Fraturas intra-articulares do calcâneo: análise clínica e biomecânica

Contreras, Marcos Emilio Kuschnaroff; Kroth, Luciano Manoel Martins; Kotani, Keith Lúcia; Silva, Jorge Luiz da; Andrade, Mário César de; Ávila, Aluísio Otávio Vargas; Berral, Francisco José

doi:10.1590/s0102-36162009000600007

Cited by 2 publications

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References 27 publications

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“…A via de acesso lateral tem sido a mais utilizada pelos autores (2,10) , embora suas modificações, como lateral em "L" e lateral em "L" amplo estejam se tornando cada vez mais prevalentes. Além do acesso lateral, a literatura descreve também acessos por via medial e pelo seio do tarso (10)(11)(12)(13) . Técnicas minimamente invasivas estão sendo descritas principalmente para pacientes com comorbidades (principalmente doença arterial obstrutiva periférica) que contraindiquem cirurgia aberta (11) .…”

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Pre-operative tomographic evaluation of calcaneum fractures in surgical planning

2018

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Objective: To perform the correlation between the preoperative tomographic evaluation of patients with calcaneal fracture diagnosis and the access routes of choice, as well as the synthesis materials used.Methods: We reviewed 19 medical records of patients between 23 and 56 years old who underwent calcaneal fracture surgery from 01/01/2014 to 12/31/2015. We evaluated the mechanism of trauma, side, Essex-Lopresti classification, Böhler and Gissane angle in the pre- and postoperative period, Sanders tomographic classification and type of osteosynthesis performed. Angular measurements served as a reference for radiological analysis of the quality of the reduction. Results: 90% of the cases were of joint depression, the other 10% considered extra-articular. The preoperative Böhler angle varied between 5 and 40°, and between 10 and 38° in the postoperative period, and 55% of the fractures had an angular reconstruction considered good (between 20° and 40°). Gissane’s angle, on the other hand, varied between 110 and 170° in the preoperative period, and 102 and 132° in the postoperative period. In the tomographic analysis, Sanders IV classification was predominant (65%), followed by type IIIBC fractures (20%), and fractures type I, IIA and IIIAB (5% each). Osteosynthesis with plate and screw was the most used method (89.47%). Conclusion: Correct use of existing diagnostic imaging resources through radiographic and tomographic results provides the possibility of better preoperative planning in the intra-articular fractures of the calcaneus. However, in this study, there was no difference in the access route and synthesis according to the tomographic classification. Level of Evidence III; Diagnostic Studies; Study of Non-Consecutive Patients.

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Pre-operative tomographic evaluation of calcaneum fractures in surgical planning

2018

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Foot Function After Surgically Treated Intraarticular Calcaneal Fractures: Correlation of Clinical and Pedobarographic Results of 65 Patients Followed for 8 Years

Dürr

Apinun

Mittlmeier

et al. 2018

Journal of Orthopaedic Trauma

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Objectives: To correlate functional deficits after surgical treatment of displaced intraarticular calcaneal fractures (DIACFs) as measured through dynamic pedobarography with clinical and radiographic long-term results. Design: Retrospective single-center study. Setting: Level 1 trauma center. Patients: Sixty-five patients with unilateral DIACFs, reexamined at an average of 8.1 years after surgery. Intervention: Internal fixation of DIACF with lateral plate or percutaneous screws. Main Outcome Measurements: Dynamic pedobarography, AOFAS, Zwipp, SF-36 scores, Foot Function Index, Böhler angle, and articular congruity. Results: When compared with the uninjured side, pedobarography of the operated foot revealed a significantly increased contact area of the hindfoot and midfoot, with a decreased contact area under first/second metatarsal (MT) and first/second toe after DIACF. Maximum pressure and pressure time integral were significantly increased at the midfoot and lateral MT with a decrease under the hindfoot and first to second MT/toe. Midfoot pressure time integral correlated with the range of plantarflexion. Fracture classification correlated with MT 1 contact time. Hindfoot and MT contact times were negatively correlated with Böhler angle. Patients with the smallest side-to-side differences in pedobarogaphy had overall highest scores and significantly greater ankle/hindfoot range of motion at follow-up. Conclusions: Significant correlations were found between clinical and pedobarographic results. Increased contact areas and time at the midfoot indicating a lateral load shift correlated with inferior outcome and decreased subtalar motion. These results support the importance of reconstruction of the subtalar joint and overall bony morphology of the calcaneus with preservation of subtalar motion as necessary for global foot function. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Fraturas intra-articulares do calcâneo: análise clínica e biomecânica

Cited by 2 publications

References 27 publications

Pre-operative tomographic evaluation of calcaneum fractures in surgical planning

Pre-operative tomographic evaluation of calcaneum fractures in surgical planning

Foot Function After Surgically Treated Intraarticular Calcaneal Fractures: Correlation of Clinical and Pedobarographic Results of 65 Patients Followed for 8 Years

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