Il trattamento chirurgico MIPO delle fratture di calcagno (calcaneoplastica)

Abstract

Fractures of the calcaneum are frequent lesions, regarding about 60% of all tarsal injuries and occurring, usually, after a fall from a height: this means that most of the affected patients are young and active, which results in long non-working periods and, often, in compensation claims for permanent inability to return to their previous occupation. These lesions are either intra-articular, involving the posterior facet, or extra-articular, located in the body or tuberosities: around 70% are intra-articular, resulting from axial loading during falls from a height or motor vehicle crashes, where the talus acts as a wedge to create a shearing force, dividing the sustentaculum from the great tuberosity. The optimal treatment is still under debate because poor results can be expected despite conservative or surgical treatment, owing to complications related to poor reduction, immobilization, algodystrophy and secondary osteopenia, late arthritis, skin healing and infection. New surgical techniques and technologies (CT scan for preoperative planning, pre-contoured low profile plates and supportive osteointegrative materials), however, have improved the outcomes of operative treatment, but still problems arise from high energy fractures because of soft tissues damage, and of predisposing factors such diabetes, vasculopathy, neurologic disease and immuno-compromission. Looking at these aspects, and at other previous experiences with minimally invasive techniques for fracture treatment, we developed a technique combining percutaneous reduction and stabilization using the kyphoplasty tool (Kyphon) for vertebral fractures. This article presents this new MIPO technique in the treatment of intra-articular fractures of the calcaneum.