Title: Percutaneous treatment of displaced intra-articular calcaneal fractures
Authors: Drs. Tim Scheppers Inger Schipper, Lucas M.M. Vogels , Abida Z. Ginai, Paul G.H. Mulder, Martin J. Heetveld, Peter Patka from the Dept of Surgery, Traumatology, Erasmus MC University Med Center, the Netherlands
Source: Journal of Orthopaedic Science 2007 12:22-27
PODIATRIC RELEVANCE:
Operative treatment of intra articular calcaneal fractures can be a challenging one. The authors of this study have developed a minimally invasive procedure to avoid complications from open reduction and internal fixation. A percutaneously applied external distractor based on the original technique introduced by Forgon and Zadravecz in 1983 applies a distraction-reduction of the fracture fragments. This article evaluates the outcome of this technique in a small cohort study over a 5 year period.
METHODS:
Over five years, 50 patients with 61 intra-articular calcaneal fractures underwent percutaneous distraction-reduction. Fractures were evaluated by Xray and CT with Bohlers, Gissane’s angles, calcaneal height, width, and lengths measured pre and post operatively. Three Kirschner wires were used for distraction of the calcaneous, talus, and cuboid; and a blunt drifter was inserted from the plantar side to unlock and elevate depressed STJ fragments. Two K wires or cancellous screws were inserted about the posterior aspect of calcaneal tuberosity. Evaluation criteria were as follows: questionnaires for patient feedback, ankle and subtalar ROM, and a Zwipp score was used with a radiologist to score osteoarthrosis of the ankle, subtalar, calcaneocuboid, and differences in Bohlers angle.
RESULTS:
42 to 72% of patients reported good to excellent results. Patient feedback was 7.2 on a 10 point scale. Ankle ROM was 88% of the normal range of motion, and the subtalar joint 67%. Fifteen percent of the patients required a secondary arthrodesis procedure as the Zwipp score overall was “fair. “In comparison to previous research, 20% of patients treated conservatively and only 4% of those treated with ORIF required a secondary arthrodesis.
COMMENTS:
While minimally invasive percutaneous fixation would by all means reduce secondary trauma to local soft tissues, infections, and scar tissue, this study admits to only a slightly more favorable functional outcome than conservative treatment alone, and less favorable versus ORIF. Also, there was no control group treated with a different method. Therefore this study can not offer definitively better surgical outcomes in treatment of intra articular calcaneal fractures. This procedure at best offers an alternative.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.