Primary fusion in worker's compensation intraarticular calcaneus fracture. Prospective study of 169 consecutive cases

López-Oliva, F.; Sánchez-Lorente, T.; Fuentes-Sanz, Adela; Forriol, Francisco; Aldomar-Sanz, Yolanda

doi:10.1016/s0020-1383(13)70184-0

Cited by 19 publications

(13 citation statements)

References 24 publications

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“…Displaced intra-articular calcaneal fractures are associated with alarmingly high rates of posttraumatic arthritis (30% to 70% within 1 year of injury), and surgical outcomes are inversely proportional to the severity of the fracture pattern, with Sanders III and IV having the worst outcomes 1 . Treating these most severe fracture patterns with primary open subtalar arthrodesis has shown favorable results in terms of union rates, pain scores, and functional outcomes throughout the literature 2,3 . However, some authors have reported rates of revision as high as 60% 4 .…”

Section: Rationalementioning

confidence: 99%

Calcaneus Fracture and Posterior Arthroscopic Primary Subtalar Arthrodesis (C-PASTA)

Martin

Yoder

2022

JBJS Essential Surgical Techniques

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Background: Complex intra-articular calcaneal fractures often resulted in secondary pain and deformity, requiring subsequent subtalar arthrodesis [1][2][3] . The literature suggests that primary subtalar arthrodesis in the acute period has good functional results 2,3 . The literature also demonstrates that posterior arthroscopic subtalar arthrodesis for chronic arthritis has favorable results 5 . Thus, we propose an approach to treating these difficult intra-articular calcaneal fractures that utilizes a posterior arthroscopic primary subtalar arthrodesis technique-aptly named Calcaneus Fracture and Posterior Arthroscopic Primary Subtalar Arthrodesis (C-PASTA). Description: The procedure begins with the patient in the prone position. The subtalar joint is visualized with a 1.9-mm flexible camera through a standard posterior arthroscopic approach. With the help of the C-arm, position in the subtalar joint space is confirmed. The joint space is debrided with use of a 4-0 shaver and then prepared for arthrodesis arthroscopically with use of an osteotome and a burr. Next, we inject allograft demineralized matrix-based bone putty under direct arthroscopic visualization to fill residual gaps or defects. The arthrodesis is performed under fluoroscopic guidance with use of 2 guidewires followed by 2 to 3 titanium compression screws. The first screw is inserted along the posteromedial calcaneus and into the talar dome medially. The second is placed laterally into the head-neck junction of the talus. The third screw is placed distal to proximal from the plantar anterior process to the talar head. Finally, images are obtained in multiple views to ensure proper screw placement, and the screws are tightened sequentially to ensure equal compression across the joint. Alternatives: Nonoperative treatment of calcaneal fractures includes cast immobilization with non-weight-bearing, although this treatment is typically reserved for nondisplaced, small extra-articular fractures 6 . Operative treatment of calcaneal fractures includes open reduction and internal fixation, which is traditionally performed via a sinus tarsi approach or extensile lateral approach. Primary subtalar arthrodesis has been utilized primarily for Sanders type-IV fractures 6 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A386).

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Section: Rationalementioning

confidence: 99%

Calcaneus Fracture and Posterior Arthroscopic Primary Subtalar Arthrodesis (C-PASTA)

Martin

Yoder

2022

JBJS Essential Surgical Techniques

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“…Primary subtalar arthrodesis has been proposed as an alternative treatment of high-grade calcaneus fractures. 17,23,26,28 Proponents argue that primary subtalar arthrodesis allows for faster recovery and good to excellent clinical, functional, and radiographic outcomes. 19,23,28 Due to small cohorts in previous studies, the complication rate following primary subtalar arthrodesis as it relates to the timing of operative fixation is not well established.…”

