SLR - May 2010 - Christopher Schmitt

Complications when using threaded K-wire fixation for displaced intra-articular calcaneal fractures

Reference: Demcoe, A.R., Verhulsdonk, M., Buckley, R.E. (2009).  Complications when using threaded K-wire fixation for displaced intra-articular calcaneal fractures.  Injury, 40, 1297-1301.

Scientific Literature Reviews

Reviewed by: Christopher Schmitt, DPM
Residency Program: St. John Hospital and Medical Center, Detroit, Michigan

Podiatric Relevance:
This retrospective study provides useful data on the open reduction and internal fixation of calcaneal fractures utilizing a novel technique consisting of an extended lateral incision and threaded 0.062 in K-wires, in addition to standard plates, screws, and bone substitutes. 

Methods:
Two hundred seventy-eight displaced intra-articular calcaneal fractures in two hundred forty-six patients were treated with open reduction and internal fixation during a nine year period (1998-2007).  All patients were treated by a single surgeon at a level one trauma center.  The surgery involved restoring the posterior facet and using threaded k-wires through the posterior aspect of the plantar surface into the calcaneal tuberosity.  The K-wires were then advanced to the subchondral surface of the posterior facet.  Large deficits in the neutral triangle were filled with calcium phosphate cement.  The lateral wall was replaced and a one-third tubular plate was placed along the lateral wall of the calcaneus.  The k-wires were cut 1cm outside of the skin.  Eight to twelve weeks status post surgery, the k-wires were removed in clinic.

Results:
All patients were followed for six months.  Operative reduction was measured by a change in Bohler’s angle which was -0.7° preoperatively and 24.0° postoperatively.  Four patients suffered a collapse of their fractures and required STJ arthrodesis.  The most common complication was infection with an incidence rate of 17% (48/278).  Other complications included pin tract infection (2%; 5/278), wound necrosis (4%; 11/278), osteomyelitis (0.4%; 1/278), wound dehiscence (0.4%; 1/278), and amputation (0.4%; 1/278).  Of the k-wires used, only 3.1% of k-wires bent or failed.

Conclusion:
Operative intervention is necessary in most patients with displaced intraarticular calcaneal fractures.  The use of threaded K-wires appears to provide stable fixation, and they do not loosen as the threads prevent the K-wires from backing out.  The plantar protruding k-wires also act to prevent weight bearing.  This technique is useful in obtaining reduction and maintaining reduction (until removed) in intra-articular fractures of the calcaneus.

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