The interlocking calcaneal nail is a steel nail with a diameter of 8 mm and a length of 65 mm that can be extended using an end cap of 5. Percutaneous fixation of displaced tonguetype calcaneal fractures is an effective treatment with acceptable clinical outcome, short hospital stay, minimal skin complications, and. Open reduction and internal fixation with a lateral plate has been established as a standard therapy. To avoid secondary soft tissue complications after surgical treatment, several lessinvasive procedures for reduction and fixation have been introduced. Review article calcaneal reduction forceps for minimally. Calcaneal fractures are a challenging clinical problem due to the complex anatomy of the os calcis, the frequent subtalar joint involvement and frequent articular displacement 1, 2. If the bone pieces are large, they can sometimes be moved back into place without making a large incision. Calcaneal fracture, plastic reduction forceps, minimally invasive treatment, external fixator calcaneal fractures are the most common inju. Percutaneous reduction and fixation of intraarticular calcaneal fractures. Calcaneus fractures 2016 orthopaedic trauma association. Twentysix consecutive patients with calcaneal fractures meeting the criteria had an attempted percutaneous reduction performed under fluoroscopic control with the patient in the lateral position. Calcaneal reduction forceps for minimally invasive treatment of. The tenaculumtype boneholding forceps helps surgeons to apply manual. Wound healing problems occur in 1625% of patients after orif of calcaneal fractures, and have been reported to be as high as 43%.
Interlocking nail fixation for the treatment of displaced. Medin was developed to combine the advantages of a minimally invasive approach and stable percutaneous fixation. Calcaneus fractures may be difficult to heal as the connecting joints and bones may also need to be repaired. Percutaneous reduction and fixation of intraarticular. Minimally invasive percutaneous osteosynthesis versus orif. The aim of this study was to evaluate the results of percutaneous reduction and fixation of intraarticular calcaneal fractures. Calcaneal fracture management via a combination of. There is no clear consensus on their management with a few reports of open curettage, bone grafting and internal fixation in the treatment of pathological calcaneal fractures. This correlates with data published on percutaneous reduction with screw fixation 9 and fractures treated with an extensile lateral approach and. The fewer screws are not enough for rigid fixation of crushed calcaneal fractures. Percutaneous treatment of displaced intraarticular.
Calcaneus bone intraarticular fracture treatment by the. We report a new technique for closed reduction using ilizarov halfrings. Comparison between the percutaneous screw fixation versus. These forces are typically linked to injuries in which an individual falls from a height, involvement in an automobile accident, or muscular stress where the resulting forces can lead to the trauma of fracture.
Depending on the impact, the heel fracture may have multiple tiny. Current controversies in management of calcaneus fractures. Percutaneous fixation of displaced intraarticular calcaneal fractures. Secondary soft tissue compromise in tonguetype calcaneal fractures. Special screws are then inserted through small incisions to hold the fracture together. Most cases of a fractured bone can be treated naturally without surgery, while more serious fractures do require a surgical procedure. It is most useful for tonguetype fractures in which the displaced portion of posterior facet remains intact to the tuberosity. The overcoming of calcaneal fractures associated with skin. To avoid these complications, a technique of percutaneous reduction and fixation with screws alone was developed. A case series, injury on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Modified essexlopresti procedure with percutaneous.
Open reduction with internal fixation orif and percutaneous surgery ps are the most common surgical procedures for the treatment of displaced intraarticular calcaneal fractures. Evaluation of anatomical alignment following percutaneous reduction with external fixation of calcaneal fractures. A novel technique for closed reduction and fixation of. The technique has been used successfully in 41 patients. Percutaneous treatment of calcaneal fractures request pdf. Sustentacular fractures in 94 of 212 calcaneal fractures 20. This study aimed to demonstrate the results of an innovative, minimally invasive surgical procedure, namely, a closed reduction. Calcaneal, talus fractures are similar, but not identical. Some proposed indications are open fractures, fractures with softtissue compromise, such as burns or large areas of fracture blistering, and combined fractures that include calcaneal and ankle or midfoot fractures. Displaced intraarticular calcaneum fractures require reduction and internal fixation for favourable long term results. The calcaneus is the most frequently injured tarsal bone.
However, surgery is difficult and is plagued with potential problems such as skin necrosis. Calcaneal fracture management via a combination of approaches. Pdf percutaneous fixation of displaced calcaneal fracture. Displaced intraarticular calcaneal fractures, percutaneous fixation. Read percutaneous treatment of highrisk patients with intraarticular calcaneus fractures. The gold standard management of fractures extending to the posterior facet is open reduction and plate fixation, but softtissue complications are frequent.
Balloon reduction and cement fixation in intraarticular. Radiographic and functional outcomes after displaced intra. Comparison between percutaneous screw fixation and plate. This minimally invasive sinus tarsi approach with new designed plate and screw fixation technique is still difficult for exposure and restoration of fractured fragments of the medial wall of the calcaneus and the calcaneus below. Open procedures are more prone to complications regarding wound healing. Lowvoltage electricity or ultrasound is applied to the skin, and both are often used in the treatment of fractures. Calcaneal bone cysts with pathological fractures are rare.
