Cohort Study on the Percutaneous Treatment of Displaced Intra-articular Fractures of the Calcaneus

Vroome, Stefan W. de; Linden, Frits M. Van der

doi:10.1177/1071100713509804

Cited by 35 publications

(22 citation statements)

References 24 publications

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“…Closed reduction and percutaneous fixation have been widely reported to significantly reduce the incidence of wound healing complications. De Vroome et al reported that postoperative infection occurred in 1 of 46 (2.4%) cases treated using closed reduction and percutaneous screw fixation [25]. However, this treatment seems to be more suitable for cases with moderately displaced fracture or non-comminuted calcaneus fracture because of the limited fixation strength.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive percutaneous osteosynthesis versus ORIF for Sanders type II and III calcaneal fractures: a prospective, randomized intervention trial

et al. 2017

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BackgroundThis randomized controlled trial compared the clinical outcomes and complications of a novel minimally invasive percutaneous osteosynthesis (MIPO) with those of conventional treatment via an extended L-shaped lateral approach for calcaneal fractures.MethodsSixty-four patients with displaced intraarticular calcaneal fractures were enrolled. The patients were randomly allocated to receive either MIPO (29 patients) or open reduction and internal fixation via an extended L-shaped lateral approach (35 patients). The same calcaneal plate (AO Synthes, Oberdorf, Switzerland) was used in both groups. The primary clinical outcomes included operative time, VAS postoperatively, and wound healing complications. Secondary clinical outcomes included time to operation, length of incision, postoperative drainage, length of hospital stay, medical expense, AOFAS score, and SF-36 score. Preoperative and postoperative calcaneal height, width, and length, Bohler’s angle, and Gissane’s angle were compared.ResultsThe operative time in the MIPO group was 52.5 ± 11.1 min, which was significantly shorter than 82.8 ± 16.2 min in the conventional treatment group (P < 0.001). One week postoperatively, the VAS value was 3.2 ± 1.4 in the MIPO group, which was lower than that in the conventional treatment group, 3.9 ± 1.3 (P = 0.038). In the conventional treatment group, 13 of 35 fractures (37.1%) had wound healing problems, whereas this issue occurred in only 2 of 29 fractures (6.7%) in the MIPO group (P = 0.004). In the MIPO group, deep and superficial infections occurred in none of the cases and 1 of 29 (3.4%) patients, respectively. Length of incision in the MIPO group was shorter than that in the conventional treatment group (4.2 ± 0.6 vs. 10.9 ± 1.5 cm; P < 0.001). Hospital stay was 9.7 ± 2.8 days in the MIPO group and 11.7 ± 2.6 days in the conventional treatment group (P = 0.004). At the last follow-up, the SF-36 scores and AOFAS scores in the two groups were comparable (P > 0.05). The postoperative radiographic data, the Bohler’s angle, Gissane’s angle, and calcaneal height, width, and length in the two groups were comparable (P > 0.05).ConclusionsCompared with conventional ORIF, the advantages of MIPO are a considerably shortened operating time and hospital stay, decreased postoperative pain, and reduced risk of wound healing complications.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive percutaneous osteosynthesis versus ORIF for Sanders type II and III calcaneal fractures: a prospective, randomized intervention trial

et al. 2017

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“…Controversy still exists regarding their classification, treatment, and postoperative management, as well as the appropriate operative technique for this type of fracture; therefore, calcaneal fractures remain among the most challenging fractures for orthopaedic surgeons to treat. Closed reduction with percutaneous pinning, a minimally invasive technique, is believed to result in fewer soft tissue injuries and fewer wound complications [ 2 ]. Indications for this technique include the following: (a) Sanders 2C tongue-type fractures; (b) displaced calcaneal tuberosity fractures; (c) temporary stabilization of fractures with severe soft tissue compromise; and (d) fractures in patients with relative contraindications to open surgery.…”

Section: Introductionmentioning

confidence: 99%

Modified Essex-Lopresti procedure with percutaneous calcaneoplasty for comminuted intra-articular calcaneal fractures: a retrospective case analysis

