Fixation Of Calcaneal Fractures Research Articles

Surgical techniques: how I do it? Mini open reduction and fixation of calcaneal fractures with fine wire circular frames

Patients with calcaneal fractures associated with significant soft tissue swelling or open wounds are not ideal candidates for extensive incisions and open reductions with internal fixation. Fine wire frame external fixateurs are being used for the treatment of displaced intraarticular fractures of the calcaneus with soft tissue compromise or in patients with moderately displaced fractures. In this paper, we present our surgical technique of treating displaced intraarticular calcaneal fractures with circular frame external fixateurs.

Efficacy analysis of L-shaped incision and internal fixation for 21 cases with intra-articular fracture of calcaneus

Objective To observe the clinical efficacy of intra-articular calcaneal fractures treatment with L-shaped incision and internal fixation. Methods 21 cases with intra-articular calcaneal fracture were treated with lateral L-shaped incision,through the Steinmann pin traction reduction, Kirschner wire and screw plate fixation,and the restoration of function in our hospital from March 2004 to June 2008. Results 21 patients in this group by L-shaped incision and internal fixation, the excellent rate of Sanders( Ⅱ type, Ⅲ type, Ⅳ type)were 96%,91% and 63% respectively,Overall satisfactory rate was 81%. sural cutaneous nerve injury was in 1 patient,less than the width of the heel in 1 patientConclusion The procedure is simple, trauma and faster recovery time, functional recovery of good, high patient satisfaction. L-shaped incision intra-articular calcaneal fracture fixation can be used as treatment of intra-articular calcaneal fracture of the main method ,should be in clinic. Key words: L-shaped incision; Intra-articular calcaneal; Fracture fixation

Lateral wall reconstruction and internal fixation for calcaneal fractures involving articular surface

跟骨骨折的治疗经历了非手术-手术-非手术的曲折过程,治疗方法很多,非手术治疗难以解剖复位,外形及功能恢复达不到满意效果.随着患者对生活质量要求的提高,开放复位内固定得到了较广泛的应用,但随着治疗病例的增加,不少严重手术并发症的发生让骨科医生备受困扰.自2001年3月至2008年10月我科收治并获得随访的累及关节面的跟骨骨折73例81足,全部采用外侧壁重建可塑形跟骨钛板内固定治疗,疗效满意,报告如下。

Percutaneous Reduction and Injection of Norian Bone Cement for the Treatment of Displaced Intra-articular Calcaneal Fractures

The treatment of intra-articular calcaneal fractures remains controversial. Although open reduction and fixation are favored by many authors, increased risk of soft tissue complications makes this method of treatment a challenge. Conversely, conservative treatment frequently leads to severe functional impairment and disability. Percutaneous surgical techniques have been employed to reduce the incidence of soft tissue complications but carry the risk of inadequate reduction and fracture stabilization. Norian SRS bone cement is an injectable calcium phosphate cement. Recent clinical studies have demonstrated the safe use of Norian SRS bone cement to augment standard plate fixation of calcaneal fractures. The authors describe their method of combining a percutaneous technique of fracture reduction with stabilization using Norian SRS bone cement. A total of 10 patients with 12 displaced intra-articular calcaneal fractures underwent this method of treatment. All 12 cases achieved adequate reduction on postoperative radiographs. Full weight bearing was started at 1 month postoperation, and none of the cases demonstrated loss of reduction on serial postoperative radiographs. No wound complications or cement-related soft tissue reactions were encountered. A 6-month assessment using the visual analog scale, the Maryland Foot Score, and the Short Form 36 general health survey showed encouraging results. Early results of treating displaced intra-articular calcaneal fractures using this method of a percutaneous technique of fracture reduction combined with Norian SRS bone cement stabilization are encouraging and promising.

Clinical study of locking plate fixation for calcaneal fractures

Clinical study of locking plate fixation for calcaneal fractures

Management of Soft-Tissue Complications of the Lateral Approach for Calcaneal Fractures