Intraarticular fractures have a poorer prognosis than extraarticular fractures. Longterm 1020 years results in 108 fractures using a prognostic ct classification, j orthop trauma volume 28, number 10, october 2014 53 we believe that certain conclusions can be reached from our data regardless of a patients sex, age, or wc status. Trauma percutaneous reduction and fixation of intraarticular calcaneal fractures. Percutaneous reduction and fixation of intraarticular calcaneal. Calcaneal fractures account for 23% of all fractures of the body, and 60% of all tarsal fractures. We performed a prospective analysis of 22 consecutive patients with sanders ii, aoota 83c2 intraarticular calcaneal fractures who underwent dualmodality imaging subtalar arthroscopic and intraoperative fluoroscopic guided percutaneous fracture fixation with a minimum followup of 2 years. Complications following management of displaced intraarticular calcaneal fractures. Calcaneal fractures are often attributed to shearing stress adjoined with compressive forces combined with a rotary direction soeur, 1975.
Original article percutaneous fixation of displaced intra. Percutaneous fixation of displaced calcaneal fracture. Calcaneus fractures are often complicated by severe softtissue compromise, with poor results noted in patients with impaired biological activity those with. Closed reduction and percutaneous fixation of calcaneal. Calcaneal fractures account for about 2% of all fractures, and 60% to 75% are displaced intraarticular fractures. The purpose of this retrospective study was to compare the clinical and radiological results of these techniques and to verify the prognostic value of the radiographic measurement tools proposed in the. An indirect reduction technique for percutaneous fixation. Percutaneous reduction and screw fixation of displaced. Double external fixation distraction with minimallyinvasive and percutaneous repair carl a. Calcaneus fractures are the most common of all tarsal fractures 60%, and account for almost 2% of all adult fractures. We report successful closed reduction and screwless fixation of an extra. Restoration of articular surfaces importance of restoring anatomy of posterior facet. This allows the tuberosity to be used as a reduction tool for the posterior facet.
Percutaneous reduction and screw fixation for all types of. Many calcaneal fractures are workrelated, as they result from a fall from height, especially in. Twentythree of the twentysix feet had an acceptable reduction, and the remaining three were treated with open reduction and internal. The following procedures are used for various types of calcaneus fractures. Kihm, dpm management of intraarticular calcaneal fractures is complex, challenging, and evolving. Over a two year period 22 cases of essexlopresti tongue type displaced calcaneum fractures were treated using percutaneous screw fixation following closed. The percutaneous technique according to forgon and zadravecz is suitable for all types of displaced intraarticular calcaneal fractures and was therefore introduced in our clinic. Paediatric calcaneal fractures are rare injuries usually managed conservatively or with open reduction and internal fixation orif. Calcaneal fracture, plastic reduction forceps, minimally invasive. Open reduction and internal fixation orif is the most popular surgical procedure. Subtalar arthroscopy and flurosocopy in percutaneous. Closed reduction was previously thought to be impossible, and very few cases are reported in the literature. The essexlopresti reduction for calcaneal fractures revisited. We believed that for treatment of various types of calcaneal fracture compared with orif the percutaneous reduction and screw fixation may lead to shorter hospital stay, decreased subtalar joint stiffness and earlier weight bearing along with much favorable patients satisfaction.
Calcaneal fractures are the most common fractures of the tarsal bones, constituting 65% of all tarsal fractures and 12% of fractures overall 1. Pdf percutaneous treatment of displaced intraarticular. The purpose of this study was to determine whether the closed reduction and percutaneous k. The aim of our metaanalysis was to compare outcomes for two surgical treatments of calcaneal fractures, percutaneous reduction and fixation. Contraindications isolated centrally depressed fragment. Minimally invasive reduction and fixation of displaced calcaneal.
Extensile open approaches to reduce and fix intraarticular calcaneal fractures are associated with high levels of wound complications. A total of 50 patients with 61 fractures and a minimum followup of 1 year were available for followup. Outcome of percutaneous fixation of calcaneal fractures. Historically, these injuries have fared poorly with or without surgical intervention 1. Evaluation of anatomical alignment following percutaneous. Calcaneus fractures resident comprehensive fracture course anatomy posterior facet middle facet sustentaculum anterior process epidemiology 2% of all fractures mechanism axial load mva 80. Percutaneous fixation of displaced tonguetype calcaneal fractures is an effective treatment with acceptable clinical outcome, short hospital stay. The ideal treatment for comminuted intraarticular calcaneal fractures is still debated.
Clinical and radiological outcomes of minimally invasive. Percutaneous treatment of calcaneus fractures associated. Clinical and radiological outcomes of minimally invasive reduction and percutaneous kwire fixation for intraarticular calcaneal fractures. The patients presented by fifty calcaneal fractures associated with skin problems in the form of severe oedema, skin blisters, bullae, degloved skin and contaminated open calcaneal fractures all of them were managed by closed reduction and percutaneous kwires fixation at. Percutaneous fixation offers a middle pathway in treating simpler variety of displaced calcaneal fractures. Percutaneous reduction and screw fixation of displaced intraarticular fractures of the calcaneus saran tantavisut, md, phinit phisitkul, md, brian o. Pdf results of intra articular calcaneal fractures. Howard jl, buckley r, mccormack r, pate g, leighton r, petrie d, galpin r.
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