Treatment Of Calcaneus Fractures Research Articles

Comparison of complications and degree of correction between the extensile lateral and sinus tarsi approaches in the treatment of calcaneus fractures: a cross-sectional observational retrospective study

Introduction: Calcaneus fractures are a challenge for traumatologists. Their complex anatomy, relative scarcity of surrounding soft tissue, and long learning curve for surgical treatment partly explain the difficulties encountered by surgeons, in addition to contributing to the high rate of complications. Objective: This study aimed to identify the differences in complication rates and degree of correction between extensile lateral access (ELA) and sinus tarsi (STA) approaches by reviewing medical records between 2018 and 2023 of patients who underwent open reduction and internal fixation of calcaneus fractures at a hospital in the interior of São Paulo. Methods: The present study followed a retrospective observational and cross-sectional model (STROBE). The Kolmogorov Smirnov test, Student-t test, Wilcoxon Rank test, Mann-Whitney test, Pearson Chi-Square test, and binary and predictive logistic regression analysis were used, adopting a confidence risk of 0.05. Results and Conclusion: A total of 77 patients were included (52 ELA and 25 STA). It was concluded that no statistical differences were observed after intergroup comparisons (ELA vs. STA). There was also no statistically significant influence of the predictor “age” on the predictors of the responses “Böhler and Gissane angles in degrees” in the final post-procedure phase. In general, STA presented a lower probability of complications with the use of the sinus tarsi route, reaching the same level of joint reduction and control of progression to osteoarthritis. All these results of the present study almost completely confirm the literary findings that appear under discussion.

Results of fixation in the treatment of calcaneus fracture: a cross-sectional study

The calcaneus bone is the largest ankle bone and calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures are intra-articular, which despite the therapeutic interventions is still known as a fracture with poor therapeutic outcomes. This study investigated the results of fixation in the treatment of calcaneus fracture among patients referred to Shahid Sadoughi and Shahid Rahmonun hospitals in Yazd during 2017-2018. This is a cross-sectional study and the data obtained from the patients with intra-articular calcaneus fracture -diagnosed by simple x-ray and CT scan- was analyzed using SPSS and statistical tests. The fractures involving the subtalar joint were included in the study. Demographic information, postoperative complications, infection, and duration of treatment and recovery were also investigated. Thirty two patients were included in the study; 28 of them (87.5%) were males and 4 patients (12.5%) were females. 93.8% of the participants suffered from postoperative chronic pain, which was the most common complication in this study. 7 patients (21.9%) had an infection, 2 of them (6.3%) had sudeck’s atrophy, 2 patients (6.3%) had peroneal tendon pain, and one of them (3.1%) had calcaneocuboid. For 19 patients, the average pre and postoperative Bahler angle was 28.96±9.60 and 20.84±11.22, respectively (p-value=0.016, r=0.544), the average pre and postoperative Gissane was 136.15±10.54 and 142.93±16.60, respectively (p-value<0.001), the average pre and postoperative calcaneal pitch angle was 24.44±6.02 and 23.36±5.11, respectively (p-value=0.023), the average pre and postoperative talocalcaneal angle was 43.20 ± 6.80 and 42.25 ± 6.19, respectively (p-value < 0.001), the average pre and postoperative tibiotalar angle was 26.30±4.56 and 24.87±5.35, respectively (p-value=0.69), and the average pre and postoperative posterior surface slope was 28.96±9.60 and 20.84±11.22, respectively (p-value=0.016). The results showed that chronic pain is the most important postoperative complication in patients with calcaneus fractures, and surgery is somewhat effective in patients with calcaneus fractures.

A historical review of calcaneal fractures: from the crucifixion of Jesus Christ and Don Juan injuries to the current plate osteosynthesis

PurposeCalcaneal fractures are one of the most challenging injuries to treat and one of the most divisive. The purpose of this historical review is to highlight the evidence of calcaneal fracture and its treatment through history.MethodsArchaeological, religious, artistic, literary and historical accounts were searched for descriptions of calcaneal fracture to give a thorough overview of the subject. The scientific literature was searched to highlight the evolution of treatment techniques.ResultsFor over 2500 years, the only available option was conservative treatment due to the high risk of infection and limb loss in a world without antibiotics, plastic surgery techniques and adequate osteosynthesis devices. At the beginning of the twentieth century, treatment was still rather crude, consisting of closed reduction by impaction by a Cotton’s mallet, immobilisation of the foot into presses and strict bed rest in a plaster cast for five weeks. Only in the case of untreatable pain, triple arthrodesis could be employed. Regardless, the results were dismal. The debate on the superiority of open reduction and primary subtalar arthrodesis over open and closed reduction spans the entire history of medicine.ConclusionThe long path of history has brought great improvement in the treatment of calcaneus fracture, but the debate about the best treatment is far from being over. There is a lack of good quality randomised control trials conducted according to an agreed set of outcome scores despite some excellent efforts. Therefore, despite the attempts made over the years and new, more precise prognostic scores, the outcomes of each technique in use today are as unique as the individuals who suffer from a calcaneal fracture.

