Frakturen des Processus anterior calcanei – häufig übersehene Verletzungen nach Sprunggelenkdistorsion

Abstract

Fractures to the anterior process of the calcaneus (PAC) have long been considered rare injuries and have received little attention in clinical research. On the contrary, recent studies have reported a distinct higher incidence, especially following ankle sprains. Decisive reasons are that fractures of the PAC are regularly missed on plain radiographs and that a clinical differentiation from injuries to the lateral ankle ligaments is difficult. With the broad availability of cross-sectional imaging modalities fractures of the PAC are diagnosed more frequently and more reliably. The purpose of this review is to give an overview on the diagnostics, classification and treatment recommendations to this topic and discuss the studies available. To date no evidence-based recommendations are available for the treatment of fractures of the PAC. The few case reports and case series published, predominantly recommend conservative treatment; however, the treatment regimens vary considerably, ranging from immobilization in a lower leg cast (2-10 weeks) to early functional treatment with full weight-bearing. The surgical treatment by open reduction and internal fixation has been described primarily for large dislocated fractures. Surgical excision is considered mainly in cases of persistent pain or symptomatic non-union following non-operative treatment. For both, non-operative and operative treatment, the case reports and case series report satisfactory outcomes for the majority of patients. Nevertheless, comparative studies and patient-rated outcome measures are missing. Therefore, evidence-based recommendations cannot be given.

Comparison of two surgical strategies for fractures of the anterior process of the calcaneus with or without bridging plate fixation

“…To date, a variety of surgical and conservative treatment options have been described in a few studies, which were dominated by case reports. 15,16,23,25,26 Case numbers were low and there was often no uniform classification or treatment consensus. 12 Most classifications of calcaneus fractures, such as the AO classification, 27 Essex-Lopresti classification 28 and the Sanders classification, 29 do not or only partially describe APC.…”

“…10 To some extent, treatment is not satisfactory in terms of the long-term prognosis, as ankylosis and disturbances in bone union may occur and may require surgery. 26 Patients that receive more invasive surgery may experience postoperative incision exudation and wound infection requiring lengthy hospital stays. 37 Although more surgeons are tending to use a minimal incision lateral approach and percutaneous fixation with wires and screws or sinus tarsi that reduces the wound size and soft tissue damage of the lateral approach, the operation is not only more difficult and often longer, but also may not result in anatomical reduction.…”

Introduction of a modified Degan classification to specify treatment algorithms in fractures of the anterior process of the calcaneus

“…Fracture of the anterior process of the calcaneus (APC) has been described as a rare fracture [1][2][3]. However, due to limited radiological capabilities, many injuries might have been missed in the past [4].…”