Ligamentotaxis for complex calcaneal fractures using Joshi's external stabilization system

Abstract

Background:Controversies exist in the literature regarding the management of complex fractures of the calcaneum. We evaluated a series of complex fractures of the calcaneum managed by ligamentotaxis using Joshi's external stabilization system (JESS) for its efficacy.Materials and Methods:Forty-five patients having complex (comminuted, intra-articular fracture with compromised soft tissue condition) fractures of the calcaneum, who were treated by external fixator (JESS) based on the principle of ligamentotaxis. The gradual distraction was done to bring the articular margins together to maintain both alpha and beta angles to near normal range. Thirteen (28.9%) patients underwent additional corticocancellous bone grafting with elevation of posterior facet. All patients were evaluated for their functional outcomes by American Orthopedic Foot and Ankle society (AOFAS) Score for the ankle and hind foot. Mean duration of follow-up was 20.5 months.Results:Forty-two (93.4%) of our patients did well with the ligamentotaxis. On evaluating final outcomes by AOFAS, approximately 71% of cases showed good results. Eleven patients (24.4%) complained of persistent heel pain in the long-term follow-up. Out of these, eight (17.8%) patients were those who had severe comminution with almost total loss of calcaneal height. The origin of heel pain was not the subtalar joint in all of these patients.On long-term follow-up none of these patients suffered from such severe pain so as to compel them to change the nature of their activity.Conclusion:We conclude that ligamentotaxis by JESS provides a viable and user-friendly alternative method of management of these complex calcaneal fractures.

Management of fracture calcaneum by reconstruction locking plate

“…In present study, the average duration of surgery was 1 hours and 55 minutes and time between injury and surgery averaged 8.5 days (range 3 to 15) The results were found similar to previous studies. 33,35,36,39,40 In present study, the average duration of surgery was 1 hours and 55 minutes and time between injury and surgery averaged 8.5 days (range 3 to 15) The results were found similar to previous studies. 35,37,38 In present study, average time of union was 10.96 weeks (range 8 to 16 weeks) which was equivalent to other study group.…”

“…The results were found similar to previous studies. [33][34][35][36][37][38] In present study of the 30 cases, 19 cases (63.33%) involved right side, 7 cases (23.33%) involved left side and 4 cases (13.33%) were bilateral The results were found similar to previous studies. [35][36][37] In present study, out of 34 fractures in 30 patients, 22 fractures (64.7%) were joint depression type and 12 fractures (35.3%) were tongue type according to EssexLopresti classification.…”

“…Rate of complication of our study were comparable with other studies. [33][34][35][36][37][38][39] In present study, the average Bohler's angle achieved was 24.6 (0-44 0 ) which was comparable with other study groups. 33,40 In present study, the AOFAS score of 90-100 was considered excellent, 75-89 as good, 50-74 as fair and <49 as poor outcome.…”

“…The results were found similar to previous studies. 33,35,38 In present study, 13.33% patients were having associated injuries. One patient (3.33%) was having lower end radius fracture, one (3.33%) is having tibia fracture and two (6.67%) were having spinal injuries.…”

“…The results were found similar to previous studies. [33][34][35][36][37] In present study, most common cause of fracture is fall from height, 83.33% of cases as in most of the studies. The results were found similar to previous studies.…”