Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

Abstract

ObjectiveTo ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures.Method126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events.ResultsAll of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R2) were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries.ConclusionThe risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk.

A novel splinting technique to protect flaps of the posterior lower extremity

“…fixators are costly, cumbersome, and complicated-with high risks of pin tract infection (Kazmers, Fragomen, & Rozbruch, in press), vascular damage (Labronici et al, 2016;Staeheli, Fraser, & Morgan, 2012), or nerve injury (Labronici et al, 2016;Poglia, Wehrli, Steinmetz, & Zermatten, 2016). Besides, not all orthopedic surgeons are available/willing to put these on solely for flap protection, creating a logistic issue.…”