Minimally invasive surgery for intra-articular calcaneus fractures: a 9-year, single-center, retrospective study of a standardized technique using a 2-point distractor

Abstract

Background A fracture of the calcaneus can be a painful and disabling injury. Treatment modalities may be conservative or operative. Surgical treatment strategies include open reduction and internal fixation (ORIF) techniques, as well as a variety of minimally invasive methods. The aim of this study was to evaluate the treatment options and post-treatment complication rates for intra-articular calcaneal fractures at the Traumacenter Linz over a 9-year period. Methods All patients with calcaneal fractures treated at the Traumacenter Linz between 2007 and 2015 were included in this study. The patients records were retrospectively reviewed, and the data, including demographic parameters, cause of injury, and the time between injury and operative treatment were analyzed. The number of secondary operative interventions due to soft-tissue complications, hardware removal, and the long-term arthrodesis rate were evaluated. Results A minimally invasive 2-point-distractor method was used in 85.8% (n = 182) of all operatively managed calcaneal fractures (n = 212) in our department. The majority of the operations (88.7%) were performed within 2 days after the accident. The secondary operation rate resulting from wound complications was 2.7% in the 2-point distractor group and 16.7% in the ORIF group. A secondary arthrodesis was performed in 4.7% (n = 9) of the subtalar joints in the entire study population. Conclusions Our data supported the assumption that severe wound complications would be less likely to occur after minimally invasive treatment compared to ORIF treatment. The rate of secondary arthrodesis in the study cohort was comparable to that in the literature. Level of evidence IV

Minimally invasive internal fixation of Sanders Ⅳ calcaneal fractures using tarsal sinus plate and cannulated screw

“…In recent years, with the growth of the construction industry, incidents involving falls from signi cant heights have been on the rise, leading to a notable increase in severe, comminuted calcaneal fractures, including Sanders IV type fractures [6]. The calcaneus, a critical weight-bearing structure for upright ambulation, exhibits a higher morbidity rate when a icted with Sanders IV type fractures [7]. However, there remains a lack of consensus in the clinical community regarding the optimal treatment approach for Sanders IV calcaneal fractures [8,9].…”

Minimally Invasive Treatment of Inversion Shortening Calcaneal Fractures in the “Out‐In” Position

“…19,20 Advantages of Guided Distractor Besch et al 21 reported excellent results using external fixators for calcaneal fractures with severe soft tissue injuries. Rodemund et al 8 reported the use of a spreader in the lateral position, but its limitations include the need to perform it under a specially designed stent. To achieve a good reduction effect and soft tissue protection, we began to use the distractor in the medial foot to correct shortening varus deformity.…”

“…6,7 However, indirect repositioning such as prying is usually performed for medial wall repositioning, which may not restore the normal length, resulting in an inversion shortening deformity. Although there are clinical reports of good results using temporary external fixation bracing and repositioning in the medial position, 8 there may be shortcomings such as occlusion of fluoroscopy and obstruction of internal fixation placement. In addition, skin necrosis rates of this technique have been reported to be as high as 13.8%-29%.…”

Minimally invasive treatment and internal fixation vs. extended lateral approach in calcaneus fractures of thalamic interest

“…The minimum calcaneal lateral approach is 5 cm proximal and in line with the base of the fifth metatarsal to provide lifting the collapsed thalamic surface, followed by introduction of percutaneous K. wires and screws under roentgenographic guidance ( Fig. 1 ) ( 13 ). Stabilization of the fracture is achieved following restoration of the thalamic surface with a steinmann nail, K. brooches or percutaneous screws.…”