A modified minimally invasive technique for intra-articular displaced calcaneal fractures fixed by transverse and axial screws

Abstract

The management of displaced, intra-articular calcaneal fracture represents a surgical challenge to even an experienced orthopedic surgeon. Plate osteosynthesis using an extended lateral approach is complicated by soft tissue problems, while those treated by closed reduction and percutaneous pinning cannot address all the intra-articular fragments sufficiently. The objective of our study is to evaluate restoration of subtalar joint and long-term functional outcomes in intra-articular displaced calcaneal fractures treated with transverse subcondral screws through a small incision on lateral aspect of calcaneus and percutaneously placed axial screws through the calcaneal tuberosity. Forty-five intra-articular calcaneal fractures were managed with this minimally invasive technique. Calcaneal height, width, length, Bohler's angle, and Gissane angle were measured preoperatively and last follow-up visit. Functional outcomes were assessed on the basis of American Orthopedic Foot and Ankle Society (AOFAS) ankle/hind foot score. Preoperative calcaneal length, height, width, Bohler's angle, and Gissane angle were improved from 68.62 ± 2.64 to 72.44 ± 2.63 mm, 39.28 ± 2.72 to 32.37 ± 2.65 mm, 47.04 ± 2.56 to 49.55 ± 2.45 mm, 12.66° ± 2.86° to 26.93° ± 2.57°, 123.91° ± 3.13° to 96.06° ± 3.92°, respectively, after surgery with P value <0.001. There were 21 (46.7%) excellent, 17 (37.8%) good, 4 (8.8%) fair, and 3 (6.7%) poor outcomes based on AOFAS ankle/hindfoot scores. Time to unite the fracture was 11.06 ± 1.82 weeks (range 8-16 weeks), and all fractures were united without major complications. Minimally invasive technique through a small incision on lateral aspect of calcaneus gives a moderately good exposure for anatomical restoration of Sander's type II and III calcaneal fractures fixed with both transverse and axial screws under fluoroscopic guidance.

Limb Reconstruction System Assisted Reduction and Internal Fixation for Intra‐Articular Calcaneal Fractures: A New Application

“…The significant benefits brought by temporary LRS external fixation in the effective maintenance of fracture fragments were the reduced use of fluoroscopy (20 times on average) and consequently less total operation time (81.68 min on average). This led to a lower rate of surgical complications, according to the very limited data reported 22,23 . Finally, the LRS external fixation in our surgical protocol was used only intraoperatively and was removed by the end of surgery; therefore, complications were caused by long‐term wearing of the external fixator, such as pin tract infection, skin strain injury, joint stiffness, edema, traction needle rupture, pain 9–14 …”

“…This led to a lower rate of surgical complications, according to the very limited data reported. 22,23 Finally, the LRS external fixation in our surgical protocol was used only intraoperatively and was removed by the end of surgery; therefore, complications were caused by long-term wearing of the external fixator, such as pin tract infection, skin strain injury, joint stiffness, edema, traction needle rupture, pain. [9][10][11][12][13][14] Evaluate the Efficacy of LRS Assisted Minimally Invasive Reduction Other methods of external fixation have also been reported.…”

A prospective comparative study between percutaneous cannulated screws and Kirschner wires in treatment of displaced intra-articular calcaneal fractures

“…The mean pre-operative angle was 2.8° (range from − 38° to 24°), and post-operatively it was 19.4° (range from 5° to 49°), but they did not give a correlation between radiographic correction and functional outcomes. Kapil Mani et al [ 38 ], who used MIS with cannulated screws for treatment of DIACFs, reported the pre-operative calcaneal length, height, width, Böhler’s angle, and Gissane angle were significantly improved after surgery, but they did not give a correlation between radiographic correction and functional outcomes.…”

“…Longer duration was needed for union in the K-wire group ( P -value = 0.016). Kapil Mani et al [ 38 ] obtained union at 11.06 ± 1.82 (range, 8–16) weeks. Arora et al [ 23 ] obtained union at a mean of 8.2 weeks.…”

Assessment of clinical outcomes after reduction of depressed calcaneal fractures using the push-out molding technique

“…[ 12 ] To reduce these complications, the use of minimal invasive techniques is increasing. However, disadvantages of these techniques, such as wound infection, impingement, tendinitis, etc., have also been reported [ [5] , [6] , [7] , [8] , [9] , [10] , [11] ].…”