Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base

Jiang, Nan; Lin, Qing; Diao, Xi-cai; Wu, Liang; Yu, Bin

doi:10.1007/s00264-012-1563-0

Cited by 126 publications

(86 citation statements)

References 28 publications

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“…Patients treated with open reduction and internal fixation (ORIF) are more likely to develop wound complications. However, surgery correlates with better patient-related outcome [3,4].…”

Section: Introductionmentioning

confidence: 99%

Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach

Backes

Schepers

Beerekamp

et al. 2013

International Orthopaedics (SICOT)

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Purpose Post-operative wound infections (PWI) following calcaneal fracture surgery can lead to prolonged hospital stay and additional treatment with antibiotics, surgical debridement or implant removal. Our aim was to determine the incidence of superficial and deep PWI and to identify risk factors (RF). Methods This study is a retrospective case series. All consecutive patients from 2000 to 2010 with a closed unilateral calcaneal fracture treated with open reduction and internal fixation (ORIF) by an extended lateral approach were included. Patient, fracture, trauma and peri-operative characteristics were collected, including RF such as smoking, diabetes mellitus, time to operation, pre-operative in-or outpatient management and wound closure technique. The primary end point was a PWI as defined by the US Centers for Disease Control and Prevention. Results A total of 191 patients were included of which 47 patients (24.6 %) had a PWI; 21 (11.0 %) and 26 (13.6 %) patients had a superficial and deep wound infection, respectively. American Society of Anesthesiologists (ASA) classification higher than ASA 1 was associated with an increased risk. Placement of a closed suction drain at the end of surgery was associated with less PWI (35 % vs 15 %, p =0.002). In this study, none of the previously reported RF were associated with an increased risk for PWI. Conclusions ORIF of displaced calcaneal fractures is associated with a high rate of PWI of 25 %. Factors that were associated with an increased risk were ASA classification other than 1 and absence of a closed suction drain placement.A closed suction drain may be a protective measure to avoid wound complications.

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“…Patients treated with open reduction and internal fixation (ORIF) are more likely to develop wound complications. However, surgery correlates with better patient-related outcome [3,4].…”

Section: Introductionmentioning

confidence: 99%

Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach

Backes

Schepers

Beerekamp

et al. 2013

International Orthopaedics (SICOT)

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“…W Kli ni ce Trau ma to lo gii WIM w War sza wie, jak rów nież w wie lu in nych ośrod kach, pre fe ro wa ny jest do stęp po bocz nej stro nie ko ści pię to wej, ze wzglę du na do brą wi zu ali za cję frag men tów zła ma nia [31][32][33][34]. Po zwa la on na do kład ne od two rze nie po wierzch ni sta wo wej oraz kształ tu pię ty, w tym czę sto uszkodzo nej ścia ny bocz nej.…”

Section: Discussionunclassified

“…In many centres, including the Department of Traumatology of the MMI, doctors prefer an ap proach on the lateral aspect the calcaneal bone due to good visualisation of fracture fragments [31][32][33][34]. It allows for precise restoration of the articular surface and the shape of the calcaneus, including the lateral wall, which is prone to damage.…”

Section: Discussionmentioning

confidence: 99%

Long-term Results of Operative Treatment of Calcaneal Fractures

Gołos¹,

Kwiatkowski²,

Piekarczyk³

et al. 2015

Ortop Traumatol Rehabil

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STRESZCZENIEWstęp. Celem pracy jest przedstawienie odległych wyników operacyjnego leczenia stawowych złamań kości piętowej z uwzględnieniem oceny subiektywnej, badania ortopedycznego oraz oceny radiologicznej.Materiał i metody. W latach 2008-2012 w Klinice Traumatologii WIM w Warszawie operacyjnie leczono 126 chorych ze złamaniami 135 kości piętowych. Analiza obejmuje chorych, którzy zgłosili się do badania -73. Większość stanowili mężczyźni (45-61,6%). Średni wiek chorych wynosił 46,2 (18-77) lat. Na podstawie diagnostyki obrazowej, chorych kwalifikowano do określonej techniki operacyjnej: małoinwazyjna metoda Westhuesa ze stabilizacją wiązką drutów "K" lub otwarte nastawienie i stabilizacja wewnętrzna płytą i śrubami. W metodyce posłużono się oceną subiektywną, badaniem ortopedycznym oraz radiologicznym. Analizę statystyczną wykonano za pomocą programu MS Excel.Wyniki. Na podstawie subiektywno-obiektywnej skali C-N, w grupie chorych leczonych małoinwazyjną metodą Westhuesa ze stabilizacją wiązką drutów "K", odnotowano 12 wyników bardzo dobrych (42,8%), 5 dobrych (17,9%), 6 zadowalających (21,4%) oraz 5 złych (17,9%). W grupie chorych leczonych płytą i śrubami przeważały wyniki bardzo dobre i dobre (58,1%) w złamaniach typu II wg Sandersa, najwięcej złych wyników odnotowano w przypadku złamań typu IV. Wyniki radiologiczne były lepsze niż czynnościowe oraz ocena subiektywna. Stwierdzono istotną statystycznie zależność pomiędzy wynikiem subiektywnym chorych i ich wiekiem (p<0,001) -najgorsze wyniki u chorych < 39 roku życia.Wnioski. 1.W leczeniu operacyjnym złamań kości piętowej kluczowe jest właściwe odtworzenie kąta Böhlera 2.Wynik radiologiczny dobry i bardzo dobry nie zawsze odpowiada dobremu wynikowi czynnoś ciowemu oraz dobrej ocenie subiektywnej 3. Gorsza ocena subiektywna u młodszych wynika z braku możli wości ich powrotu do aktywności sprzed urazu.Słowa kluczowe: stawowe złamanie kości piętowej, odległe wyniki leczenia, leczenie operacyjne, przezskórna stabilizacja SUMMARY Background. This paper presents the long-term results of surgical treatment of intra-articular calcaneal fractures, including subjective evaluation, orthopaedic examination and radiographic evaluation.Material and methods. A total of 126 patients with 135 calcaneal fractures were treated surgically at the Department of Traumatology of the Military Medical Institute in Warsaw between 2008 and 2012. The analysis involves 73 patients (53 persons were lost to follow-up), including 45 men (61.6%). The mean age of the patients was 46.2 years (18-77 years). Based on imaging studies, patients required specific surgical techniques: the minimally invasive Westhues method involving fixation with a bundle of K-wires or open reduction and internal fixation with a plate and screws. The outcomes of the surgical treatment of calcaneal fractures were assessed on the basis of a subjective evaluation and orthopaedic and radiographic examinations. Statistical analysis was performed using Microsoft Excel.Results. Based on the Creighton-Nebraska scores, in ...

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“…Fixed-angle locking compression plate osteosynthesis through the lateral approach is currently the gold standard procedure for the surgical management of calcaneal fractures [1][2][3]. The extensile lateral approach, however, is often associated with soft tissue complications [4,5].…”

Section: Discussionmentioning

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

International Orthopaedics (SICOT)

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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.

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Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base

Abstract: Although surgical repair may increase the complication probability, it is the price that has to be paid for better reconstruction of the calcaneus and better functional results. Taken as a whole, surgery is probably the optimal choice in DIACF treatment.

Cited by 126 publications

References 28 publications

Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach

Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach

Long-term Results of Operative Treatment of Calcaneal Fractures

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

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