Calcaneal Plating for Intraarticular Calcaneal Fractures: Mid-Term Clinical and Radiographic Outcomes
Abstract
Objective: To evaluate the clinical and radiographic outcomes and wound complications of patients with closed calcaneal fractures undergoing open reduction and internal fixation with conventional extended lateral approach. Methods: The study included 35 closed calcaneal fractures of 32 consecutive patients (28 male, 4 female) undergoing open reduction and plate fixation in our department between 2007 and 2013. All patients were operated using the extended lateral incision. All patients were examined using direct radiography and computed tomography. Böhler’s angle and Sanders classification were recorded. The American Orthopedic Foot and Ankle Society (AOFAS) scoring system was used for the clinical functional assessments. Results: AOFAS score was significantly and positively correlated with the preoperative Böhler’s angle (r=0.667, p<0.001) and significantly and negatively correlated with the Sanders classification type (r=-0.765, p<0.001). The wound site problem was observed only in 2 patients (one had superficial wound site infection and the other developed skin necrosis), for whom good results were achieved after appropriate treatments. Conclusion: The open reduction internal fixation technique with lateral incision provided postoperative satisfactory results clinically and radiologically for intraarticular calcaneal fractures. If sufficient time is waited preoperatively for soft tissue recovery, wound site complications can be avoided in open surgery.References
Nork SE, Barai DP. Ankle and hindfoot trauma. In: Fischgrund JS, editor. Orthopaedic knowledge update. Rosemont, IL; American Academy of Orthopaedic Surgeons; 2008.
Clare MP, Lee WE, Sanders RW. Intermediate to long-term results of a treatment protocol for calcaneal fracture malunions. J Bone Joint Surg Am 2005;87:963-73.
Kundel K, Funk E, Brutscher M, Bickel R. Calcaneal fractures: operative versus nonoperative treatment. J Trauma 1996;41:839-45.
Schepers T, Ginai AZ, Van Lieshout EM, Patka P. Demographics of extra-articular calcaneal fractures: including a review of the literature on treatment and outcome. Acta Orthop Trauma Surg 2008;128:1099-106.
Swanson SA, Clare MP, Sanders RW. Management of intra-articular fractures of the calcaneus. Foot Ankle Clin 2008;13:659-78.
Guerado E, Bertrand ML, Cano JR. Management of calcaneal fractures what have we learnt over the years? Injury 2012;43:1640-50.
Böhler L. Diagnosis, pathology and treatment of fractures of the os calcis. J Bone Joint Surg Am 1931;13:75-89.
Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am 2000;82:225-50.
Toolan BC, Wright Quinones VJ, Cunningham BJ, Brage ME. An evaluation of the use of retrospectively acquired preoperative AOFAS clinical rating scores to assess surgical outcome after elective foot and ankle surgery. Foot Ankle Int 2001;22:775-8.
Tornetta P 3rd. Percutaneous treatment of calcaneal fractures. Clin Orthop Relat Res 2000:91-6.
Eastwood DM, Langkamer VG, Atkins RM. Intra-artıcular fractures of the calcaneum. Part II: open reduction and internal fixation by the extended lateral transcalcaneal approach. J Bone Joint Surg Br 1993;75:189-95.
Paul M, Peter R, Hoffmeyer P. Fractures of the calcaneum. A review of 70 patients. J Bone Joint Surg Br 2004;86:1142-5.
DiGiovanni CW, Benirschke SK, Hansen ST. Foot injuries. In: Browner BD, Jupiter JB, Levine AM, Trafton PG. Skeletal Trauma: basic science, management and reconstruction. WB Saunders: 2003:2375-492.
Ibrahim T, Roswell M, Rennie W, Brown AR, Taylor GJ, Gregg PJ. Displaced intra-articular calcaneal fractures: 15-year follow-up of a randomised controlled trial of conservative versus operative treatment. Injury 2007;38:848-55.
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int 1994;15:349-53.
Rammelt S, Zwipp H. Calcaneal fractures: facts, controversies and recent developments. Injury 2004;35:443-61.
Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am 2000;82:225-50.
Clare MP. Calcaneal fractures. In: Pinzur MS, editor. Orthopaedic Knowledge Update: Foot and Ankle 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2008:75-94.
Thordarson DB. Foot and Ankle Trauma. In: Thordarson DB, editor. Foot and Ankle. Philadelphia: Lippincott Williams & Wilkins; 2004:288-319.
Murphy GA. Fractures and dislocations of foot. In: Canale ST, editor. Campbell’s Operative Orthopaedics. Vol 4, 10th Edition. Philadelphia: Mosby; 2003:4231-47.
Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res 1993:87-95.
Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ 2014;349:g4483.
Jiang N, Lin QR, Diao XC, Wu L, Yu B. Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base. Int Orthop 2012;36:1615-22.
Stephenson JR. Treatment of displaced intra-articular fractures of the calcaneus using medial and lateral approaches, internal fixation, and early motion. J Bone Joint Surg Am 1987;69:115-30.
Stephenson JR. Surgical treatment of displaced intraarticular fractures of the calcaneus. A combined lateral and medial approach. Clin Orthop Relat Res 1993:68-75.
Kwon JY, Guss D, Lin DE, Abousayed M, Jeng C, Kang S, et al. Effect of Delay to Definitive Surgical Fixation on Wound Complications in the Treatment of Closed, Intra-articular Calcaneus Fractures. Foot Ankle Int 2015;36:508-17.
