Semiinvasive lateral subtalar aproach for osteosynthesis of calcaneal fractures

Czech version

Authors: Martin Carda; Martin Pompach
Authors‘ workplace: Department of Trauma Surgery, Clinic of Surgery, Regional Hospital of Pardubice ; Oddělení úrazové chirurgie chirurgické kliniky, Pardubická krajská nemocnice, a. s.
Published in: Úraz chir. 18., 2010, č.2

Overview

AIM:
A wide spectrum of approaches to the management of calcaneal fractures have already been defined. A conservative approach, which brings unsatisfactory outcomes with dislocated fractures, percutaneous techniques with a limited possibility of anatomic reposition, and a technique of open reposition using an extended lateral approach, which is considered to be the golden standard of today. This method is associated with a risk of complications during the healing process of soft tissues. The aim of the authors was to test a subtalar approach and to find out, whether it is possible to achieve a good reposition and satisfactory fixation results with a low percentage of complications.

MATERIALS AND METHODS:
The authors treated a total number of 65 calcaneal fractures from 2007 to 2009; 8 of them with the conservative treatment, 35 with percutaneous osteosynthesis and 22 of them semiinvasively. During the semiinvasive approach, the authors carry out an open reposition of fragments of the dorsal facete at the level of subtalar joint from an opening cut on the lateral side of the leg, fixing the fragments with transversally inserted screws to the sustentacular fragment. Finally, percutaneously inserted screws in the long axis of the leg unite the tuberosity fragment with processus anterior and with the posterior joint surface.

RESULTS:
The authors compared the outcomes and the incidence of complications of the percutaneous and semiinvasive methods. No deep infec-tion was reported in either of the groups, surface dehiscence of the surgical wound was reported in 6 % of the patients treated with the percutaneous method and in 9 % of the patients treated semiinvasively. A loss of reposition was noted in 11 % of patients following percutaneous osteosynthesis and in 5 % of the semiinvasively treated patients. Pain on exertion was reported by 35 % of the patients following percutaneous treatment and 14 % of patients treated with the semiinvasive approach.

CONCLUSION:
The authors managed to obtain better results with the semiinvasive approach to the treatment of calcaneal fractures, when compared to percutaneous osteosynthesis. Due to the lower incidence of complications, the authors consider this method to be a good treatment alternative to the treatment with an extended lateral approach, namely for risk patients.

KEY WORDS:
Calcaneal fracture, semiinvasive subtalar approach.

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Labels

Surgery Traumatology Trauma surgery

Surgical treatment of frontobasal injury with CSF leak-our experience

Mechanism of injury of transitional ankle fractures

Article was published in

Trauma Surgery

2010 Issue 2