scholarly journals Pediatric calcaneal fractures

2009 ◽  
Vol 1 (1) ◽  
pp. 9 ◽  
Author(s):  
Hobie Summers ◽  
Patricia Ann Kramer ◽  
Stephen K. Benirschke
Keyword(s):  
Operative Treatment ◽  
Treatment Protocol ◽  
Skeletally Immature ◽  
Calcaneal Fractures ◽  
Articular Fractures ◽  
Wound Healing Problems ◽  
Operative Fixation ◽  
Fracture Types ◽  
Böhler’S Angle

Although operative treatment of displaced, intra-articular fractures of the calcaneus in adults is generally accepted as standard practice, operative treatment for the same fractures in the skeletally immature remains controversial, potentially because the outcome for fracture types (intra- vs. extra-articular) and severity (displaced vs. nondisplaced) have been confounded in studies of children. We review herein the results of 21 displaced, intra-articular fractures in 18 skeletally immature patients, who were treated with open reduction and internal fixation using a standard surgical approach and protocol developed for adults. The average pre-operative Böhler's angle on the injured side was -5° (range: -35 - +35) compared to 31° (range: +22 - +47) on the uninjured side, indicating substantial displacement. There were no post-operative infections or wound healing problems, and all but one patient was followed to union (average follow-up: 1.5 years; range: 0.30-4.3 years). Maintenance of reduction was confirmed on follow-up radiographs with an average Böhler's angle of 31° (range: +22 - +49). We demonstrate that results for operative fixation of displaced, intra-articular calcaneal fractures in the skeletally immature are comparable to those in adults when the treatment protocol is the same.

scholarly journals A comparative study of operative and conservative treatment of intraarticular displaced calcaneal fractures

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
K. Ramachandra Kamath ◽  
Sharan Mallya ◽  
Atmananda Hegde
Keyword(s):  
Operative Treatment ◽  
Calcaneal Fracture ◽  
Calcaneal Fractures ◽  
American Orthopaedic ◽  
One Year ◽  
A Prospective Study ◽  
Operative And Conservative Treatment ◽  
Böhler’S Angle ◽  
Better Than

AbstractThe treatment of intra-articular displaced calcaneal fracture is debatable. We conducted a prospective study to compare operative and non-operative treatment for intra-articular displaced calcaneal fractures. Patients were assigned to two groups based on the treatment given (operative and nonoperative) and were regularly followed for a period of 1 year. The outcome measures were assessed by Modified Rowe’s Score (MRS), Visual Analogue e Scale (VAS) and The American Orthopaedic Foot and Ankle Society (AOFAS) scale. The outcome related to patient’s job was noted after one year and compared with pre-injury status. Fifty five patients with 61 calcaneal fractures were studied. Thirty of them were operated and 31 were treated conservatively. Out of 30 operated cases, Bohler’s angle was restored in 25 cases and these had good results with all three outcome scores at 1 year follow up and remaining 5 cases showed fair results (Mean MRS: 74.783, VAS: 3.348, AOFAS: 78.783). Thirty one cases treated with cast also showed fair results (Mean MRS: 57.368, VAS: 4.944, AOFAS: 71.211). The overall outcome of operated cases were better than non-operated cases (unpaired T test MRS: 5.807 p < 0.001, VAS: 4.387 p < 0.001, AOFAS: 2.728 p = 0.008) . Operative treatment of displaced intra-articular calcaneal fractures gave good results at one year follow up, provided Bohler’s angle was restored to normal range. Non operative treatment gave fair results. Complications were seen both with operative and non-operative treatment.

A COMPARATIVE STUDY OF OPERATIVE AND CONSERVATIVE TREATMENT OF INTRAARTICULAR DISPLACED CALCANEAL FRACTURES.

