re-establishing calcaneal length and height and eliminating heel varus. Reduction of the tubercle allows for reduction of the posterior facet through a sinus tarsi approach. Posterior screws were utilized for cases with severe comminution. Primary outcome measures included radiographic angular and linear dimensions and the rate of post-operative wound complications. Secondary outcomes included rate of nonunion, secondary surgeries, and other complications. Demographic data included the patient’s age, gender, mechanism of injury, injured extremity, time to surgery, smoking and diabetes history, presence of fracture blisters, and time to follow-up. Patients were followed to radiographic union. Results: Twenty-two patients (age 50.6 +/- 16.1 years) met the inclusion criteria. Preoperatively, 11 were Sanders IIA, 7 Sanders IIB, 1 Sanders IIIAB, 2 Sanders IIIAB, and 1 Sanders IV. Two (9.1%) had a superficial wound infection treated with local wound care. Two patients underwent removal of hardware (posterior screws). There were no cases of nonunion, osteomyelitis, deep infection, tibial nerve injury, or loss of fixation. The preoperative Bohler’s angle averaged 11.3 +/- 10.0 (range -5 to 36) degrees and the postoperative Bohler’s angle averaged 30.3 +/- 7.6 (range 16 to 40) degrees (p < 0.05). Calcaneal height measured 4.6 +/-0.41 (range 4.2 to 5.2) cm preoperatively and 4.96 +/- 0.48 (range 4.3 to 5.8) cm postoperatively (p < 0.05). No patients underwent a subtalar fusion. Conclusion: The goals of any approach for calcaneus fractures are to obtain anatomic fracture reduction and stable fixation while minimizing postoperative complications. Our study demonstrates a significant improvement in radiographic calcaneal alignment utilizing a novel minimally invasive medial and sinus tarsi approach to intra-articula...
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