Provisional Reduction and External Fixation of Acute Displaced Intra-articular Calcaneus Fractures: Surgical Technique and Clinical Results

The treatment of calcaneus fractures has been a topic of ongoing debate with controversies regarding the best treatment options and algorithms. Sparse literature exists examining the role of external fixation in initial reduction and the maintenance of bony alignment. The authors describe a technique of a medially based 3-pin provisional external fixation for the treatment of a displaced intra-articular calcaneus fractures with the review of 26 patients with an average follow-up of 26 months. A fourth pin utilized in the case of tongue-type fractures is introduced as an important adjunct to this treatment paradigm. Level of Evidence: Diagnostic Level IV—therapeutic. See Instructions for Authors for a complete description of levels of evidence.

Using screws from glycosyled lactic acid (PLGA) in the treatment of calcaneus fractures

Introduction. Heel bone fractures account for about 3 % of the total number of fractures. Various methods of surgical treatment were used depending on the features of a fracture, the condition of soft tissues in a damage area, the general condition of a patient and co-morbidity. The objective was to improve the results of treatment of heel bone fracture by using screws made of glycosylated lactic acid. Methods and materials . The examination and treatment methods as well as the results of surgical treatment of 89 patients diagnosed with a heel bone fracture were analysed. Depending on the type of fractures, all the patients were divided into 4 groups according to Sanders. Results . We studied the short-term (100 %) and long-term (82.5 %) results of treatment of patients using the point-based assessment systems - the Foot Function Index (FFI) scale, and the Clinical rating system for the Ankle and Hindfoot scale. Conclusion . The current study showed that the use of bioimplants along with classical osteosynthesis is one of the advanced technologies in traumatology and orthopedics, which allows to expand the possibilities of surgical fixation of heel bone fractures.

Редукция осложнений лечения переломов пяточной кости

Редукция осложнений лечения переломов пяточной кости

OUR EXPERIENCE IN THE TREATMENT OF CALCANEUS FRACTURES

Treatment of Calcaneus fractures needs improvement of modern methods. The purpose of the work is to reveal the structural and functional advantages of the results of surgical treatment of patients with intra-articular fractures of the calcaneus with the use of bone plastic. Material and methods. Case histories of 51 patients treated surgically at the clinical bases of the Department of General Surgery between 2014–2019, retrospectively studied for impressionable intraatricular fractures of 53 calcaneus bones with displacement. The average age of trauma victims was 34.7 ± 1.6 years (26 to 51 years), women - 9 (17.64%), men - 42 (82.35%). All patients operated by open reduction and osteosynthesis (group A; n = 10; 19.6%), and in combination with an osteoplasty by autograft from the iliac crest, biocermic implant (group B; n = 37; 80.4%). Results. At 18 months, excellent results (100–90 points for AOFAS) were achieved in 14 (41.6% - group A; 58.4% - group B) patients, good (89–80 points for AOFAS) in 23 (42, 8% - group A; 57.2% - group B) patients, satisfactory (79-70 points for AOFAS) - in 10 (60.0% - group A; 40.0% - group B) patients, unsatisfactory (less from 70 AOFAS points) - in 4 (75.0% - group A; 25.0% - group B) patients. Conclusions. The use of a bio-ceramic bone implant has proven to be a promising direction for osteoplastic interventions with good deformation resistance in the long term. Replacement of bone defect with an auto-osseous graft at the reference osteoplasty in separate terms showed higher bone density compared to none, but less than when using a bioceramic filler Post-operative deformity of the calcaneus testifies to the difficulties of treatment of this pathology, which requires further search for the most optimal materials for replacement of the bone cavity in order to achieve the possibility of early mobilization, preservation of the anatomic structure of the calcaneus, congruence of joint surfaces, prevention of complications.

