SLR - October 2021 - Zohaib Moon

Quality of Life and Clinical Evaluation of Calcaneoplasty with a Balloon System for Calcaneal Fracture at 5 Years of Follow-Up

Reference: Maccagnano, G., Noia, G., Cassano, G. D., Sarni, A. L., Quitadamo, R., Stigliani, C., ... & Pesce, V. (2021). Quality of Life and Clinical Evaluation of Calcaneoplasty with a Balloon System for Calcaneal Fracture at 5 Years of Follow-Up. Advances in Orthopedics, 2021.

Scientific Literature Review 

Level of Evidence: Level IV

Reviewed By: Zohaib Moon, DPM 
Residency Program: Northwest Medical Center – Margate, FL 

Podiatric Relevance: Calcaneal fractures account for 2 percent of all fractures and 60 percent of all tarsal bone fractures, making them exceedingly common injuries of the lower extremity. While ORIF is considered the standard treatment for the intra-articular subtype, there is a generalized controversy due to its associated complications. Therefore, several minimally invasive techniques have been proposed to avoid frequent and recurrent postoperative problems, such as wound dehiscence and infection. These newer techniques include arthroscopically assisted reduction and fixation, external fixation, and balloon calcaneoplasty. The purpose of this study was to evaluate the clinical and quality of life outcomes at a five-year follow up of patients treated with calcaneoplasty. 

Methods: The study was retrospective case series, evaluating a total of 20 patients who underwent calcaneoplasty with a Balloon System (Kyphon), Tricalcium phosphate augmentation, and pin fixation between 2012 and 2016. Inclusion criteria were age over 18 years and a calcaneal fracture with thalamic articular involvement (Sander’s type II, III, and IV). X-ray and CT scans were performed preoperatively and at five years follow-up (57.9 ± six months).

All cases were done in the prone position. Initial reduction was done utilizing calcaneal traction followed by k-wires to maintain reduction. Fluoroscopy was used to determine calcaneal alignment and fracture reduction. A trocar was placed into the calcaneus followed by a cannula and bone tamp. The balloon was then inflated under fluoroscopy. The use of k-wires positioned distally as a palisade aided in the resulting reduction force of the expanding balloon. Additional K-wires were used to maintain the reduction obtained. Prior to injection into the defect, bone cement (CaPO4) was prepared, and the balloon was removed. 

Percutaneous K-wires were removed on postoperative day seven. All patients underwent the same postoperative protocol, implementing a progressive load from day 15 after surgery. On follow-up, patients were subjected to AOFAS scores, VAS scale, and SF-36. 

Results: All 20 patients were available at the final follow-up. The average AOFAS score was 82.25/100. The mean VAS was 2.7/10. The average “Physical Health” and “Mental Health” parameters were 81.25 and 83.55, respectively. Regarding postoperative complications, there were no cases of superficial or deep infections. There was one case of tricalcium phosphate migration at the subtalar joint. 

Conclusions: Clinically, balloon-assisted reduction, pin fixation, and tricalcium phosphate augmentation have shown comparable or better outcomes according to the AOFAS, VAS, and SF-36 when compared to studies that evaluated ORIF. Further comparative studies with a larger patient sample are needed which assess the quality of life in the several techniques used to treat calcaneal fractures. 

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