Comparison of Percutaneous Screw Fixation and Calcium Sulfate Cement Grafting Versus Open Treatment of Displaced Intra-Articular Calcaneal Fractures

Purpose The optimal treatment of calcaneal fractures is controversial. A specific subgroup of healthy patients has good outcomes with open reduction and internal fixation using an extensile lateral approach. However, there are many patients who do not fit into this category. Consequently, they are either denied surgical intervention or put at significant risk of developing complications as a result of open surgical intervention. Minimally invasive reduction and fixation (MIRF) of calcaneal fractures can restore the height, width, length and shape of the hindfoot in addition to restoring the orientation of the posterior facet of the calcaneus (Böhler's angle). Methods We present a series of 31 patients treated with minimally invasive reduction and fixation technique using threaded K wires and Steinmann pins as an alternative treatment method in patients who are not suitable for open reduction and internal fixation. Results The mean time to surgery from injury was six days (range one to ten days). The mean duration of surgery was 35 minutes (range 11-52 minutes). The mean followup was 14.9 months (range of seven to 30 months). The mean change in Böhler's angle and length of the calcaneus from intra-operative fixation to final followup were 18.7°and 4.7 mm, respectively. The complication rate was low and there was one case of a superficial wound infection and no cases of deep infection or peroneal impingement in this series. Conclusion The MIRF technique with the use of threaded K wires has not been previously described in the literature. In our experience, the operative time is short and can be safely performed even in the presence of extensive soft tissue swelling in the immediate period following injury. The infection risk is low and calcaneal morphology was improved and maintained in terms of Böhler's angle. This technique is suitable to be considered in patients who have significant medical co-morbidities (smokers, diabetics, peripheral vascular disease) and in those patients who are not suitable for an extensile lateral approach and internal fixation.

Section: Discussionmentioning

confidence: 99%

Minimally invasive reduction and fixation of displaced calcaneal fractures: surgical technique and radiographic analysis

Arastu

Sheehan

Buckley

2013

“…Although the predictive value of Böhler's angle on outcome remains a subject of debate, the initial angle at the time of trauma still guides treatment [5,6]. There is a considerable amount of literature on the change of Böhler's angle following surgically treated displaced intra-articular calcaneal fractures throughout the followup (Table 1) [7][8][9][10][11][12][13][14][15][16][17]. Data on Böhler's angle in conservatively-treated fractures, however, are limited.…”

Section: Introductionmentioning

confidence: 99%

The fate of Böhler’s angle in conservatively-treated displaced intra-articular calcaneal fractures

Bakker

Halm

Lieshout

et al. 2012

Purpose Although the predictive value of Böhler's angle on outcome remains subject of debate, the initial angle at the time of trauma still guides treatment. Changes in Böhler's angle during follow-up are frequently reported following surgical treatment of displaced intra-articular calcaneal fractures (DIACF). The aim of the present study was to determine the changes in Böhler's angle as a measure of secondary fracture displacement following conservative management of DIACF. Methods Thirty-eight patients with a total of 44 displaced intra-articular calcaneal fractures treated conservatively with a minimum of two lateral radiographs during follow-up were analysed. Böhler's angle at different follow-up times was measured by three observers. The change in angle was compared with the angle at trauma, and influence of trauma mechanism and common calcaneal fracture classifications were determined. Results The results showed a significant decline over time of the Böhler's angle in conservatively-treated patients of more than 11°on average at a mean follow-up of 29.2 weeks. This decrease was not related to gender, the initial angle, or the Essex-Lopresti or Sanders classification. A statistically significantly higher decrease was detected in high energetic trauma compared with low energetic trauma. Conclusion The conservative treatment of displaced intraarticular calcaneal fractures is still a viable option, yet a significant secondary displacement in time should be taken into account, as reflected in a decrease of Böhler's angle of 11°up to one year following trauma.

“…Minimally invasive treatment modalities have been established to avoid these complications, and, when performed by skilled surgeons, the clinical results are comparable and the risk of abnormal wound healing is lower [7,8,13,[22][23][24]. Furthermore, Chen et al concluded that minimally invasive screw osteosynthesis augmented with calcium sulphate cement results in a more rapid return to weight-bearing, diminished joint stiffness and increased patient satisfaction [13]. Kline et al prefer the minimally invasive surgical modality due to their positive experience primarily in patients with an increased risk of abnormal wound healing [23].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the use of locking compression plate osteosynthesis, inadequate stabilisation leads to protracted non-weight-bearing and partial weight-bearing of the affected limb as well as to osteosynthesis failure. Thus, several biomechanical and clinical studies have been performed to evaluate various augmentation methods using bone cement [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

A biomechanical comparison of fixed angle locking compression plate osteosynthesis and cement augmented screw osteosynthesis in the management of intra articular calcaneal fractures

Rausch

Klos²,

Wolf

et al. 2014

Purpose The purpose of this study was to investigate whether cement-augmented screw osteosynthesis results in stability comparable to conventional fixed-angle locking plate osteosynthesis using cadaveric bones to model a Sanders type 2B fracture. Methods Seven pairs of fresh frozen human calcanei and the corresponding tali were used. The specimens were assigned pairwise to two study groups in a randomised manner. In order to determine the initial quasi-static stiffness of the boneimplant construct, testing commenced with quasi-static compression ramp loading; subsequently, sinusoidal cyclic compression loading at 2 Hz was performed until construct failure occurred. Initial dynamic stiffness (cycle 1), range of motion (ROM), cycles to failure and load to failure were determined from the machine data during the cyclic test. In addition, at 250-cycle intervals, Böhler's angle and the critical angle of Gissane were determined on mediolateral X-rays shot with a triggered C-arm; 5°angle flattening was arbitrarily defined as a failure criterion. Results Bone mineral density was normally distributed without significant differences between the groups. The augmented screw osteosynthesis resulted in higher stiffness values compared to the fixed-angle locking plate osteosynthesis. The fracture fragment motion in the locking plate group was significantly higher compared to the group with augmented screw osteosynthesis. Conclusions The results of this study indicate that in our selected test set-up augmented screw osteosynthesis was significantly superior to the conventional fixed-angle locking plate osteosynthesis with respect to primary stability and ROM during cyclic testing.