Stable Osteosynthesis Research Articles

Polytraumatized patient with two columns fracture of the acetabulum and skin abrasion, which incision to use with soft tissue: A case report at 15 years follow-up

Posterior fractures of the acetabulum are the most frequent pattern of acetabular fractures. Based on the works of Judet and Letournel, accurate reduction and stable osteosynthesis with early mobilization have become the gold standard for the treatment of posterior acetabular fractures. Recently, a less invasive approach has been described to decrease Kocher-Langenbeck (K-L) approach complications. The clinical case describes a patient affected by two-column fractures of the acetabulum with skin abrasions of the gluteus. The clinical evaluation was based on Merle d’Aubigne and Postel scoring, which Matta has modified. The approach used is a modified, less invasive K-L: a straight skin incision from the midpoint between the posterior superior iliac spine and the posterior tip of the greater trochanter. We observed the essential advantages using this approach were a lesser split of the gluteus maximus and no risk of damage for the superior gluteal nerve. In the early postoperative rehabilitation, we examined the strength of the gluteus maximus, which was better than in patients treated with the typical Kocher–Langenbeck approach. The patient resumed after fifteen years after surgery; hip mobility is complete and painless.

Anatomical fixation of tibial intercondylar eminence fractures in children using a threaded pin with an adjustable lock

IntroductionTibial intercondylar eminence fractures are a rare pathology causing anterior laxity of the knee, which requires anatomical reduction and a stable osteosynthesis. The aim of this study was to present the clinical results of reinsertion in anatomical position of these fractures, in the paediatric population, using a threaded pin with an adjustable lock. HypothesisOur hypothesis was that the clinical results would be satisfactory and comparable to the literature. MethodThis retrospective, monocentric study involved 34 consecutive patients with tibial intercondylar eminence fractures, divided into 55.9% with type 2, 35.2% with type 3, 8.8% with type 4 according to Meyers & McKeever, operated on between March 1999 and March 2018. Assessments were performed at a minimum follow-up of 1-year and included the Lysholm, subjective International Knee Documentation Committee (IKDC) and Tegner activity scores, and the measurement of anterior knee laxity by the KT1000. ResultsAt the average follow-up of 8.8 years, 7 patients were lost to follow-up, 2 required anterior cruciate ligament reconstruction. Pathological residual laxity was present in 25% of cases and instability in 16%. The average Lysholm score was 93.1±9.8, the average subjective IKDC was 93.8±6.4 and the average Tegner score was 5.6±1.5. The average anterior laxity of the knee was 0.7±2.0mm. ConclusionThe anatomical reinsertion using a threaded pin with an adjustable lock for tibial intercondylar eminence fractures in a paediatric population provides good functional results and is comparable to the data in the literature. Level of evidenceIV; retrospective.

Cementation of proximal femoral nails of the very elderly subject in per-trochanteric fractures

The management of pertrochanteric fractures (PTF) in the very elderly relies on early verticalisation to limit complications of the decubitus and this requires stable osteosynthesis allowing immediate full support without risk of mechanical failure. The aim of the study was to analyse the value of cementing the cervicocephalic blade during osteosynthesis with a proximal femoral nail. A prospective bicentric comparative study was con- ducted. Patients over 90 years of age with PTF were included. Centre A used a PFNA (Proximal Femoral Nail Antirotation) nail without blade cementing and Centre B used the same nail with blade cementing. The primary endpoint was the occurrence of disassembly of the osteosynthesis requiring revision surgery. Secondary endpoints were functional out- come (resumption of walking), postoperative pain and duration of surgery. Sixty-four patients were included in Centre A and 23 patients were included in Centre B. Mean age, gender, functional abilities before fracture, fracture type and tip-apex distance were comparable between the groups. Postoperative pain and duration of surgery did not show significant differences between the groups. Four patients operated on with an uncemented PFNA (6.25%) and one patient operated on with a cemented PFNA nail (4.35%) showed early dismantling. The rate of patients returning to walking was significantly higher in the cemented group (p=0.00005). No significant differences in the rate of dismantling were observed between the two groups. However, the group operated on with a cemented PFNA showed better functional recovery with a significantly higher rate of walking recovery.

Three-Dimensional Osteosynthesis Plates for the Surgical Treatment of Mandibular Fractures.

