Intramedullary nailing for calcaneal fractures: what are the available techniques? A review of the literature

Abstract

Objective. Displaced intra-articular fractures of the calcaneus (DIACF) may be treated in several ways. In recent years, intramedullary locking devices (ILD) have been proposed with the aim to reduce complications and improve long-term results. In this regard, we have reviewed the literature in order to identify devices currently available and evaluate their characteristics. Methods. Following a PRISMA checklist, Medline, Scopus and EMBASE databases were searched to identify studies reporting use of ILDs to treat DIACFs. In this review, only technical notes were included. Manuscripts selected were critically analysed in order to highlight common points and differences among surgical techniques. Results. Overall, four technical notes dealing with ILDs were found, of which two concerned the Calcanail® (FH Orthopedics, Heimsbrunn, France) and two the C-Nail® implant (Medin, Nov. Město n. Moravě, Czech Republic). While the Calcanail® is stabilised by two screws and allows indirect reduction of the posterior facet, the C-Nail® involves direct visualisation of the joint space and use of multiple multi-directional screws to achieve final stabilisation. Conclusions. Although similar in the design, the Calcanail® and the C-Nail® lead to the reduction and stabilisation of fragments through different mechanisms. In both cases the restoration of heel height and anatomical reduction of the subtalar joint are the primary goals of surgery.

Dexamethasone versus Dexmedetomidine as Adjuvants in Ultrasound Popliteal Sciatic Nerve Block for Hallux Valgus Surgery: A Mono-Centric Retrospective Comparative Study

“…In the foot and ankle area, a few previous studies have investigated the role of the ultrasound popliteal sciatic nerve block to perform surgical procedures. [44][45][46] A double-blind RCT conducted by Vermeylen et al (in which saline, clonidine 100 mcg and dexamethasone 5 mg as adjuvants to ropivacaine 0.75% were compared) showed that the addition of dexamethasone to ropivacaine significantly prolonged the duration of analgesia (about 9 hours) and the time to motor block regression (about 13 hours) in HV surgery. In Vermeylen et al study the duration of the motor blockade was 32 h, whereas in ours it was 18 h. The increase in the duration of motor blockade was to be expected as higher concentrations of local anesthetic and higher doses of dexamethasone were used.…”

Functional outcomes after intramedullary nailing (C-Nail®) of severe calcaneal fractures with mean follow-up of 36 months

“…Although Calcanail® and C-Nail® share similarities in their design, the implants achieve reduction and fixation through different mechanisms. While the Calcanail® is stabilized by two screws and relies on indirect reduction of the posterior facet, the C-Nail® requires direct visualization of the joint space through a sinus tarsi approach and several multi-directional screws [ 25 ]. There is still no clarity on whether the locking plate or intramedullary nailing is superior [ 26 ].…”