The extended lateral approach to the hindfoot: Anatomical basis and surgical implications

Freeman, Brian J. C.; Duff, Sarah; Allen, Patricia; Nicholson, Helen; Atkins, Roger M.

doi:10.1302/0301-620x.80b1.7987

Cited by 87 publications

(51 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This considerable rate of wound infections is more likely the result of our type of surgical approach. As we recently started performing calcaneal surgery more often by an even more extended lateral approach according to Freeman et al [28] and (in less complex fractures) via the sinus tarsi approach [29,30], the severe wound complication rates appear to have decreased. In the latter type of approach a wound complication rate of 29 % in the ELA versus 6 % in the less invasive sinus tarsi approach was described [31].…”

Section: Discussionmentioning

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)

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

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)

View full text Add to dashboard Cite

show abstract

“…However, its main drawback is the high wound complication rate [1][2][3][4][5]. Various anatomic studies concluded that injury of the lateral calcaneal artery (LCA) at the site of the vertical incision is responsible for ischemia and necrosis of the lateral calcaneal flap [14][15][16]. In an attempt to reduce the wound complication rate, numerous minimally invasive and percutanous methods were developed [6][7][8][9][10][17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Management of displaced intra-articular calcaneal fractures using the limited open sinus tarsi approach and fixation by screws only technique

Abdelazeem

Khedr

Abousayed

et al. 2013

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose Evaluation of management of the displaced intraarticular calcaneal fractures (DIACF) Sanders types II and III by using minimally invasive sinus tarsi approach and fixation by screws only technique. Methods Open reduction using the limited lateral approach and internal fixation using screws only was studied in 33 patients with unilateral isolated simple DIACF with a mean age of 35 years (15 type II patients and 18 type III patients). All patients were evaluated both clinically and radiologically. Results With a mean follow-up period of 28.8 months (range 12-53 months), no cases of failure of reduction or displacement of hardware were detected. The mean AOFAS was 91.73 points while the mean MFS was 95.09 points. Twenty-eight patients were able to resume their pre-injury level of work while the remaining five refrained to sedentary jobs. The mean pre-operative Bohlers' angle was 2.8°(range from -38º to 24º) while postoperatively it was 19.4°(range 5º to 49º). There was no statistically significant difference when comparing the results (AOFAS p-value 1.00, MFS p-value 0.81) between Sanders' type II and III fractures.One patient had postoperative superficial wound infection. Seven patients complained of prominent screw heads. Complex regional pain syndrome occurred in seven patients and was treated successfully at six months duration.Conclusion The limited open sinus tarsi approach can be used successfully to treat displaced Sanders type II and III fractures. It allows for adequate visualization and reduction. Fixation by screws only is also sufficient. It also clearly avoids the major wound complication problems.

show abstract

“…All of the lower limbs were amputated at the level of the tibial diaphysis. An extended lateral approach was performed on all specimens [16]. The dissected fasciocutaneous flap was then removed to expose the calcaneum.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Alterations of Calcaneal Height on the Ankle and Chopart’s Joint: A Cadaveric Study

Yousri¹,

Se²,

Atkins³

2017

Clin Res Foot Ankle

View full text Add to dashboard Cite

Fracture of the calcaneum is common, and the majority are displaced intra-articular fracture patterns. Over the last three decades there have been considerable advances in the management of this injury. Open reduction and internal fixation is an accepted treatment for displaced fractures, and percutaneous techniques are now emerging. However, surgical treatment remains controversial, and many fractures are still managed conservatively.Non-operative management of displaced fractures may result in a disabling fracture malunion. The malunion is often a widened and depressed calcaneum, with subtalar joint disruption. This creates a five time risk of requiring a subtalar arthrodesis within 5 years of injury. Affected patients are frequently men of working age, with potentially significant socioeconomic consequences. Bone Block Distraction Arthrodesis (BBDA) is a technique used for the management of calcaneal malunion. In BBDA, restoration of the talocalcaneal height has been described for reconstitution of the talocalcaneal relationship. By restoring the talo calcaneal height, anterior tibio-talar impingement is relieved and ankle dorsiflexion range improved.In our clinical experience we have also noted a rotational change in the talus with loss of calcaneal height. We hypothesised that depression of the calcaneal articular surface causes extension of the talus in the sagittal plane, causing anterior tibiotalar impingement, but additionally, incongruity of the talonavicular joint. This hypothesis is important in surgical correction, because classical BBDA may need to be modified to include reversal of the abnormal talar rotation to restore Chopart's joint alignment. Appropriate restoration of the subtalar joint surface and talonavicular joint anatomy is likely to reduce the need for arthrodesis, and improve function.This cadaveric study is a proof of concept aiming to demonstrate changes in talar inclination and talo-navicular joint alignment following loss of calcaneum height, as is the case in calcaneum malunion, and then following restoration of the calcaneal height as in BBDA.

show abstract

The extended lateral approach to the hindfoot: Anatomical basis and surgical implications

Cited by 87 publications

References 0 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

Management of displaced intra-articular calcaneal fractures using the limited open sinus tarsi approach and fixation by screws only technique

The Effect of Alterations of Calcaneal Height on the Ankle and Chopart’s Joint: A Cadaveric Study

Contact Info

Product

Resources

About