External fixation for displaced intra-articular fractures of the calcaneum

Abstract

A minimally-invasive procedure using percutaneous reduction and external fixation can be carried out for Sanders' type II, III and IV fractures of the os calcis. We have treated 54 consecutive closed displaced fractures of the calcaneum involving the articular surface in 52 patients with the Orthofix Calcaneal Mini-Fixator. Patients were followed up for a mean of 49 months (27 to 94) and assessed clinically with the Maryland Foot Score and radiologically with radiographs and CT scans, evaluated according to the Score Analysis of Verona. The clinical results at follow-up were excellent or good in 49 cases (90.7%), fair in two (3.7%) and poor in three (5.6%). The mean pre-operative Böhler's angle was 6.98 degrees (5.95 degrees to 19.86 degrees), whereas after surgery the mean value was 21.94 degrees (12.58 degrees to 31.30 degrees) (p < 0.01). Excellent results on CT scanning were demonstrated in 24 cases (44.4%), good in 25 (46.3%), fair in three (5.6%) and poor in two (3.7%). Transient local osteoporosis was observed in ten patients (18.5%), superficial pin track infection in three (5.6%), and three patients (5.6%) showed thalamic displacement following unadvised early weight-bearing. The clinical results appear to be comparable with those obtainable with open reduction and internal fixation, with the advantages of reduced risk using a minimally-invasive technique.

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

“…Tornetta [18] reported using the EssexLopresti reduction technique for treating Sanders IIC fractures with screw fixation. There have been numerous reports of less invasive surgical techniques using screws [6,8,9], bioabsorbable screws [20], arthroscopically assisted with screws [10], K wires [7,12], external fixation to aid reduction with percutaneous screws [11], and external fixation [21] alone to treat displaced intra and extraarticular fractures with satisfactory results described. Schildhauer and Sangeorzan [22] described the use of a push screw, which allows controlled and gradual reconstitution of the length and height (Böhler's angle) of the hindfoot, though, it is only recommended as a temporary salvage procedure.…”

Monoaxial external fixation of the calcaneus: An anatomical study assessing the safety of monoaxial pin insertion

“…Percutaneous reduction and external fixation was used to treat 52 patients with closed articular displaced calcaneal fractures in a study by Magnan et al (2006) [18]. For this study, the monoaxial Orthofix Mini-Fixator (series M300) was used.…”

A Comparison of Extensile Lateral Approach and Sinus Tarsi Approach for the Sanders Type II Calcaneal Fracture

“…최종 추시에서 양 군 간 Bohler각, Gissane각, 골절 전위 정도를 비교한 결과 유의한 차이가 없었다 (Table 2). , 둘째는 관절경을 이용하는 방법 6,14) , 셋째는 외고정 장치를 이용하는 방법이다 10,12,15) . 짧은 절개를 이용하는 방법은 족근동에서 거골하 관절을 따라서 절개를 하거나 4,7,8) 아킬레스건의 외측연을 따라서 종절개를 하는 방법 13) 으로 크게 구분할 수 있다.…”

“…관절경을 이용한 방법은 경피적 으로 S핀과 K강선을 이용하여 골절편을 정복하면서 후외측 삽입구를 통해 관절경으로 골절된 관절면의 정복을 확인한 다 6,14) . 외고정 장치를 이용한 방법은 족근동에 1 cm가량 짧은 절개를 하고 골막 거상기로 골절편을 들어올려 정복 한 후 핀을 삽입하고 외고정 장치를 장착한다 10,12) . 최소 침습적 방법은 크게 두 가지 경우에 사용할 수 있 다 17) .…”