The effect of a heel-unloading orthosis in short-term treatment of calcaneus fractures on physical function, quality of life and return to work \u2013 study protocol for a randomized controlled trial

BackgroundThere are no standardized therapy guidelines for rehabilitation of calcaneus fractures. While there is consensus on non or partial weight-bearing, the use of supporting devices such as specific foot ankle orthosis is still a matter of debate. Recently, a heel-unloading orthosis (“Settner shoe”) was introduced for aftercare of these fractures, allowing walking by shifting the load to the middle-foot and forefoot. This orthosis enables early mobilization of patients suffering from either one-sided or two-sided fractures. The Settner shoe can be applied in non-operative therapy and after surgery. Specifically in calcaneus fractures, early regain of physical activity has been highlighted as one of the key factors for quality of life and the ability to return to work. Thus, we hypothesize that mobilization with the Settner shoe results in improved quality of life and greater physical activity within the first 3 months.MethodsThis is going to be analyzed by a randomized controlled study comparing treatment with and without this specific orthosis. The secondary outcome measure is the time point of return to work in patients aged between 18 and 60 years, with calcaneus fracture. Furthermore, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a 3-dimensional gait analysis, and the Euroqol-5 dimension-3 level (EQ-5D-3 L) questionnaire for quality of life are assessed.DiscussionThis is the first trial applying a standardized rehabilitation protocol in patients with calcaneus fractures, aiming to improve the non-operative part of treatment by use of an orthosis.Trial registrationClinicalTrials.gov, NCT03572816. Registered on 27 July 2018.

"Skin and Wound Complications after Calcaneal Fracture Fixation"

Soft tissue complications are one of the most feared complications after operative treatment of calcaneus fractures. The incidence of wound complications is reported to be as high as 32%. The better understanding of the blood supply of the hind-foot together with the development of minimally invasive and percutaneous techniques helped to reduce such complications. Authors have reported on patient and surgery related factors that can contribute to skin and soft tissue complications however; drawing a definitive conclusion about the importance of each of these factors is cumbersome. In this article, we discussed the reported incidence of soft tissue complications associated with operative treatment.

Clinical observation of biomimetic mineralized collagen artificial bone putty for bone reconstruction of calcaneus fracture.

This study investigated clinical outcomes of biomimetic mineralized collagen artificial bone putty for bone reconstruction in the treatment of calcaneus fracture. Sixty cases of calcaneal fractures surgically treated with open reduction and internal fixation in our hospital from June 2014–2015 were chosen and randomly divided into two groups, including 30 cases treated with biomimetic mineralized collagen artificial bone putty as treatment group, and 30 cases treated with autogenous ilia as control group. The average follow-up time was 17.2 ± 3.0 months. The results showed that the surgery duration and postoperative drainage volume of treatment group were significantly lower than control group; there were no statistically significant differences in the fracture healing time, American Orthopaedic Foot and Ankle Society scores at 3 and 12 months after surgery, Böhler’s angle, Gissane’s angle and height of calcaneus between the two groups. There were no significant differences in wound complication and reject reaction between the two groups, while significant difference in donor site complication. As a conclusion, the implantation of biomimetic mineralized collagen artificial bone putty in the open reduction of calcaneal fracture resulted in reliable effect and less complications, which is suitable for clinical applications in the treatment of bone defect in calcaneal fractures.

Percutaneous Method to Determine Optimal Surgical Approach for Delayed Treatment of Calcaneus Fracture.

Percutaneous Method to Determine Optimal Surgical Approach for Delayed Treatment of Calcaneus Fracture.

Statistical, Morphometric, Anatomical Shape Model (Atlas) of Calcaneus.

The aim was to develop a morphometric and anatomically accurate atlas (statistical shape model) of calcaneus. The model is based on 18 left foot and 18 right foot computed tomography studies of 28 male individuals aged from 17 to 62 years, with no known foot pathology. A procedure for automatic atlas included extraction and identification of common features, averaging feature position, obtaining mean geometry, mathematical shape description and variability analysis. Expert manual assistance was included for the model to fulfil the accuracy sought by medical professionals. The proposed for the first time statistical shape model of the calcaneus could be of value in many orthopaedic applications including providing support in diagnosing pathological lesions, pre-operative planning, classification and treatment of calcaneus fractures as well as for the development of future implant procedures.

Analysis of the effect of plastic titanic plates internal fixation in the treatment of intra-articular calcaneus fracture

Objective To explore the efficacy and safety of plastic titanic plates internal fixation in the treatment of intra-articular calcaneus fracture.Methods 42 patients with intra-articular calcaneus fracture were selected and taken lateral calcaneal improvement “L” shaped incision for the correction of calcaneal shortening and valgus deformity.Skidmore needle went through collapse of the articular surface below from calcaneal fractures after block nodules along with bone shaft,and restored Bohler angle,Gissane angle and bone length,height,and the lateral fracture piece was reset.The fixation was taken by plastic reconstruction titanic plates,and the fracture was inspected by Xray.Results In 42 patients,the fracture healing time was (11.4 ± 0.6) weeks.The fracture position was good on the line,and the articular surface of calcaneus and talus was smooth,and the Bohler angle,Gissane angle of calcaneus were returned to normal.The excellent rate was 90.5％ by Maryland score.No surgical causes of broken plate and screw breakage were found.Conclusion Internal fixation with open reduction and plastic titanic plates internal fixation for the treatment of intra-articular calcaneal fractures has a significant effect and safety,which is worthy of promotion. Key words: Calcaneal, fractures ; Internal fixators