2021 ◽  
pp. 9-10
Author(s):  
Ranjeet Kumar ◽  
Shree Prakash Singh
Keyword(s):  
Operative Treatment ◽  
Calcaneal Fractures ◽  
American Orthopaedic ◽  
One Year ◽  
A Prospective Study ◽  
Operative And Conservative Treatment ◽  
Methods Of Treatment ◽  
Böhler’S Angle ◽  
Better Than

The methods of treatment of displaced intra-articular calcaneal fractures have always been surrounded by controversies, whether operative treatment is better or conservative. We conducted a prospective study to compare operative and non-operative treatment for intra-articular displaced calcaneal fractures. Patients were assigned to two groups based on the treatment given (operative and nonoperative) and were regularly followed for a period of 1 year. The outcome measures were assessed by Modied Rowe's Score (MRS), Visual Analogue e Scale (VAS) and The American Orthopaedic Foot and Ankle Society (AOFAS) scale. The outcome related to patient's job was noted after one year and compared with pre-injury status. 30 patients with 41 calcaneal fractures were studied. Thirty of them were operated and 21were treated conservatively. Out of 20 operated cases, Bohler's angle was restored in 15 cases and these had good results with all three outcome scores at 1 year follow up and remaining 5 cases showed fair results (Mean MRS: 74.783, VAS: 3.348, AOFAS: 78.783). 21 cases treated with cast also showed fair results (Mean MRS: 57.368, VAS: 4.944, AOFAS: 71.211). The overall outcome of operated cases were better than non-operated cases (unpaired T test MRS: 5.807 p<0.001, VAS: 4.387 p<0.001, AOFAS: 2.728 p=0.008) . Operative treatment of displaced intra-articular calcaneal fractures gave good results at one year follow up, provided Bohler's angle was restored to normal range. Non operative treatment gave fair results. Complications were seen both with operative and non-operative tr

Restoring the Anatomy of Calcaneal Fractures: A Simple Technique With Radiographic Review

2016 ◽  
Vol 10 (3) ◽  
pp. 235-239 ◽  
Author(s):  
James M. Cottom ◽  
Joseph S. Baker
Keyword(s):  
Critical Angle ◽  
Simple Technique ◽  
Varus Deformity ◽  
Mean Difference ◽  
Calcaneal Fractures ◽  
Articular Fractures ◽  
Anatomic Reduction ◽  
Surgical Fixation ◽  
The Mean ◽  
Böhler’S Angle

Displaced, intra-articular fractures of the calcaneus result in gross deformity of the hindfoot, which must be reduced during surgical fixation. Described techniques aimed at restoring the normal anatomy of the calcaneus have mostly been focused on percutaneous methods, which are not without complication. Described in this report is a method of anatomic reduction during open reduction and internal fixation of these injuries, which uses a lamina spreader to simultaneously reduce calcaneal varus, restore calcaneal height, reduce the subtalar joint, and restore normal calcaneal width. Additionally, 6 patients with 7 calcaneal fractures were identified that underwent this technique, and radiographic review was performed. Varus deformity of the calcaneus was measured as 93.8 ± 4.3° (range 88.1° to 100.5°) preoperatively and 83.3 ± 3.7° (range 77.8° to 89.4°) postoperatively, with a mean difference of 10.9 ± 5.6° (range 1.3° to 17.3°; P = .0564). Bohler’s angle was measured as 16.5 ± 16.9° (range −7.5° to 37.9°) preoperatively and 33.3 ± 12.5° (range 20.5° to 54.5°) postoperatively, the mean difference being 16.7 ± 15.0° (range 0.4° to 39.9°; P = .0288). Critical angle of Gissane was measured as 108.8 ± 14.0° (range 93.1° to 132.4°) preoperatively and 123.3 ± 6.6° (range 113.9° to 134.4°) postoperatively, with a mean difference of 16.2 ± 9.1° (range 5.8° to 29.7°; P = .0004). Levels of Evidence: Level IV: Retrospective

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

2020 ◽  
Vol 86 (2) ◽  
pp. 44-49
Author(s):  
Andrzej Bargiel ◽  
◽  
Mirosław Falis
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Operative Treatment ◽  
Minimally Invasive Techniques ◽  
Calcaneal Fractures ◽  
Poor General Health ◽  
Articular Fractures ◽  
Sinus Tarsi Approach ◽  
The Stability ◽  
Invasive Techniques

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.

