Open reduction and internal fixation in dislocated intraarticular calcanear fractures, 2. – practical part

Czech version

Authors: Vladimír Popelka; Radoslav Zamborský; Peter Dečo; Peter Šimko
Authors‘ workplace: Department of trauma surgery, University Hospital in Bratislava - Kramare ; Klinika úrazovej chirurgie, FN Bratislava-Kramáre
Published in: Úraz chir. 20., 2012, č.1

Overview

The study objectives:
For its complex morphology calcaneus is one of the most complicated bones in human body. Anatomic restoration of its shape is often difficult, mostly in intraarticular fractures. When it's healed in malposition it can lead to serious permanent consequences with significant limitation in everyday life.

The aim of this prospective study was to verify the correctness of plate osteosynthesis indication in intraarticular heel fractures following the treatment algorithm at our department.

Material:
During the 5year period (3/2006 3/2011) we have performed surgical treatment in 59 patients (45 men76 %, 14 female24 %) at the Department of Trauma Surgery in University Hospital BratislavaKramáre. We have recorded 12 cases (24 %) of bilateral calcanear fractures, therefore the total number of surgically treated intraarticular fractures was 71. According to current classifications we have recorded 39 Sanders type II fractures (50 %), 23 Sanders type III fractures (32 %) and 9 Sanders type IV fractures (13 %).

Methods:
We have performed plate osteosynthesis in 46 cases of the total number 71 fractures (64,5 %). Calcanear plate was used in 22 fractures of Sanders II depression type (31 %), also in all 23 fractures of type Sanders III (32 %) and in one case with fracture type Sanders IV (1,5 %). Indication criteria were strictly followed in all cases where the ORIF was performed. Authors have selected extended lateral approach (Seattle) in 44 cases and medial approach (Mc Raynolds) in two cases. The average admission to surgical intervention time was 8,2 days.

Results:
The average follow up period was 6 to 36 months. Two scoring systems (CreightonNebraska Health Foundation Assessment score and Ankle Hindfoot AOFAS scale) were used to evaluate limb function. In the group of 46 patients with ORIF we have achieved excellent result in 26 cases (56,5 %) and good results in 9 cases (9,5 %). In 8 cases (17,5 %) the results were only satisfactory and 3 cases (6,5 %) were evaluated as poor. We have recorded 3 wound healing complications (6,5 %) where a marginal skin necrosis was present. Postoperative algodystrophic syndrome was present in one case (2,2 %).

Conclusion:
Open reduction and internal fixation using calcanear plate is a reliable surgical treatment in Sanders II depression type and Sanders III intraarticular fractures.

Key words:
ORIF open reduction and internal fixation, surgical approaches.

Sources

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Surgery Traumatology Trauma surgery

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Article was published in

Trauma Surgery

2012 Issue 1