J Korean Fract Soc.  2013 Apr;26(2):126-132. 10.12671/jkfs.2013.26.2.126.

The Result Treated by Open Reduction and Internal Fixation with Minimally Invasive Technique in Joint Depressive Calcaneal Fracture

• Jo SH
• Lee JY
• Ha SH
• Cho SW
• Park SH

• KMID: 1496167
• DOI: http://doi.org/10.12671/jkfs.2013.26.2.126

Abstract

PURPOSE
To evaluate the short term follow-up results of minimally invasive technique in the management of Sanders type II, III, and IV joint depressive calcaneal fracture.
MATERIALS AND METHODS
Between May 2008 and May 2011, we studied 17 cases undergoing treatment with minimally invasive technique with modified sinus tarsi approach for Sanders II, III, and IV joint depressive intra-articular calcaneal fracture and were followed up for more than 1 year. We evaluated the treatment result by assessing the radiologic parameters (Bohler angle, Gissane angle, and calcaneal height/width/length) and clinical outcomes (American Orthopaedic Foot and Ankle Society [AOFAS] score and visual analog scale [VAS]) and investigating the complication.
RESULTS
Radiological results improved from 7.9degrees to 19.8degrees in the Bohler angle after the operation. Satisfactory results were obtained in clinical assessment with average AOFAS score of 82.45 and the average VAS score of 3.94. We experienced 3 cases of complications, 1 case of superficial wound infection and radiologic findings of subtalar arthritis in 2 cases.
CONCLUSION
Minimally invasive technique may be a useful alternative surgical method in the management of Sanders type II, III, and IV joint depressive calcaneal fracture that cannot adopt extensile approach, which enable to obtain good radiological and clinical results.

Keyword

Calcaneus fracture; Joint depressive Intra-articular fracture; Minimally invasive technique

MeSH Terms

Animals
Ankle
Arthritis
Follow-Up Studies
Foot
Joints
Wound Infection

Figure

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  Fig. 1 (A) Exposure of posterior facet using the sinus tarsi approach with 3-5 cm size skin incision. (B) Intra-operative lateral fluoroscope image shows posterior facet reduction using schantz-pin. (C) Lateral fluoroscope image shows stabilized posterior facet fragment with a 4.5 cannulated screw. (D) Other fragment fixation with a 6.5 cannulated screw.

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  Fig. 2 Methods of measurement of Gissane angle, calcaneal length (A), Böhler angle, calcaneal height (B) and calcaneal width and heel varus angle (C).

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  Fig. 3 (A, B) Preoperative lateral radiograph and computed tomography (CT) image of a 40 year old male patient shows Sanders IIIab type joint depression calcaneal fracture. Preoperative Böhler angle is 2.2 degrees and Gissane angle is 108.8 degrees. (C) Postoperative radiograph shows increased Böhler angle to 15.8 degrees and Gissane angle to 116.1 degrees. (D, E) After twelve months, a follow-up lateral radiograph shows Böhler angle 14.6 degrees and CT image shows complete bone union and good alignment of subtalar joint.

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