Mandible fractures can be treated with different plate systems, that is, miniplates or three-dimensional (3D) plates. This systematic review describes the effectiveness and clinical outcomes of 3D plates used in fractures of the mandible and aims to critically evaluate its risks and benefits. A comprehensive electronic search was conducted without date but with restriction to articles written in English. Studies in humans, including randomized or quasi-randomized controlled trials and retrospective studies, were included. The outcome parameters measured were number of patients, fracture classification, results, follow-up period, postoperative complications, and mean age of patients. Major complications were defined as those needing additional surgical intervention, for example, malocclusion, infection or plate fracture. Accordingly, complications not needing additional surgical intervention were defined as minor (ie, dehiscence, trismus). Guided by the PRISMA statement and the Cochrane Handbook for Systematic Reviews of Interventions, the authors identified 44 publications with a total of 1790 patients. Among the articles selected for the final review, there were 32 reported prospective studies, 12 reported retrospective studies. Regarding the evaluation of quality, 8 studies showed a low value of the risk of bias, 17 a moderate risk, and 19 a high risk. There were statistically significant advantages for 3D plates in mandibular fractures in terms of postoperative complications, for example, wound dehiscences or plate fracture. The 3D plate is an effective treatment modality for mandibular fractures, with low incidence of major complications, decreased length of operation time, and increased stability of osteosynthesis.

Does the position of a sustentacular screw influence the stability of a plate osteosynthesis of a calcaneal fracture? A biomechanical study.

The purpose of the study was to compare the stability of the plate osteosyntheses of intra-articular calcaneal fractures using various types of a sustentacular screw insertions. A geometrical model of a calcaneal fracture was created. The fracture was fixed with a plate and screws with a uniform distribution. The individual models differed regarding the position of the sustentacular screw. The screw was inserted using three different variants: Model A: into the tip of sustentaculum tali, Model B: under the sustentaculum tali, and Model C: into the inferior peripherial rim of the sustentacular fragment. In all three variants, the screw was either locked into the plate via threads or unlocked. The model was loaded with force in the vertical direction. The stiffness of individual models was evaluated using the finite element method, which was expressed as the maximum force (Fmax) that the system was able to transmit and by determining the magnitude and distribution of reduced stress (σred) on the individual parts of the model of a fixed calcaneal fracture. The greatest stiffness of the system was observed in the Model B (Fmax = 335.8 N). The least stiffness was observed in Model C (Fmax = 296.3 N). This model also produced the greatest load on bone tissue was observed (σmaxred = 67.5 MPa). The least load on bone tissue was measured in Model B (σmaxred = 53.7 MPa). The load on the plate was similar in all three models (814.0-820.0 MPa). The analyses suggest that in a plate osteosynthesis of a calcaneal fracture, the insertion of a sustentacular screw under the tip of the sustentaculum tali is acceptable in terms of osteosynthesis stability. This sustentacular screw position reduces the risk of the screw penetrating into the talocalcaneal joint.

Stable osteosynthesis of cage in cage technique for surgical treatment of proximal humeral fractures

BackgroundThe treatment of a displaced proximal humeral fracture is still a matter of controversy. The purpose of this study was to report outcomes at a long-term follow-up after fixation augmentation using peek (polyether-ether-ketone) cage and locking compression plate (LCP).MethodsA total of 27 patients (average age 53.8 years, range 19–86 years) were treated with peek cage and LCP. All of them had a minimum radiographic and clinical follow-up of 1 years. Outcomes were assessed using the Constant-Murley score (CMS), disability of the arm, shoulder and hand (DASH) score. Complications were also recorded during follow-up.ResultsThe average follow-up was 28 months (range 12–48 months). The mean functional outcomes were as follows: CMS, 73.3 (range 61–86); DASH, 45.9 (range 27–68). A total of 4 patients had complications: osteonecrosis developed in one patient, loss of reduction was observed in 1 patient and stiffness was occurred in two patients.ConclusionThe use of peek cage and LCP has been a valuable option in the treatment of proximal humeral fractures. The complication rate was acceptable. Suitable void filler in the proximal humerus for reconstructing the medial column integrity attains mechanical stability in reducing the incidence of the complications.