Internal compression treatment of intra-articular fracture of the calcaneum by anatomical plate with compression bolt through sinus tarsi approach

Objective To observe the curative effect of internal compression in the treatment of intra-articular fracture of the calcaneus by anatomical plate with compression bolt through the sinus tarsi approach.Methods Forty-nine patients with 62 calcaneal fractures treated with anatomical plate with compression bolt through sinus tarsi approach from September 2006 to May 2009 were enrolled in the study.According to Sanders classification,there were 39 patients with type Ⅱ fractures,20 with type Ⅲ fractures and three with type Ⅳ fractures.The axial and lateral view X-ray radiographs and the axial,semi-coronal and sagittal computed tomography (CT) images of the heel were taken before and after operation.The reduction of posterior articular surface of calcaneus and calcaneal shape was observed and the width,height,length,B(o)hler' s angle and Gissan' s angle were measured on the radiographs,respectively.Partial weight bearing was allowed 12 weeks after operation and full weight beating was allowed 16 weeks after operation.The anatomical plates were removed 8-15 months after operation.The Maryland hindfoot score system was applied to evaluate the function of the hindfoot postoperatively.Results All the patients were followed up for 7.5-23 months (average 10.6 months),which showed no wound infection.The reduction of the posterior facet was nearly anatomical (less than 3 mm articular displacement) in all patients and the shape of the calcaneus was satisfactory.The width,height,length,B(o)hler' s angle and Gissan' s angle were improved significantly in all patients (P ＜0.01 ).According to Maryland hindfoot scoring system,29 feet scored 90-100 points (excellent),18 feet scored 80-90 points (good),10 feet scored 70-80 points (moderate) and 5 feet scored 60-70 points (poor).A total of 40 patients (82％) were able to return to their original occupations at mean 9.1 months ( 6.0-12.9 months ) after the injury.Conclusion The anatomical plate with compression bolt internal fixation through sinus tarsi approach is an ideal method for the treatment of displaced intra-articular calcaneus fracture. Key words: Calcaneus; Fracture fixation, internal; Surgical approach

Treatment of Calcaneus Fractures: Recent Trend for Acute Fractures and Complications

Treatment of Calcaneus Fractures: Recent Trend for Acute Fractures and Complications

Treatment of calcaneus fractures using calcium phosphate cement (=BIOPEX cement)

Treatment of calcaneus fractures using calcium phosphate cement (=BIOPEX cement)

Elizarov Transosseous Osteosynthesis in the Treatment of Patients with Calcaneus Fractures

The urgency of the problem of the treatment of calcaneus fractures is well-grounded. The peculiarities of the Elizarov transosseous osteosynthesis in the treatment of patients with various types of calcaneus fractures are shown. The analysis of remote results of the treatment of 50 patients with these fractures is carried out.

Treatment of intra-articular calcaneus fractures with a para-articular external fixator]

Operative treatment of the calcaneus is still in discussion. For a better management of soft tissue problems an optimized fixator frame for primary treatment of calcaneus fractures was developed in the Dept. of trauma surgery University of Kiel. A one-plane bilateral construction with one insertion point in the tibia and two in the tuberosity of calcaneus is used. It allows efficient reduction by ligamentotaxis, stable fixation and active motion in ankle joint. We treated 40 patients with 45 calcaneus fractures. In 25 cases the fixator was definite and later plate or screw fixation was performed 20 times. 35 patients with 40 fractures were examined by means of the "Kiel score for calcaneus fractures". Patients who were treated definite reached better longterm-results on average than patients who underwent a secondary open osteosynthesis. Concrete guidelines for the therapy of intraarticular calcaneus fractures are presented.

Early Wound Complications of Operative Treatment of Calcaneus Fractures: Analysis of 190 Fractures

Early Wound Complications of Operative Treatment of Calcaneus Fractures: Analysis of 190 Fractures

Outpatient treatment of calcaneus fractures in children

In the trauma center from 1973 to 1979, 80 cases of fractures of the heel bones in children were registered. Since both calcaneus were injured in 4 victims, the number of fractures was 84, or 1.0% of all fractures and 10.9% of foot fractures in children aged 1 to 15 years. 73 children with calcaneus injuries are boys. There were only 12 children under the age of 7, the rest were older. In all children, fractures occurred as a result of direct trauma: in 73 from a fall from a height and in 7 from a blow or compression of the heel region. The right and left heel bones were injured equally often. Significant displacement of fragments of the calcaneus with damage to its articular surfaces in children is relatively rare. We identified such fractures in 8 patients. Their treatment, as well as those of victims with fractures of both calcaneus bones, was carried out in stationary conditions.