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VOLUME 5 , ISSUE 2 ( August, 2010 ) > List of Articles

Original Article

Surgical treatment of displaced intra-articular calcaneal fracture using a single small lateral approach

Mohamed F. Mostafa, Gamal El-Adl, Ehab Y. Hassanin, M-Serry Abdellatif

Keywords : Foot injuries, Fracture fixation, Internal, Minimally invasive surgical procedures

Citation Information : Mostafa MF, El-Adl G, Hassanin EY, Abdellatif M. Surgical treatment of displaced intra-articular calcaneal fracture using a single small lateral approach. 2010; 5 (2):87-95.

DOI: 10.1007/s11751-010-0082-z

License: CC BY-NC-SA 4.0

Published Online: 31-08-2010

Copyright Statement:  Copyright © 2010; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

The objective of this study was to evaluate the outcome of semi-open reduction and minimal internal fixation through a single small lateral approach as a minimally invasive technique for treatment of displaced intra-articular calcaneal fractures. This prospective study was conducted on eighteen patients (16 men and 2 women). The average age was 37.7 (22–55). The most common cause of injury was a fall from height in fourteen patients. Patients were operated on within a mean time of 4.8 days of admission (1–11 days) and were followed up for an average period of 24.1 months (6–39 months). Patients were evaluated clinically using the Creighton-Nebraska Heath Foundation Assessment score of Crosby and Fitzgibbons (J Bone Joint Surg (Am) 72-A:852–859, 1990). The scoring system proposed by Knirk and Jupiter was used for radiological assessment of the posterior subtalar joint (Knirk and Jupiter in J Bone Joint Surg (Am) 68-A: 647–659, 1986). The skin incision healed in all cases without necrosis, infection, or sural nerve injury. All fractures healed after an average of 8 weeks (7–10 weeks), and patients returned to the routine daily activities after an average time of 4.3 months (3–7 months). In conclusion, semi-open reduction and minimal internal fixation through a small lateral approach is an effective treatment for carefully selected cases of displaced intra-articular calcaneal fractures.


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  1. Al-Mudhaffar M, Prassad CV, Mofidi A (2000) Wound complications following operative fixation of calcaneal fractures. Injury 31:461-464
  2. Bezes H, Massart P, Delvaux D, Fourquet JP, Tzari F (1993) The operative treatment of intra-articular calcaneal fractures: indications, techniques, and results in 257 cases. Clin Orthop 290:55-59
  3. Buckley R, Tough S, Mc Cormack R et al (2002) Operative compared with non operative treatment of displaced intra-articular calcaneal fractures. J Bone Joint Surg (Am) 84-A:1733-1744
  4. Burdeaux BD Jr (1997) Fractures of the calcaneus: open reduction and internal fixation from the medial side a 21-year prospective study. Foot Ankle 18:685-692
  5. Burdeaux BD (1983) Reduction of calcaneal fractures by the McReynolds Medial Approach Technique and its experimental basis. Clin Orthop 177:87-103
  6. Carr JB (1994) Surgical treatment of the intra-articular calcaneus fractures. Orthop North Am 25:665-675
  7. Carr JB (2005) Surgical treatment of intra-articular calcaneal fractures: a review of small incision approach. J Orthop Trauma 19:109-117
  8. Crosby LA, Fitzgibbons T (1990) Computerized tomography scanning of acute intra-articular fractures of the calcaneus: a new classification system. J Bone Joint Surg (Am) 72-A:852-859
  9. Crosby LA, Fitzgibbons TC (1996) Open reduction and internal fixation of type II intra-articular calcaneus fractures. Foot Ankle 17:253-258
  10. Essex-Lopresti P (1952) The mechanism, reduction technique, and results in fractures of the Os Calcis. Br J Surg 39:395-419
  11. Hammesfahr R, Fleming LL (1981) Calcaneal fractures: a good prognosis. Foot Ankle 2:161-171
  12. Harvey EJ, Grujic L, Early JS et al (2001) Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int 22:868-873
  13. Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg (Am) 68-A:647-659
  14. Leung KS, Chan WS, Shen WY et al (1989) Operative treatment of intra-articular fractures of the OsCalcis: the role of rigid internal fixation and primary bone grafting. J Orthop Trauma 3:232-240
  15. Leung KS, Yuen KM, Chan WS (1993) Operative treatment of displaced intra-articular fractures of the calcaneum: medium-term results. J Bone Joint Surg 75-B:196-201
  16. Marcey LR, Benirschke SK, Sangeorzan BJ, Hansen ST Jr (1994) Acute calcaneal fractures: treatment options and results. J Am Acad Orthop Surg 2:36-43
  17. McMaster M (1976) Disability of the hindfoot after fracture of the tibial shaft. J Bone Joint Surg (Br) 58-B:90-93
  18. McReynold IS (1982) Trauma to the Os calcis and heel cord. In: Jahss MH (ed) Disorders of the foot. WB Saunders, Philadelphia, pp 1497-1542
  19. Murphy GA (1998) Fracture and dislocations of foot. In: Canale ST (ed) Campbell's operative orthopaedics. Mosby-Year Book, St Louis-Missouri, pp 1924-1971
  20. Paley D, Hall H (1993) Intra-articular fractures of the calcaneus: a critical analysis of results and prognostic factors. J Bone Joint Surg (A) 75-A:342-354
  21. Perry J (1983) Anatomy and biomechanics of the hindfoot. Clin Orthop 177:9-15
  22. Pozo JL, Kirwan EOG, Jackson AM (1984) The long-term results of conservative management of severely displaced fractures of the calcaneus. J Bone Joint Surg (Br) 66-B:386-390
  23. Sanders R, Fortin P, DiPasquate T, Walling A (1993) Operative treatment in 120 displaced intra-articular calcaneal fractures: results using a prognostic computed tomography scan classification. Clin Orthop Relat Res 290:87-95
  24. Sarrafian SK (1983) Anatomy of the foot and ankle. JB lippincott, Philadelphia, p 157
  25. Stephenson JR (1983) Displaced fractures of the Os Calcis involving the subtalar joint. Key Ankle 4:91-101
  26. Stephenson JR (1987) Treatment of displaced intra-articular fractures of the calcaneus using medial and lateral approaches, internal fixation, and early motion. J Bone Joint Surg (Am) 69-A:115-130
  27. Thordarson DB, Krieger LE (1996) Operative Vs. Nonoperative treatment of intra-articular fractures of the calcaneus: a prospective randomized trial. Foot Ankle 17:2-9
  28. Thordarson DB, Latterier M (2003) Open reduction and internal fixation of calcaneal fractures with a low profile titanium perimeter plate. Foot Ankle Int 24:217-221
  29. Wei SY, Okere E, Esmail AN, Bor CT, Delong WG (2001) Operatively treated calcaneus fractures: to mobilize or not to mobilize. Univ Penn Orthop J 14:71-73
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