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

Abstract

The extended lateral side approach is a common technique in the surgical treatment of calcaneal fractures, with thalamic collapse offering a good exposure of the fractured site; however, it can be burdened with complications due to soft tissue trauma. The present study aimed to compare patients treated with minimally invasive osteosynthesis through a minimum lateral approach and internal fixation with patients that were treated using internal fixation with an extended lateral side approach in cases of intra-articular calcaneal fractures with thalamic fracture. Patients were evaluated preoperatively and postoperatively by performing clinical and imagistic examinations, with radiography scans of the anterior-posterior calcaneal profile and computer tomography. Furthermore, preoperative and postoperative analyses of the Böhler angle on the radiological profile, complications and duration of the hospital admission for both groups were performed. There were 36 patients (39 calcaneal fractures) in group 1 and 24 patients (29 calcaneal fractures) in group 2. The results demonstrated no statistically significant differences in the preoperative (P=0.72) and postoperative (P=0.20) Böhler angle values. The postoperative Böhler angle average values were 26.9 in group 1 and 29.3 in group 2. A total of 11 patients were treated with Kirschner wires inserted in the calcaneus, and in 2/ll cases, one of the brooches registered a migration movement. There were no cases of material migration in the fractures that were stabilized by inserting Kirschner brooches up to the astragalus and cuboid bones. Taken together, the results of the present study demonstrated no significant differences in the Böhler angle values between the minimally invasive and open reduction techniques. However, the antibiotic therapy period, as well as the infection rate were lower in patients that were treated using the minimally invasive technique, suggesting that this technique was superior with respect to lower complication rates and improved functional results.

A nomogram for predicting post‐operative wound complications after open reduction and internal fixation for calcaneal fractures

“… 25 With the wide application of expanded L‐shaped incisions, PWCs are gradually discovered by orthopaedic physicians. 4 For patients who are diagnosed with superficial infections, a good outcome can be achieved after active treatment. However, it is devastating to patients who are diagnosed with deep infections, even though there is low mobility.…”

“…However, the benefits of operative treatment may be offset by the subsequent complications 25 . With the wide application of expanded L‐shaped incisions, PWCs are gradually discovered by orthopaedic physicians 4 . For patients who are diagnosed with superficial infections, a good outcome can be achieved after active treatment.…”

“…Open reduction and internal fixation (ORIF) is generally considered the best available approach for restoring the overall anatomy of the calcaneal and reconstructing the posterior talocalcaneal (subtalar) joint after a displaced intra‐articular calcaneal fracture. 4 , 5 The most widely surgical technique is open reduction and internal fixation with a plate, using an expanded L‐shaped incision on the lateral wall of the heel and with or without bone grafting. 6 , 7 However, the most common and recalcitrant complications are related to surgical incisions; examples include infection of the incision and necrosis of the skin margin.…”

“…Treatment may consist of operative or conservative management. Open reduction and internal fixation (ORIF) is generally considered the best available approach for restoring the overall anatomy of the calcaneal and reconstructing the posterior talocalcaneal (subtalar) joint after a displaced intra‐articular calcaneal fracture 4,5 . The most widely surgical technique is open reduction and internal fixation with a plate, using an expanded L‐shaped incision on the lateral wall of the heel and with or without bone grafting 6,7 .…”

Metagenomic Next-Generation Sequencing for Periprosthetic Joint Infections

“…Chronic infection presents with progressive pain, skin fistula formation, and/or drainage of purulent secretions, and occurs >3 months after the intervention of arthroplasty (dissemination of the infection can be hematogenous, with a primary starting point, or by direct inoculation in the case of infectious agents with low virulence, especially in the case of coagulase-negative staphylococci, Cutibacterium acnes , and Corynebacterium). In order to diagnose PJI, the histology of the synovial tissue, the number of leukocytes in the synovial fluid [ 4 ], determination of the levels of systemic inflammatory markers (such as ESR, CRP, and IL-6 [ 9 ]), imaging investigations (such as standard radiographs), technetium-labeled bone scans, MRI, CT, and PET/CT have been used [ 10 ]. Recently, new techniques have been developed to identify the pathogen, the conventional methods used in the past were accompanied by a high failure rate (due to the lack of isolation of a pathogenic microorganism through the premature administration of antibiotics and seeding techniques on culture media) [ 11 ].…”