Soft-tissue complications after using the lateral approach for internal fixation of calcaneal fractures are relatively frequent, even in skilled hands. The global management of these wounds has never been standardized. The authors present a series of 24 patients with wound edge necrosis of lateral approaches for displaced intra-articular calcaneal fractures. Follow-up ranged from 5 to 52 months. The wound was covered with a local subcutaneous transverse flap in six cases, a sural subcutaneous flap in 12 cases, and a distal vastus lateralis free flap in six cases. Hardware was removed only if gross malalignment of the fracture was present. A treatment algorithm is proposed. All the transverse local flaps were successful. Two sural flaps had complications that were salvaged with a free flap. All free flaps were successful, and all fractures healed. No chronic infections developed. The authors' algorithm proved useful. For minor necroses (<1.5 cm wide) with supple tissues and no infection, the transverse local subcutaneous flap was effective. For moderate-sized wounds (1.5 to 5 cm) with no infection, a sural subcutaneous flap was used. In infected wounds with good fracture reconstruction, a free flap was used without hardware removal. If unsatisfactory bone reconstruction and infection were present, hardware removal and a sural flap were appropriate. For extensive defects (>5 cm) or when regional flaps failed, a free flap was useful.

Treatment of chronic calcaneal osteomyelitis following internal fixation for calcaneal fractures

目的 探讨跟骨骨折内固定术后慢性跟骨骨髓炎伴溃疡或皮肤缺损的治疗方法及疗效评估.方法 1999年2月～2005年6月收治跟骨骨折内固定术后慢性跟骨骨髓炎伴溃疡或皮肤缺损17例患者采用清除病灶,根据死腔部位及大小选择设计不同的带血管蒂肌皮瓣或皮瓣填充覆盖,一期消灭死腔,改善局部血运,覆盖创面,并于皮瓣覆盖的上、下部分别将冲洗及引流管置入原死腔部位进行持续冲洗治疗.结果 全部患者获得3个月～3年(平均25个月)的随访,术后移植组织全部成活,骨髓炎无复发,足跟部皮瓣外形良好,13例感觉恢复好,耐磨擦能力尚可,能够负重.结论 组织移植并持续冲洗的治疗方法具有手术操作简单、供区损伤小、成功率高和疗效好等优点,是治疗跟骨骨折内固定术后慢性跟骨骨髓炎伴溃疡或皮肤缺损的理想方法。

A Biomechanical Comparison of Locking and Nonlocking Plates for the Fixation of Calcaneal Fractures

Locking plate systems have been developed in an attempt to increase the strength of fracture fixation and, in so doing, allow earlier mobilization and rehabilitation. The purpose of our study was to compare the mechanical integrity of the locking plate and traditional nonlocking plate fixation for calcaneal fractures in a cadaver model. Our hypothesis was that the locking plate construct provides stronger fixation than the nonlocking plate construct. We created a Sanders type-IIB fracture in 10 pairs of fresh-frozen cadaver feet (bone mineral density, 0.50 +/- 0.14 g/cm2 age, 69 +/- 16 years). One foot of each pair was fixed with a nonlocking calcaneal plate (Synthes, Paoli, PA), and the contralateral foot was fixed with the Locking Calcaneal Plate (Synthes, Paoli, PA). The specimens then were cyclically loaded through the tibia from 0 to 700 N at 1 Hz on a materials testing machine to simulate weightbearing. Fragment displacement was measured with a three-dimensional kinematic analysis system. Significance was set at p < 0.05. There was no significant difference between the two plating systems with respect to the mean (+/- SD) number of cycles to failure (locking plate, 3261 +/- 2355; nonlocking plate, 2271 +/- 2465). In a cadaver model of type-IIB calcaneal fractures, locking plate fixation did not provide a biomechanical advantage over traditional nonlocking plate fixation.

Operative treatment of plate fixation for calcaneal fractures

Operative treatment of plate fixation for calcaneal fractures

Postoperative Wound Complications after Internal Fixation of Closed Calcaneal Fractures: A Retrospective Analysis of 126 Consecutive Patients with 148 Fractures

The aim of the study was to analyse the number of soft-tissue complications after internal fixation of calcaneal fractures and to evaluate risk factors leading to these complications. A retrospective analysis of 126 consecutive patients with 148 operatively treated calcaneal fractures was performed. Only primarily closed fractures were included in the study. Wound healing was problematic in 35 cases (24 per cent). The wound was infected in 23 cases (16 per cent) and a wound edge necrosis was observed in 12 cases (8 per cent). The soft tissue complication needed operative treatment in 20 cases (14 per cent). The complications did not lead to amputations in any case. In the end of the follow up all wounds had healed. The statistical analysis identified a longer delay in surgery and longer operation time to be positive risk factors for wound complications.

