Calcaneal Fracture Management

Kiewiet, Nathan J.; Sangeorzan, Bruce J.

doi:10.1016/j.fcl.2016.09.013

Cited by 26 publications

(9 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It may be speculated, that many of those patients with simple Sanders Type 2 fractures could have been treated with percutaneous or less invasive methods that could have resulted in superior function and less soft-tissue complications. 55 56 57 58 59 Therefore, comparative trials should also include those patients with severe injuries.…”

Section: What Is the Current Evidence?mentioning

confidence: 99%

Calcaneal Fractures — Should We or Should We not Operate?

Rammelt

Sangeorzan

Swords

2018

IJOO

Self Cite

View full text Add to dashboard Cite

The best treatment for displaced, intraarticular fractures of the calcaneum remains controversial. Surgical treatment of these injuries is challenging and have a considerable learning curve. Studies comparing operative with nonoperative treatment including randomized trials and meta-analyses are fraught with a considerable number of confounders including highly variable fracture patterns, soft-tissue conditions, patient characteristics, surgeon experience, limited sensitivity of outcome measures, and rehabilitation protocols. It has become apparent that there is no single treatment that is suitable for all calcaneal fractures. Treatment should be tailored to the individual fracture pathoanatomy, accompanying soft-tissue damage, associated injuries, functional demand, and comorbidities of the patient. If operative treatment is chosen, reconstruction of the overall shape of the calcaneum and joint surfaces are of utmost importance to obtain a good functional result. Despite meticulous reconstruction, primary cartilage damage due to the impact at the time of injury may lead to posttraumatic subtalar arthritis. Even if subtalar fusion becomes necessary, patients benefit from primary anatomical reconstruction of the hindfoot geometry because in situ fusion is easier to perform and associated with better results than corrective fusion for hindfoot deformities in malunited calcaneal fractures. To minimize wound healing problems and stiffness due to scar formation after open reduction and internal fixation (ORIF) through extensile approaches several percutaneous and less invasive procedures through a direct approach over the sinus tarsi have successfully lowered the rates of infections and wound complications while ensuring exact anatomic reduction. There is evidence from multiple studies that malunited displaced calcaneal fractures result in painful arthritis and disabling, three-dimensional foot deformities for the affected patients. The poorest treatment results are reported after open surgical treatment that failed to achieve anatomic reconstruction of the calcaneum and its joints, thus combining the disadvantages of operative and nonoperative treatment. The crucial question, therefore, is not only whether to operate or not but also when and how to operate on calcaneal fractures if surgery is decided.

show abstract

Section: What Is the Current Evidence?mentioning

confidence: 99%

Calcaneal Fractures — Should We or Should We not Operate?

Rammelt

Sangeorzan

Swords

2018

IJOO

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, the focus of treatment for intra-articular calcaneal fractures is still the accurate reduction in fractures. Most scholars[ 23 - 25 ] believe that regardless of which treatment plan is adopted, the treatment goal needs a good recovery of the calcaneal anatomy. In most cases, poor calcaneus reduction results from poor reduction in the medial wall (column).…”

Section: Discussionmentioning

confidence: 99%

Application of medial column classification in treatment of intra-articular calcaneal fractures

Zheng

Xia

Yang

et al. 2020

WJCC

View full text Add to dashboard Cite

BACKGROUND There are many types of treatments for calcaneal fractures, including conservative treatment, conventional surgical treatment, and minimally invasive surgery. The choice of specific treatment options is still controversial. Open reduction and internal fixation are currently the most commonly used surgical procedures in the clinic. A good fracture reduction effect can be achieved by using the lateral extension incision of the calcaneus; however, many studies have reported a high incidence of postoperative incision complications. Although there are many methods for the classification of intra-articular calcaneal fractures, it is generally believed that the computed tomography (CT) classification proposed by Sanders has high application value in the selection of treatment methods and evaluation of prognosis of calcaneal fractures. However, this method has no clear guiding significance for the choice of surgical incision and surgical plan. AIM To explore the application and clinical efficacy of medial column classification in the treatment of intra-articular calcaneal fractures. METHODS From July 2017 to July 2018, 91 patients, including 60 males and 31 females aged 27 to 60 years, were enrolled. All participants had closed intra-articular calcaneal fracture, and their surgical options were selected under the guidance of medial column classification. The patients’ fractures were classified according to the Sanders classification: Type II, 35 cases; Type III, 33 cases; and Type IV, 23 cases. Among them, 53 patients had medial column displacement (shortened varus) and underwent open reduction and internal fixation with L-lateral incision of the calcaneus; 38 patients had no displacement of the medial column and underwent open reduction and internal fixation with tarsal sinus incision. The calcaneus Böhler angle, Gissane angle, length, width, height, and step thickness of the articular surface were evaluated by X-ray and three-dimensional CT before and after surgery and at the last follow-up. Foot function recovery was assessed by the Maryland foot scoring criteria. RESULTS All patients were followed for 5 to 14 mo, with an average of 10.5 ± 2.9 mo. The fractures of all patients healed, and the healing time was 10 to 19 wk, with an average of 10.8 ± 1.5 wk. One patient developed wound infection 1 wk after surgery and was actively debrided and implanted with antibiotic calcium sulfate to control the infection. The patient's fracture healed 5 mo after surgery. One patient developed a sural nerve injury, and the symptoms disappeared 3 mo after surgery. The patients were assessed according to the Maryland foot scoring system: Excellent in 77 cases, good in 10, and fair in 4. The excellent and good rate was 95.6%. CONCLUSION Medial column classification can effectively guide the surgical selection for intra-articular fractures of the calcaneus.

show abstract

“…It also decreases incision length and overall dissection, which should decrease wound healing issues. The STA still allows for direct visualization of the lateral wall, posterior facet, anterolateral fragment, and anterior process to ensure quality reduction [30]. Classically, the STA can be performed with the patients lateral or prone.…”

Section: Sinus Tarsimentioning

confidence: 99%

“…Final fixation can be with screws or a combination of screws and low-profile plates (Fig. 3a, b) [14,30,33,35]. General principles of fixation include lag screw fixation from lateral to medial of the posterior facet fragments to the sustentaculum as described by Phisitkul et al [19].…”

Section: Sinus Tarsimentioning

confidence: 99%

See 1 more Smart Citation

Limited Approaches to Calcaneal Fractures

Wagstrom

Downes

2018

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

Numerous randomized control trials, cohort studies, and meta-analyses have been done in the last 3 years comparing surgical treatment of calcaneus fractures. These studies indicate minimally invasive procedures decrease wound complication rates and achieve similar radiographic and clinical outcomes to open reduction internal fixation. In comparing different surgical treatment methods to non-operative treatment, operative management has increased complication rates but may lead to better functional outcomes in certain patient populations. Optimal treatment for displaced intra-articular calcaneus fractures continues to be debated. Current literature would suggest that the decision to operate be based on patient and fracture characteristics and surgeon capabilities. Minimally invasive techniques aim to improve patient reported outcomes and quality of life while decreasing complications and offer another option for surgeons in the treatment of displaced intra-articular calcaneal fractures.

show abstract

Calcaneal Fracture Management

Cited by 26 publications

References 29 publications

Calcaneal Fractures — Should We or Should We not Operate?

Calcaneal Fractures — Should We or Should We not Operate?

Application of medial column classification in treatment of intra-articular calcaneal fractures

Limited Approaches to Calcaneal Fractures

Contact Info

Product

Resources

About