Controversial technologies in intramedullary osteosynthesis of rats femur fractures

The aim: to conduct a comparative study of osteoreparative regeneration, namely in the periosteal and intermediate areas of the cortex, during intramedullary osteosynthesis of the femur of rats with and without reaming of the bone marrow canal.
 Materials and methods. The work is based on the results of an experimental study conducted on 56 white mature laboratory rats, which simulated diaphyseal fracture of the femur and performed stable nail osteosynthesis with reaming of the bone marrow canal in the first series and without reaming in the second series of the experiment. Histological examination of the specimens was performed on the 7th, 14th, 28th and 90th day after surgery.
 Results. The procedure of reaming the bone marrow canal reduces the potential reparative capacity of bone tissue in the endosteal area and leads to “distorted” activation of the process of the cortex restructuring. There is a significant activation of osteoclastic resorption.
 Conclusions. Bone fusion is more active with the use of intramedullary fixator without reaming of the bone marrow canal, because its reaming reduces the manifestations of reparative potentials in the endosteal region and leads to excessive activation of the resorptive process of restructuring the cortex of both endosteal and central part

A Peculiar Case of Open Complex Elbow Injury with Critical Bone Loss, Triceps Reinsertion, and Scar Tissue might Provide for Elbow Stability?

BackgroundComplex elbow injuries (CEIs) are severe and rare lesions, difficult to treat correctly due to the different patterns of clinical presentations. Standard methods cannot often be applied. The main goals of the treatment are performing a stable osteosynthesis of all fractures, obtaining a concentric and stable reduction of the elbow by repairing the soft tissue constraint lesions, and allowing early motion. Since the introduction of virtual reality (VR) approaches in clinical practice, three-dimensional (3D) computed tomography (CT) and 3D printing have revolutionised orthopaedic surgeries, thus helping to understand the anatomy and the pathology of complex cases.Case descriptionWe discussed a case of CEI, characterised by an extended soft tissue (IIIB Gustilo classification) and neurovascular lesions associated with bone loss in a young female patient. Olecranon fracture was type IIIB according to Mayo classification. We outlined the steps of a pluri-tissue reconstructive approach and stressed the importance of 3D printing in the preoperative planning for such cases. Finally, peculiar final functional patient outcomes were reported.ConclusionIn this case, we found out that triceps reinsertion and scar process may provide for the joint stability in a low-demanding patient. 3D printing and VR approaches in clinical practice can be useful in the management of CEIs associated with an important bone and soft tissue loss.How to cite this articleFacco G, Politano R, Marchesini A, et al. A Peculiar Case of Open Complex Elbow Injury with Critical Bone Loss, Triceps Reinsertion, and Scar Tissue might Provide for Elbow Stability? Strategies Trauma Limb Reconstr 2021;16(1):53–59.

Biodegradable cement augmentation of gamma nail osteosynthesis reduces migration in pertrochanteric fractures, a biomechanical in vitro study

BackgroundCut-out of gamma nail often results from poor primary bone stability, suboptimal reduction (varus) and excentric placement of the head element which may lead to “instability” and frequently requires revision.Various studies have shown that augmentation with polymethylmethacrylate cement increases the primary stability of osteosynthesis. However, it has not yet been widely used in fracture treatment due to certain disadvantages, e.g., the lack of osteointegration, the formation of an interface membrane or the presence of toxic monomers. Few studies show that biodegradable bone cements increase the stability of osteosynthesis in different anatomical regions and therefore could be an alternative to polymethylmethacrylate cement in the treatment of pertrochanteric fractures. MethodsTwo biomechanical situations were simulated using 24 Sawbones (simple and multifragmentary pertrochanteric fractures; AO-classification 31-A1 and 31-A2. Both groups were stabilized using the Gamma3® nailing system with and without biodegradable bone cement. Sawbones underwent the same cyclic loading test, simulating 10.000 gait cycles loading the bones with three times body weight. Migration was determined by comparing computed tomography scans recorded before and after the mechanical testing. The three-dimensional migration of the lag screw was calculated, and the rotation of the head around the longitudinal axis was determined. FindingsBiodegradable cement reduced migration by approximately 35% in 31-A1 fractures (25.4% in 31-A2 fractures) and the rotation of the head around the lag screw by approximately 37% in 31-A1 fractures (17.8%, 31-A2). InterpretationUse of biodegradable bone cement improved the primary stability of gamma nail osteosynthesis in the biomechanical model.

