Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications

Abstract

Background:In a retrospective study we analysed intra-articular calcaneal fracture treatment by comparing results and complications related to fracture stabilization with nonlocking calcaneal plates and locking compression plates.Materials and Methods:We performed 76 osteosynthesis (67 patients) of intra-articular calcaneal fractures using the standard extended lateral approach from February 2004 to October 2007. Forty-two operations using nonlocking calcaneal plates (group A) were performed during the first three years, and 34 calcaneal fractures were stabilized using locking compression plates (group B) in 2007. In the Sanders type IV fractures, reconstruction of the calcaneal shape was attempted. Depending on the type of late complication, we performed subtalar arthroscopy in six cases, arthroscopically assisted subtalar distraction bone block arthrodesis in six cases, and plate removal with lateral-wall decompression in five cases. The patients were evaluated by the AOFAS Ankle-Hindfoot Scale.Results:Wound healing complications were 7/42 (17%) in group A and 1/34 (3%) in group B. No patient had deep osseous infection or foot rebound compartment syndrome. Preoperative size of Böhler's angle correlated with postoperative clinical results in both groups. There were no late complications necessitating corrective procedure or arthroscopy until December 2008 in Group B. All late complications ccurred in Group A. The overall results according to the AOFAS Ankle Hindfoot Scale were good or excellent in 23/42 (55%) in group A and in 30/34 (85%) in group B.Conclusion:Open reduction and internal fixation of intra-articular calcaneal fractures has become a standard surgical method. Fewer complications and better results related to treatment with locking compression plates confirmed in comparison to nonlocking ones were noted for all Sanders types of intra-articular calcaneal fractures. Age and Sanders type IV fractures are not considered to be the contraindications to surgery.

Treatment of Subtalar Calcanean Fractures Using Trans-Osseous Limited Lateral Approach

“…Four patients (9.5%) had associated injuries. Other stu dies showed a more or less similar percentages [13][14][15][16][17][18][19][20][21][22][23].…”

Comparison of percutaneous cannulated screw fixation and calcium sulfate cement grafting versus minimally invasive sinus tarsi approach and plate fixation for displaced intra-articular calcaneal fractures: a prospective randomized controlled trial

“…However, the high concern about wound-related complications with the extensile lateral L-shaped approach has troubled many orthopedic surgeons [ 7 ]. The complication rate after surgical treatment has been reported to range from 11 to 25 % [ 4 – 7 , 20 , 21 ]. As one of the most widely applied minimally invasive techniques, the sinus tarsi approach has the advantage of direct visualization of the posterior articular facet and fewer wound-related complications [ 11 , 12 , 15 ].…”

Desenho de placa em forma de borboleta para tratamento de fraturas do calcâneo

“…However, the conventional L-shaped incision at the lateral calcaneus usually has poor healing and/or infections 6 . Howard, et al 7 compared 206 cases (226 calcaneal fractures) and found that the open reduction and internal fixation group showed greater efficacy of treatment than the nonsurgical group; however, the former group had 28% of complications while the latter had only 19%.…”