The Modified Palmer Lateral Approach for Calcaneal Fractures: Wound Healing and Postoperative Computed Tomographic Evaluation of Fracture Reduction

Abstract

In 32 consecutive intra-articular calcaneal fractures (28 patients, 4 bilateral), open treatment was done using the modified Palmer lateral approach and the reduction was assessed with postoperative radiography and computed tomography (CT) (coronal and axial images, 1-2 days after surgery). Retrospective analysis of the available radiographs and CT scans was done in 27 fractures (25 patients, 2 bilateral) to assess accuracy of reduction achieved; in five fractures the studies were not available. Sanders classification was type I in 2 (7%), type II in 20 (74%), and type III in 5 (19%) fractures; the calcaneocuboid joint was involved in 9 (33%) fractures. Reduction included elevation of the depressed lateral side of the posterior facet, reduction of the neck (anterior third of calcaneus) to the body (middle third of calcaneus), realignment of the posterior tuberosity, and reduction of lateral wall blowout; internal fixation was done with cannulated screws. Mean (+/-SD) values of the following displacement parameters were significantly improved after surgery: Böhler's angle, posterior facet angle, lateral posterior facet articular depression, heel width (coronal CT), and calcaneal height. There was no significant difference between preoperative and postoperative values of mean angle of Gissane, posterior tuberosity position, and body width and length on axial CT. One (3%) of the 32 fractures was associated with preoperative (traumatic) full-thickness skin necrosis at the sinus tarsi that required free muscle flap coverage. One (3%) postoperative wound healing complication occurred, consisting of wound dehiscence and drainage at the central portion of the surgical wound in a smoker, which resolved with dressing changes and antibiotics. In conclusion, the modified Palmer lateral approach enabled open reduction of major features of calcaneal fractures with less soft-tissue risk than more extensile approaches.

Postoperative complications after closed calcaneus fracture treated by open reduction and internal fixation: A review

“…2,3,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] A total of 2046 ORIF cases were reported in these articles. Incidence rates of infection and skin flap necrosis, neurovascular injury, posttraumatic arthritis, malreduction/implant problems or nonunion were 13.6%, 2.8%, 1.2%, 0.8% and 0.1%, respectively.…”

A Comparison of Extensile Lateral Approach and Sinus Tarsi Approach for the Sanders Type II Calcaneal Fracture

“…수술 적 치료 방법 중에는 내측 도달법 18) , 단순 외측 도달법 1) , 내-외측 동시 도달법 16) , 후외과 도달법 9) 등이 소개되었으나 외측을 광범위하게 노출하여 정복한 후 금속판으로 고정하 는 방법이 가장 널리 알려져 있다 3,17) . 광범위 외측 도달법 은 좌상 및 종창 조직을 피함으로써 단순 외측 도달법에서 문제가 되었던 창상 감염과 비복신경 손상을 줄이고 혈액 순환을 보존할 수 있는 장점이 있다 5,7) . 그러나 광범위한 골막하 박리로 인한 연부조직의 합병증이 생길 수 있고 비 복신경 손상 및 비골건염이 문제가 되기도 한다 7) .…”

“…광범위 외측 도달법 은 좌상 및 종창 조직을 피함으로써 단순 외측 도달법에서 문제가 되었던 창상 감염과 비복신경 손상을 줄이고 혈액 순환을 보존할 수 있는 장점이 있다 5,7) . 그러나 광범위한 골막하 박리로 인한 연부조직의 합병증이 생길 수 있고 비 복신경 손상 및 비골건염이 문제가 되기도 한다 7) . 최종 추시에서 양 군 간 Bohler각, Gissane각, 골절 전위 정도를 비교한 결과 유의한 차이가 없었다 (Table 2).…”

“…, 둘째는 관절경을 이용하는 방법 6,14) , 셋째는 외고정 장치를 이용하는 방법이다 10,12,15) . 짧은 절개를 이용하는 방법은 족근동에서 거골하 관절을 따라서 절개를 하거나 4,7,8) 아킬레스건의 외측연을 따라서 종절개를 하는 방법 13) 으로 크게 구분할 수 있다. 짧은 절 개를 하면 후방 관절면의 외측 관절면을 포함하는 골절편 의 전위를 육안적으로 보고 정복할 수 있다는 것이 장점이 지만 전체적인 윤곽이나 관절면 이외의 부분은 경피적으로 정복하고 고정해야 한다.…”

Towards uniformity in communication and a tailor-made treatment for displaced intra-articular calcaneal fractures

“…These findings are supported by the growing body of evidence on the sinus tarsi approach (PubMed and Google Scholar search). Approximately 17 published series report on the sinus tarsi approach or on a modified sinus tarsi approach [1][2][3][4][5][6][7][8][9][10][11][12][13][14][16][17][18]. These case series involve 491 patients (average 29 per study; range 13-99), with 528 calcaneal fractures (31 average per study; range 13-106).…”