Накостный остеосинтез при лечении взрослых пациентов с переломами дистального отдела бедренной кости: история, настоящее, перспективы (обзор мировой литературы)

Introduction Distal femoral fractures are a challenging medical and social problem as they may occur at any age. All the available osteosynthesis types can be used to treat such injuries. However, despite the disadvantages, fixation with plates has been the most common and developed. Aim of study was to analyze the world literature and summarize the information regarding the use of plate fixation in the treatment of distal femoral fractures, identifying unresolved issues and promising directions. Materials and methods The following sources were used for collecting the information: Pubmed and E-library databases, publications of Elsevier, Springer and other publishing companies, materials of the Russian National Library, AO Surgery Reference on line. Results A review of global literature demonstrated that a minimally invasive approach which allows for bone fragment blood flow and stable fixation with a locking compression plate (LCP) are the most important factors that can improve the quality of treatment with plating. Discussion Plate fixation is still the most preferred method in the treatment of distal femoral fractures. In most severe injuries, accompanied by the medial support loss (33–A3, 33–C2 and 33–C3 fracture types according to AO classification), the use of not only the lateral but also the medial plate to achieve stable osteosynthesis has been discussed. Conclusion Further advance of the technology for treating these injures may be associated with designing an “anatomical” medial plate and a method for its minimally invasive implantation. Development of a lateral plate which could provide the stability similar to bilateral osteosynthesis seems even more prospective. Undoubtedly, such a plate would be useful in limb reconstruction surgery as well, for changing the external fixation to internal one after deformity correction and limb lengthening.

Epidemiological and Therapeutic Developments in Pelvic Ring Fractures Type C from 2004 to 2014 - a Retrospective Data Analysis of 2,042 Patients in the German Pelvic Register (DGU).

Pelvic ring fractures type C present a special challenge due to their high instability, the possible accompanying injuries and the high mortality rate of up to 18.9%. The aim of this retrospective analysis was to use the data from the DGU pelvic register to identify changes in the epidemiology and therapy for type C pelvic ring fractures between 2004 and 2014. 2,042 patients with type C pelvic ring injury were retrospectively included. Three time periods with roughly equal patient groups were specified and differences in epidemiology and the type of therapy were evaluated. For the surgical cases, the time of the operation, the duration of the operation, blood loss, the location of the fracture and the type of osteosynthesis were evaluated and the reduction result was recorded. For the period under review, there is an age shift in the incidence of a type C pelvic ring fracture towards older age. The isolated pelvic injury has increased, while the proportion of pelvic injuries in the context of polytrauma has steadily decreased. Complications and mortality decreased as a percentage. The tendency towards minimally invasive procedures could be shown in the surgical care. Navigated procedures in the area of the pelvic ring have so far not proven successful. We were able to show that the majority of the patients are increasingly old, that there is no relevant trauma in the history and that there is an increase in the isolated pelvic fracture type C and a decrease in the number of polytraumatised or multiply injured patients. In conjunction with mortality from pelvic ring injuries, the successes of standardised, pelvic-specific emergency management, an adapted time of operation outside the vulnerable phase and stable osteosynthesis care, which enable early functional follow-up treatment, are also evident.

Specialized trauma care in the acute period of trauma for a victim with unstable pelvic ring injury and acute acetabulum fracture

The final reconstructive treatment of complex pelvic injury in a patient with combined trauma in the acute period of traumatic disease is presented. Indirect reposition, limited access, stable functional osteosynthesis were performed, which allowed to obtain a good anatomical and functional outcome.

Iatrogenic Fracture of the Lower Jaw: A Rare Complication of Lower Molar Extraction.

Iatrogenic mandible fracture is a rare complication of a tooth extraction with an incidence between 0.0033-0.0034%. This study retrospectively analyzes a total of 8 patients who underwent lower molar extraction associated with mandible fracture during tooth removal in the period from April 2006 to March 2019. The assessed parameters were age and sex of patients, method of tooth extraction, side distribution of fracture, type of extracted tooth, the position of a lower third molar, presence of bone pathological lesion formed in connection with a tooth, displacement of bone fragments, and sensory impairment in the innervation area of the mental nerve. The position and impaction of the lower third molars were evaluated according to Pell and Gregory's classification and Winter's classification. One fracture was left-sided, and 7 fractures were right-sided. In 6 cases, Winter's extraction elevator was used. In 7 patients, the mandible fracture was treated surgically by performing stable osteosynthesis with the plates and screws. One patient was treated conservatively. This work analyzes the causes of iatrogenic mandible fractures and provides recommendations to reduce the risk of their occurrence.

How we decide when to immobilize the wrist after stable osteosynthesis of displaced distal radius fracture.