Section: Subtalar Arthrodesismentioning

confidence: 99%

“…17,23,26,28 Proponents argue that primary subtalar arthrodesis allows for faster recovery and good to excellent clinical, functional, and radiographic outcomes. 19,23,28 Due to small cohorts in previous studies, the complication rate following primary subtalar arthrodesis as it relates to the timing of operative fixation is not well established. To the best of our knowledge, this study is the first to suggest that performing primary subtalar arthrodesis as the index procedure for the treatment of intra-articular calcaneus fractures, as compared to a matched cohort of patients undergoing open reduction and internal fixation, may not be an independent factor for increasing wound complication rates, regardless of the operative approach.…”

Section: Subtalar Arthrodesismentioning

confidence: 99%

“…29 Indeed, for higher grade injuries, some have advocated primary subtalar arthrodesis, although such studies did not evaluate whether wound complications were higher with this strategy. 17,23,26,28 Operative interventions have been shown to have an overall short-term wound complication rate approaching 30%, with reported complications ranging from superficial skin slough to deep infections. 22 The incidence of deep infections varies widely in the literature, ranging from 1.8% to 21%.…”

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confidence: 99%

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Effect of Delay to Definitive Surgical Fixation on Wound Complications in the Treatment of Closed, Intra-articular Calcaneus Fractures

et al. 2015

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“…Surgical treatments have been shown to be associated with more favorable consequences that non-surgical methods 10 , 13 , 15 , 17 , 18 In type IV fractures based upon Sander’s classification, early Arthrodesis is recommended. 19 , 20 Open reduction internal fixation (ORIF) is the most common surgical method used to treat calcaneus fractures conducted with a lateral approach. In spite of its favorable consequences, there is great concern about the complications following soft tissue operation such as infection and wound dehiscence.…”

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confidence: 99%

Comparison of calcaneus joint internal and external fractures in open surgery and minimal invasive methods in patients

2018

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Surgical management of calcaneal fractures has various complications. In recent years, minimally invasive surgeries have been utilized for a wide range of surgical procedures on different body parts significantly declining complications. This paper compares surgical outcomes of calcaneal fracture management between the open reduction and internal fixation technique (ORIF) and the MIS technique. In this randomized clinical trial forty patients with calcaneus fractures were randomly assigned to two equal groups; ORIF group and MIS group. Patients were followed for 1 year post-operatively. Gissane and Bohler’s angles, AOFAS questionnaire, pain intensity, ability to conduct previous activities and various complications like wound healing complications and irritation with shoe wear were assessed in the final post-operative visit. Eventually data obtained from the two groups were compared. All patients obtained fracture union. Bohler’s and Gissane angles significantly increased and decreased, respectively, after the operation in both groups (p˂0.05), however, no significant difference was found between the two research groups. AOFAS scores and pain intensity was similar in both groups, however, surgical duration in the MIS group was significantly less than the ORIF group (P=0.021). Only one patient from the ORIF group was not able to resume his previous occupation. 12 patients from the ORIF group and five patients from the MIS group experienced irritation from shoe wear (p=0.025). In the ORIF group, 4 patients suffered from wound healing complications, however, none of the patients of the MIS group had wound complications (p=0.035). In conclusion, based on the results, it can be concluded that the MIS technique demonstrated better functional and radiographic outcomes as well as a more favorable complication profile, thus, it is recommended for the management of calcaneus fractures.

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Primary fusion in worker's compensation intraarticular calcaneus fracture. Prospective study of 169 consecutive cases

Cited by 19 publications

References 24 publications

Calcaneus Fracture and Posterior Arthroscopic Primary Subtalar Arthrodesis (C-PASTA)

Calcaneus Fracture and Posterior Arthroscopic Primary Subtalar Arthrodesis (C-PASTA)

Effect of Delay to Definitive Surgical Fixation on Wound Complications in the Treatment of Closed, Intra-articular Calcaneus Fractures

Comparison of calcaneus joint internal and external fractures in open surgery and minimal invasive methods in patients

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