“Smile” Incision: An Approach for Open Reduction and Internal Fixation of Calcaneal Fractures

A consecutive group of 73 patients (77 calcaneal fractures) treated with open reduction and internal fixation through a smile-shaped lateral approach to the hindfoot were reviewed retrospectively. Inclusion criteria were a closed displaced intra-articular fracture of the calcaneus, no compartment syndrome, and adequate followup. Followup ranged from 4 months to 4 years. One patient had a deep wound infection that required removal of hardware and intravenous antibiotics. No deep dehiscence or flap necrosis occurred. Superficial dehiscence occurred in three patients (4%) and superficial necrosis was seen in nine patients (12%); all resolved with continued casting to protect the wound. Six patients (8%) complained of numbness or pain in the sural nerve distribution. No symptomatic neuromas were seen. Reflex sympathetic dystrophy occurred in three patients (4%); all resolved with sympathetic blocks. Only one patient required an additional procedure for treatment of a wound-related problem or infection. The "smile" incision provides good fracture exposure for reduction without added morbidity.

A Comparison of Plates With and Without Locking Screws in a Calcaneal Fracture Model

We compared different plates in an experimental calcaneal fracture model under biocompatible loading. Four plates were tested: a plate without locked screws (Synthes), and three different plates with locked screws (Newdeal, Darco, Synthes). Synthetic calcanei (Sawbone) were osteotomized to create a fracture model, and the plates were fixed onto them. Seven specimens for each plate model were subjected to cyclic loading (preload 20 N, 1,000 cycles with 800 N, 0.75 mm/s), and load to failure (0.75 mm/s). Motion, forces, plastic deformation of the plate, and consequent depression of the posterior joint facet were analyzed. During cyclic loading, all plates with locked screws showed statistically significant lower displacement in the primary loading direction than the plates without locked screws. Mean values (mm) of maximal displacements for each plate during cyclic loading were as follows: Synthes, 3.5; Darco, 4.5; Newdeal, 5.0; Synthes without locked screws, 7.5; (p < 0.001). No statistically significant differences between the plates were found in relation to loads to failure and corresponding displacement. This is the first biomechanical study to assess the stability of different plates currently in use in our practice for the fixation of calcaneal fractures. Our results showed that plates with locked screws provided greater stability during cyclic loading than the plate without locked screws.

A simple method of skin flap retraction for calcaneal fracture fixation

The extended lateral approach to the calcaneum is the only adequate exposure to allow open reduction and internal fixation of calcaneal fractures. The main early complication of operative intervention is wound breakdown at the apex of the flap. We present a technique that avoids excessive retraction of the tip of the flap, provides excellent exposure of the operative field, and does not interfere with intra-operative imaging. After elevation of the lateral soft tissues in a standard fashion K-wires are passed into the inferior aspect of the talus adjacent to the central portion of the flap. These can then be bent proximally and anteriorly in a fan like arrangement. These wires then maintain the retraction of the skin flap throughout the procedure. Since adopting this technique we have noted an improvement in wound healing rates and recommend this procedure when dealing with these challenging injuries.

WOUND-HEALING RISK FACTORS AFTER OPEN REDUCTION AND INTERNAL FIXATION OF CALCANEAL FRACTURES: Does Correction of Bohler's Angle Alter Outcomes?

The study reviewed in this article evaluated a group of patients who underwent surgical therapy for calcaneal fractures at a Level I trauma center. One group of patients was treated after outpatient referral to the center, whereas the other group was admitted to, and underwent surgery at, the center. This study attempted to determine which patient risk factors or injury characteristics might lead to an increased rate of wound-healing complications. Bohler's angle is a classic radiographic method of determining the severity of calcaneal injury in this group of patients. The question posed by the authors of this study was: Does a drastic correction in Bohler's angle lead to an increased incidence of wound-healing complications? The authors do not recommend undercorrection of Bohler's angle but urge avoidance of overcorrection and stress the importance of early surgical fixation after lateral skin wrinkling is found.

Percutaneous treatment of calcaneal fractures.

Percutaneous fixation of calcaneal fractures has limited indications. It is most useful for tongue-type fractures in which the displaced portion of posterior facet remains intact to the tuberosity. This allows the tuberosity to be used as a reduction tool for the posterior facet. The technique has been used successfully in 41 patients. In the current study, the indications and technique are reviewed in detail.