Fractures of the distal radius are frequently associated with injuries of the scapholunate (SL) and lunotriquetral (LT) ligaments. Our study is aimed at revealing their hidden lesions by employing a fast and accessible fluoroscopic identification. We investigated 40 patients who were indicated for plate osteosynthesis of distal radius fracture. After completing the osteosynthesis, the procedure was concluded with a wrist arthrography. The patients with SL and LT interval lesions had their wrists immobilized by a plaster splint while patients with normal findings with an elastic bandage. The patients were followed up for 12 months after the surgery. The functional results were evaluated by Mayo wrist score. The intra-operative examination identified 62.5 % of patients with lesions of SL and/or LT interval, and 37.5 % of patients were lesion-free. The Mayo wrist scores after 3, 6 and 12 months in patients whose wrists were not immobilized were 72, 86.3, and 86.3, respectively. The latter scores in the group of patients with external immobilization were 54.4, 82, and 84.8, respectively. The difference between the groups was significant three months after the surgery. After six and twelve months, the difference became negligible. The exclusion of hidden lesions allows earlier rehabilitation, while in patients with signs of lesions, it is appropriate to immobilize the wrist (Tab. 1, Fig. 3, Ref. 31). Text in PDF www.elis.sk Keywords: distal radius fractures, scapholunate ligament, lunotriquetral ligament, fluoroscopic, diagnosis.

Risk factors and prevention of nosocomial pneumonia in polytrauma

Nosocomial pneumonia (NK) is one of the most frequent complications of polytrauma leading to death. Meanwhile, the recommendations on prevention of NK in case of polytrauma have not been specified so far. This is due in large part to the lack of study of the pathophysiology of severe combined trauma. The review presents the results of modern experimental and clinical studies of the effect of shock, immune distress syndrome, posttraumatic immunosuppression, the phenomenon of mutual aggravation of lesions, age, sex, concomitant pathology on the risk of NK in polytrauma. The role of iatrogenic risk factors for NK in polytrauma – intubation of trachea and artificial lung ventilation (AVL), massive hemotransfusions, immobilization, the phenomenon of “second strike” after multiple surgeries has been determined. The most effective measures of NK prevention are reduction of the duration of AVL, prevention of oropharyngeal colonization and aspiration in case of AVL, use of inhalation antibacterial drugs, antishock measures, early mobilization of the patient, the earliest possible stable functional osteosynthesis by minimally traumatic methods. The data on the effectiveness of selective decontamination of intestines, probiotics and glucocorticosteroids for the prevention of NK in polytrauma are inconsistent. A promising area of NK prophylaxis may be the development of agents that regulate the complex mechanisms of immune response to polytrauma and prevent secondary acute lung injury and post-traumatic immunosuppression.

Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture.

Traumatic hip dislocation can be isolated or associated with acetabular fracture. Both injuries require emergency reduction of the dislocated hip. Avascular necrosis of the femoral head (AVN) is a potential complication that accompanies these severe injuries. Our objective is to identify the risk factors that cause AVN. We retrospectively analyzed 44 patients with traumatic hip dislocations (Group A) and patients with posterior fracture-dislocation of the acetabulum (Group B). The average follow-up was 5.38years in Group A, 5.59years in Group B. We used the Thompson-Epstein classification for hip dislocation and the Harris Hip Score (HHS) for evaluating final outcomes. In Group A, we analyzed 21 patients with isolated posterior hip dislocation. We had one (4.76%) case of AVN. In Group B, we analyzed 23 patients with posterior acetabular fracture-dislocation. We had eight (34.78%) patients with AVN (p = 0.016, p < 0.05). With hip reduced 6-12h after injury, we had AVN in one (4.34%) patient, with reduction 12-24h, AVN was present in two (8.69%), while in hip reduction done after 24h of injury, AVN was present in five (21.73%) patients (p = 0.030, p < 0.05). An essential prerequisite for the prevention of AVN of the femoral head after hip dislocation is emergency hip reduction. In acetabular fracture-dislocation, emergency hip reduction, anatomical reduction of the acetabular fracture and early stable osteosynthesis are also important. Main factor affecting the development of AVN is late reduction of the hip.

Arthroscopic osteosynthesis of capitellum fractures: Feasibility study and clinical study on 2 cases

BackgroundThe current management of displaced capitellum fractures is traditionally surgical. Most authors perform open reduction and internal fixation. The working hypothesis was that closed reduction and internal fixation of capitellum fractures is achievable by arthroscopy. MethodsWe carried out a cadaveric study on six fresh frozen elbows. We performed two Bryan and Morrey type I fractures of the capitellum, three type II and one type IV using a 15 mm osteotome. Fracture reduction was performed under arthroscopy using a probe hook and an aiming femoral instrument set. Fixation with a lag screw was performed under arthroscopy and radioscopic control. We reviewed, two patients who had been operated on for a type I and type II capitellum fracture and osteosynthesized under arthroscopy with a 7.5 years follow-up. ResultsIn our cadaveric study, we obtained anatomical reduction and stable osteosynthesis in four cases. We had two failures (2 type II fractures) due to a fracture of the fragment during screwing. In our clinical study, range of motion was very satisfactory with only a 5° extension deficit. The x-rays did not reveal any signs of osteoarthritis or periarticular ossification. One patient had minimal signs of osteonecrosis. ConclusionsArthroscopic osteosynthesis of capitellum fractures is feasible and reproducible. We recommend cannulated lag screws for Bryan and Morrey type I and IV fractures and adjustable lock pins for type II fractures. We have shown that this technique gives good results on two patients with a 7.5-year follow-up. Level of evidenceIV.

