SLR - May 2023 - Alexsandra R. Szajna, PGYI
Title: A novel minimally invasive percutaneous treatment for Essex-Lopresti joint depression-type DIACFs by ligamentotaxisReference: Chen Z, Fan C, Zhang J, Zhao C, Du X, Huang W, Ni W, Luo G. A novel minimally invasive percutaneous treatment for Essex-Lopresti joint depression-type DIACFs by ligamentotaxis. BMC Surg. 2022 Dec 16;22(1):431. doi: 10.1186/s12893-022-01868-6. PMID: 36527011; PMCID: PMC9756504.
Level of Evidence: Level of Evidence: II
Reviewed By: Alexsandra R. Szajna, PGYI
Residency Program: UF Health Jacksonville, FL
Podiatric Relevance: Traumatic injuries of the calcaneus are some of the most challenging injuries. Historic open reduction internal fixation of displaced intra-articular calcaneal fractures comes with high rates of wound complications which is why Foot and Ankle surgeons have worked hard in the past 10 years to formulate percutaneous techniques. The aim of this study was to explore the efficacy of minimally invasive treatment by ligamentotaxis with a hypothesis that minimally invasive techniques of depressed intra articular calcaneal fractures (DIACF) will restore anatomic alignment without significant wound complications.
Methods: 39 patients in a single-center retrospective study reviewing percutaneous reduction and screw fixation was performed on group (A) by using a homemade tri-plane calcaneal distraction reductor (TCDR), 2.0mm K-wire drilled into the compression fragment, and ultimately three cannulated screws for definitive fixation. Surgically, group (B) underwent traditional ORIF using the lateral extensile approach. Core principles of calcaneal ORIF were achieved in both groups, that being maintaining calcaneal length, width and height, as well as restoring varus/valgus alignment. Primary purpose was to explore advantage of minimally invasive percutaneous treatment, summarize surgical technique and summarize the complicaions. Analysis included SPSS software to quantify t tests and chi-squared tests.
Results: Ultimately, all patients returned to their activity of daily living (ADL’s) and respective work environments. Follow-up ranged from 14 to 56 months, all calcaneal fractures healed. The preoperative waiting time and hospital stay of Group A were significantly shorter than those of Group B with results respectively showing 3.7 ∓ 1.6 days and 7.2 ∓ 1.7 days; 6.9 ∓ 2.0 days and 12.4 ∓ 1.5 days. For operative time and radiological parameters there were no significant differences. No significant differences were shown in the AOFAS scores, MFS or VAS scores between the two groups. In group B, wound complications reported included 1 superficial incision infection, 2 skin necrosis, and 1 deep infection.
Conclusions: Overall, the authors show successful results and efficacy of percutaneous fixation of comminuted calcaneal fractures. This study focuses on how minimally invasive techniques can still maintain the fixation principles of calcaneal fractures when compared to open reduction and internal plate fixation. Limitations encountered were small sample size. These results are beneficial to metropolitan trauma centers where early treatment and management is the goal. Minimally invasive techniques of the forefoot have been well established and this type of research continues to give promising results of minimally invasive principles for rearfoot reconstruction foot and ankle surgery.