Wound complications following operative fixation of calcaneal fractures

The aim of our study was to find the incidence of wound complications following operative fixation of fractured calcanea and identify the risk factors contributing to them. We retrospectively reviewed the results of operative treatment of 33 calcaneal fractures in 30 patients over a 4-year period. We report an overall wound complication rate of 18.1%. Wound infection, haematoma, dehiscence and heel necrosis were noted in our series with or without underlying osteomyelitis. We identified the following as risk factors to the causation of post-operative wound complications: (a) fall of more than 3.4 m ( p<0.005); (b) surgery within 7 days ( p<0.05); (c) operating time in excess of 2 h ( p<0.05); (d) tourniquet time in excess of 1.5 h ( p<0.001). We recommend careful attention to these factors in treating calcaneal fractures.

Operative techniques in open reduction and internal fixation of calcaneal fractures

The calcaneus is the most commonly fractured tarsal bone. The degree of intraarticular involvement is assessed byusing both plain radiographs and computed tomography scans. Patient swelling is reduced as soon as possible after the injury by the use of a bulky dressing and a plaster splint or an external compression pump. A lateral approach is used to expose the fracture with the creation of an osteocutaneous flap. Articular surfaces are reduced initially followed by reestablishment of normal heel height and width. The fracture fragments are temporarily held in place with Kirshner wires. Subarticular screws are used for initial reduction and support of the posterior and middle facets. The lateral wall is stabilized to the body of the calcaneus with a lateral plate and screws. A double–layered closure technique is used to prevent wound dehiscence. Solid fixation allows for early postoperative range of motion.

Wound margin necroses after open calcaneal reconstruction. Anatomical considerations of surgical approach

Skin and soft tissue necrosis of the heel are the main problems following open reposition and fixation of calcaneal fractures. In order to demonstrate how the classic approaches harm the supplying vessels, the classic medial, lateral, enlarged lateral and bilateral approaches have been simulated in ten lower limbs prepared by arterial latex injection. Bases on anatomic literature and on these findings, we have proposed two modified approaches that minimize damage to the vessels of the adjacent soft tissues yet allow exact reposition of the fractures.

Internal fixation of calcaneus fractures: an anatomical study of structures at risk.

This study examines the risk of injury to medial soft-tissue structures during the fixation of calcaneal fractures performed through a lateral approach. An L-shaped lateral incision was performed on 10 fresh cadaver feet. The calcaneus was divided into three zones for study. Ten K-wires were inserted in a standard configuration from a lateral starting point extending through the medial cortex. The feet were dissected medially to measure the distance from each exiting K-wire to the medial and lateral plantar vessels, the calcaneal branch of the posterior tibial nerve, and the tendons of the flexor hallucis longus, flexor digitorum longus, and posterior tibialis. The mean risk of injury to these medial structures was calculated for each lateral insertion site. Wires placed in the subchondral bone of the posterior facet or anterior to the critical angle of Gissane were determined to be at high risk of injury to the medial soft tissues. Structures at risk included the medial and lateral plantar nerves and vessels and the flexor hallucis longus tendon. Caution should be exercised when inserting K-wires, drills, and screws into high-risk areas to avoid iatrogenic injury to the medial structures.

The lateral extended approach for reduction and osteosynthesis of calcaneal fractures

Handling of soft-tissues about the hind foot is a major problem after osteosynthesis of calcaneal fractures. The surgical approach plays an essential role in soft-tissue healing. There is no consensus on the exact approach to the hind foot especially in internal fixation of calcaneal fractures. In a retrospective study of 36 calcaneal fractures the outcome of a standardised postero-lateral hockey-stick approach has been controlled. The results show that this approach allows full access to the subtalar space and osteosynthesis of complex calcaneal fractures without major risks to the soft-tissue about the hind foot. Le devenir des tissus mous de l'arrière-pied représente un problème majeur après ostéosynthèse de fractures du calcaneum. L'abord joue un rôle essentiel dans la vitalité des tissus mous. Il n'existe pas de consensus sur les voies d'abord exactes de l'arrière-pied, en particulier pour la fixation de fractures du calcanéum. Dans notre étude rétrospective de 36 fractures du calcanéum, l'abord était postéro-latéral en crosse avec mobilisation d'un lambeau péronier périostocutané. Elles on été contrôlées pour la récupération des tissus mous. Les résultats montrent que cet abord se révèle sûr en ce qui concerne l'abord sous-talien et la vitalité des tissus mous. Il permet l'ostéosynthèse des fractures complexes du calcanéum sans risques majeurs pour les tissus mous de l'arrière-pied.