Shih

Kuo

Yeh

et al. 2018

BMC Musculoskelet Disord

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BackgroundThe ideal treatment for comminuted intraarticular calcaneal fractures is still debated. Open reduction and internal fixation (ORIF) is the most popular surgical procedure; however, wound complications, implant choice, and infection remain major concerns. This study aimed to demonstrate the results of an innovative, minimally invasive surgical procedure, namely, a closed reduction technique using large-diameter Steinmann pins and percutaneous calcaneoplasty using injectable calcium sulfate cement (MIIG X3, Wright Medical Technology, Inc., Arlington, TN), in patients with comminuted calcaneal fractures.MethodsFrom January 2012 to January 2014, 20 patients (three women, 17 men) with comminuted calcaneus fractures (Sanders classification type III and Essex-Lopresti classification joint-depression type fracture) were included. Plain films and CT scans were obtained preoperatively in all patients. The operation was performed within three days post-injury, and patients were not allowed to bear weight until three months postoperatively. During this period, the patients were educated on how to perform bed exercises for joints above the surgical site, including muscle strengthening and body conditioning. Early active range of motion exercises for the ankle and forefoot began 3 to 6 weeks postoperatively. All patients were followed up regularly. The results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and Böhler’s angle of the calcaneus.ResultsAfter an average follow-up of two years, none of the patients required further surgery or experienced soft tissue complications. The clinical results were rated good to excellent on the AOFAS scale in 80% of the cases (16 of 20 patients), and most patients had pain relief and returned to their former daily activities at the same level as before the injury.ConclusionsA modified Essex-Lopresti procedure with percutaneous calcaneoplasty appears to be a safe and effective procedure to treat comminuted calcaneal fractures with acceptable functional results. Long-term outcomes and additional cases using this technique are required to support our conclusion.

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“…2The published rate of arthrodesis is between 0 and 15% after minimally invasive surgery: 0-12% after ORIF, and 3.8-17% after conservative means. (23)(24)(25)(26)(27)(28)(29)(30)(31)(32) The subtalar arthrodesis rate of 0% described by Park et al was based on a relatively low number of patients and only one year follow-up. (29) In extremely complex intra-articular fractures, a primary subtalar arthrodesis is postulated to achieve satisfactory results.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Surgery for Intra-Articular Calcaneus Fractures: A 9-Year, Single-Center, Retrospective Study of A Standardized Technique Using A 2-Point Distractor

Rodemund

Krenn

Kihm

et al. 2020

Preprint

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Background: A fracture of the calcaneus can be a painful and disabling injury. Treatment modalities may be conservative or operative, as in open reduction and internal fixation (ORIF) via different approaches, including a number of minimally invasive methods. The aim of this study was to evaluate the treatment options and post-treatment complication rates for intra-articular calcaneal fractures at the (xxx institution blinded xxx) over a 9-year period. Methods: All patients with calcaneal fractures treated at the (xxx institution blinded xxx) between 2007 and 2016 were included in this study. The patients’ protocols were retrospectively reviewed, and the data, including demographic parameters, cause of injury, and the time between the accident and the first operative treatment were analyzed. Secondary operative interventions due to soft-tissue complications, hardware removal, and the long-term arthrodesis rate were evaluated. Results: A minimally invasive 2-point-distractor method was used in 85.8% (n=182) of all operatively managed calcaneal fractures (n=236) in our department. The majority of the operations (88.7%) were performed within two days after the accident. The secondary operation rate resulting from wound complications was 2.7% in the 2-point distractor group and 16.7% in the ORIF group. A secondary arthrodesis was performed in 4.7% (n=9) of the subtalar joints in the entire study population. Conclusions: Our data supported the assumption that severe wound complications would be less likely to occur after minimally invasive treatment compared to ORIF treatment. Additionally, our arthrodesis rate was comparable to that in the literature.

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Cohort Study on the Percutaneous Treatment of Displaced Intra-articular Fractures of the Calcaneus

Abstract: Level IV, retrospective case series.

Cited by 35 publications

References 24 publications

Minimally invasive percutaneous osteosynthesis versus ORIF for Sanders type II and III calcaneal fractures: a prospective, randomized intervention trial

Minimally invasive percutaneous osteosynthesis versus ORIF for Sanders type II and III calcaneal fractures: a prospective, randomized intervention trial

Modified Essex-Lopresti procedure with percutaneous calcaneoplasty for comminuted intra-articular calcaneal fractures: a retrospective case analysis

Minimally Invasive Surgery for Intra-Articular Calcaneus Fractures: A 9-Year, Single-Center, Retrospective Study of A Standardized Technique Using A 2-Point Distractor

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