Ankle fractures in children and adolescents

In children and adolescents, injuries of the ankle are seen frequently in routine practice. The fracture pattern is less dependent on the mechanism of injury than on the maturity of the growth plate. Therefore, adifferentiation is made between fractures with open epiphyses and fractures with aclosing growth plate in adolescents. The potential for growth-related spontaneous deformity correction is limited, so axial alignment especially in the frontal plane has to be achieved during initial treatment. In displaced articular fractures an anatomical reconstruction of the articular surface and stable osteosynthesis have to be achieved to minimize the risk of early osteoarthritis. Growth arrest is not always avoidable despite an ideal reconstruction and can occur in all fracture types; however, with optimal conservative or surgical treatment, iatrogenic damage of the epiphysis can be avoided thereby reducing the incidence of growth disorders as acomplication of ankle fractures in children and growing adolescents.

Safety, efficacy and functional outcome of flexible nailing (ESIN) in unstable fractures of both bones of forearm in children

Background: Elastic intramedullary nailing has been designed and is being used. Elastic intra-medullary nailing, a minimally invasive technique, confers elastic and stable osteo-synthesis. Elastic stable intra-medullary nailing (ESIN) consists of introducing one or two elastic nails through the metaphyseal flare into the medullary canal, advancing them through the fracture site and then impacting them into the opposite meta-physis. Methods: The prospective descriptive study was carried out in our Hospital from March 2017 to February 2018. The follow-up study continued till 0ctober 2018. Thus, the recruitment period was of 12 months and the follow-up period was a mean of 12. 8 months (range: 8 to 19 months). Functional outcome was measured according to the Daruwalla’s clinical grading, Price et al. criteria; and UEF index (46, 64). Results: The excellent to good results as per UEFI questionnaire was 96.16%. Excellent to good results were obtained using Daruwalla’s & Price et al. measurements. Conclusion: Elastic intramedullary nailing gives good results in paaediaric forearm fractures.

Treatment of intra-articular calcaneus fractures – a review of current treatment options

Treatment of calcaneal fractures remains a challenge for the orthopedic surgeon and is still controversial. There is no consensus on whether surgery is a better option that non-operative treatment. The indications for non-operative treatment are non-displaced extra-articular fractures and intra-articular fractures with fragment displacement of less than 2 mm on CT image (Sanders type 1) This type of treatment should be considered in patients with peripheral vascular disease, uncontrolled diabetes mellitus, uncooperative patients and in poor general health. Open repositioning and internal stabilization with LCP plateand screws is now considered the gold standard in the surgical treatment of DIACF. Despite the atraumatic surgical technique and modification of operational approach (limited-incision sinus tarsi approach [STA]) the risk of local complications is as high as 18 percent. Hence the observed constant development of minimally invasive methods. Their aim is to reduce the number of complications in relation to the ORIF method while ensuring anatomical reposition and equally stable osteosynthesis. The most popular minimally invasive techniques include closed reposition using the Westhus method and stabilisation with Kirschner wires, cannulated screws, treatment with external fixators or percutaneous balloon plasty. Each of the techniques listed above can be successfully used to treat transarticular fractures as early as the first few days after injury. The problem is the stability of the union, the quality of reduction and its maintenance until union is achieved and the long period of required weight relief of the operated limb.The methods using intramedullary nails offer new possibilities among minimally invasive techniques. The technique of surgery and implant designs differ significantly, but the possibility of correct reposition, the stability of osteosynthesis and the results of treatment obtained, according to the authors of the studies, are promising. Ultimately, the choice of the method of surgical treatment of calcaneal fractures should be selected taking into account the type of fracture, comorbidities, local condition of periarticular tissues as well as the experience and preferences of the operator. It seems that due to the development of imaging techniques and the lower number of complications after minimally invasive procedures, further development of these techniques should be expected.