Results after operative treatment of intra-articular calcaneal fractures with a minimum follow-up of 2years

Injury ◽  
1998 ◽  
Vol 29 (8) ◽  
pp. 593-599 ◽  
Author(s):  
J.T.F.J. Raymakers ◽  
G.H.G. Dekkers ◽  
P.R.G. Brink
Keyword(s):  
Operative Treatment ◽  
Calcaneal Fractures

Operative vs. Nonoperative Treatment of Intra-Articular Fractures of the Calcaneus: A Prospective Randomized Trial

1996 ◽  
Vol 17 (1) ◽  
pp. 2-9 ◽  
Author(s):  
David B. Thordarson ◽  
Lauren Eric Krieger
Keyword(s):  
Randomized Trial ◽  
Operative Treatment ◽  
Excellent Result ◽  
Early Mobilization ◽  
Nonoperative Treatment ◽  
Prospective Randomized Trial ◽  
Functional Score ◽  
Articular Fractures ◽  
Nonoperative Group

Thirty patients with displaced, intra-articular calcaneus fractures were randomized to operative or nonoperative treatment. All patients had two or three major articular fragments of the posterior facet (Sanders type II or III). Nonoperative treatment included early mobilization and delayed weightbearing. Operative treatment involved open reduction and rigid internal fixation with a plate and screws through an extensile, L-shaped lateral approach followed by early mobilization and delayed weightbearing. Fifteen operative patients were evaluated at an average of 17 months follow-up and 11 nonoperative patients were seen at 14 months average follow-up. In the operative group, there were 7 excellent results, 5 good results, 2 fair results, and 1 poor result, and in the nonoperative group there was 1 excellent result, 3 good results, 1 fair result, and 6 poor results (difference significant at P < 0.01). A functional scoring system of 0–100 points was developed based upon the responses to an outcome assessment questionnaire. The average functional score for the operative group was far superior at 86.7, compared with 55.0 for the nonoperative group ( P < 0.0001). Subtalar range of motion averaged 20° for the operative group and 17° for the nonoperative group with pain on extremes of motion of 25% of the operative patients compared with 100% of the nonoperative patients. This study is the first prospective, randomized trial to demonstrate the superior results of current operative treatment with early mobilization compared with nonoperative treatment.

MANAGEMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES WIILIZAROV RING FIXATIO

2021 ◽  
pp. 40-43
Author(s):  
Nirottam Singh ◽  
Jagdish Jagdish ◽  
Hemant Jain ◽  
Kishore Raichandani
Keyword(s):  
Functional Outcomes ◽  
Operating Time ◽  
Anatomic Reconstruction ◽  
X Rays ◽  
Calcaneal Fractures ◽  
Type Iv ◽  
Fall From Height ◽  
Pin Tract Infection ◽  
Böhler’S Angle

Objective: Calcaneal fractures are caused by a high velocity force to the heel, mostly in road trafc accidents or fall from height. Debate continues regarding the best management of calcaneal fractures. We aim at evaluating the radiological and functional outcomes of displaced intra-articular calcaneal fractures treated with Ilizarov ring xation. Methods: intra-articular calcaneal Eighteen consecutive patients with fractures [Sanders type II (10), Sanders type III(6), and Sanders type IV (2)] were treated with the Ilizarov ring xator from Sep 2017 to June 2020. Patients were evaluated in terms of associated injuries and x-rays of anteroposterior, lateral and axial views of the calcaneus. CT scan was done to assess the amount of comminution and articular depression. Patients were followed up clinically and radiologically at least for 1 year. Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society (AOFAS) scale. Radiological assessment was done by Bohler's angle and Gissane's angle along with measurement of calcaneal height and width. Results: At average follow-up of 18.5 months, average AOFAS score was 80.5 (range 71 to 90), with 6.25% having excellent, 75% having good, 12.5% having fair and 6.25%having poor results. All patients had stable ankle joint with all having dorsiexion and plantar exion more than 30°. All patients are able to wear their previous size shoes. The mean Bohler's angle, mean Gissane's angle, calcaneal height and width were 21.5°, 126.3°, 4.36 cm and 3.80cm respectively at nal follow-up. Four patients had supercial pin tract infection. One patient had collapse of posterior facet after removal of xator with peroneal tendinitis. All fractures united and none needed secondary bone grafting. Patients returned to work on an average of 5.5 months. Conclusion: Ilizarov external ring xation gives good functional outcomes, manifested by restoring near normal anatomic reconstruction of morphology and alignment of the calcaneus. The added advantages of these procedures are the considerably shortened operating time and hospital stay, no need of highly equipped operation theatres and the reduced risk of complications related to surgical exposure.

scholarly journals K. wire fixation versus conservative treatment of closed displaced intra-articular calcaneal fractures

2019 ◽  
Vol 15 (1) ◽  
pp. 86-94
Author(s):  
Mohammed Sh. Al-Edanni
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Technique ◽  
Treatment Result ◽  
Invasive Technique ◽  
Calcaneal Fractures ◽  
Articular Fractures ◽  
Subtalar Arthritis ◽  
Wire Fixation ◽  
One Year

Background: Calcaneus is a spongy cancellous bone with rich blood supply , its fracture heals more rapidly providing no occurrence of infection and soft tissue injury around ,no gross malposition of fragments. The associated pain leads to a major impairment in life quality. The aim of treatment for calcaneal fractures is the decrease of pain and rebuilding of walking ability for patients with normal foot shape and the ability to wear normal foot wear. To reduce complications, a minimally invasive technique for the treatment of displaced intra-articular fractures of the calcaneus was preferred to use. The purpose of this study was to determine whether the closed reduction and percutaneous K. wire fixation of displaced intra-articular calcaneal fractures results in better functional outcome at a minimum one year follow up after the injury compared with those after non-operative management. Methods: One hundred and eleven displaced closed intra-articular calcaneal fracture in 105 patients (six were bilateral) were seen at the orthopedic department of Al-Kindy teaching hospital and Shaih Zaid hospital , only 45 cases included in this study and prospectively evaluated with an average follow-up time of minimum  of one year (1–3years follow-up). For radiographic evaluation, plain radiographs and CT scans were obtained. The Maryland Foot Score was used for clinical estimate. Sanders type II, III and IV fractures were diagnosed. Results: The incidence of subtalar arthritis was correlated with the severity of fracture. Böhler’s angle was restored in 70.1% (47 of 67) of the cases. The majority (77.7%) of patients were content with their treatment result. The rate of significant complications was 6.5%. Discussion: Percutaneous K. wire fixation of displaced intra-articular calcaneal fractures presented minimally invasive technique which showed comparable results with a low rate of serious complications and is a viable alternative for the treatment of intra-articular, dislocated calcaneal fractures. Conclusions: the functional results after K. wires fixation of displaced intra-articular calcaneal fractures were better than those after non-operative care.

scholarly journals Subtalar arthroscopy and fluoroscopy in percutaneous fixation of intra-articular calcaneal fractures

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668499 ◽  
Author(s):  
Gin Way Law ◽  
Nicholas Eng Meng Yeo ◽  
William Yeo ◽  
Kevin Koo ◽  
Keen Wai Chong
Keyword(s):  
Functional Outcomes ◽  
Subtalar Joint ◽  
Time Frame ◽  
Percutaneous Fixation ◽  
Calcaneal Fractures ◽  
Anatomical Reduction ◽  
Intraoperative Fluoroscopy ◽  
Böhler’S Angle

Introduction: Percutaneous fixation of intra-articular calcaneal fractures is traditionally assisted only by intraoperative fluoroscopy. Previous studies have demonstrated that the additional use of subtalar arthroscopy in anatomical reduction of the posterior calcaneal facet of the subtalar joint for less complex calcaneal fractures yielded positive results up to 2-year follow-up. This study aims to investigate long-term outcomes of these patients using similar evaluation parameters. We hypothesized that this novel technique with dual-imaging can provide sustainable, long-term benefits with good functional outcomes and significant restoration of the Bohler’s angle. Methods: We performed a retrospective study of 15 Sanders II, AO-OTA 83-C2 intra-articular calcaneal fractures in 14 patients who underwent subtalar arthroscopy and fluoroscopy guided percutaneous fracture fixation with a minimum follow-up of 5 years. Outcome measures were assessed using the ankle and hindfoot NPRS, AOFAS ankle–hindfoot score, and SF-36 Physical Function subscale preoperatively and at 3 months, 6 months, 1 year, 2 years and 5–8 years postoperatively. The Bohler’s angle was measured preoperatively, immediately postoperatively and at 5–8 years postoperatively. Results: We report excellent functional outcomes in all scores as well as continued improvements in the majority of patients across all time points with minimal subsidence of the corrected Bohler’s angle over our study time frame. Conclusion: Subtalar arthroscopy with intraoperative fluoroscopy in anatomical reduction of the posterior calcaneal facet of the subtalar joint is most useful in Sanders type II, AO-OTA 83-C2 fractures with excellent functional outcomes and good preservation of the corrected Bohler’s angle on long-term follow-up.

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