Clin Orthop Surg.  2018 Sep;10(3):374-379. 10.4055/cios.2018.10.3.374.

Radiological and Clinical Effectiveness of a Novel Calcaneal Fracture Brace after Intra-articular Calcaneal Fracture Surgery

• Yoo CH
• Kang C
• Hwang DS
• Hwang JM
• Lee GS
• Park YC

• KMID: 2418759
• DOI: http://doi.org/10.4055/cios.2018.10.3.374

Abstract

BACKGROUND
After calcaneal fracture surgery, a short leg splint and cast are typically applied. However, these restrict joint exercises, which is inconvenient for patients. In addition, there is a risk of complications, such as pressure ulcers or nerve paralysis with a short leg cast. In this study, we evaluated clinical and radiological outcomes of the use of a specially designed calcaneal brace after calcaneal fracture surgery.
METHODS
From among patients who underwent open reduction and internal fixation for calcaneal fracture between July 9, 2013 and May 31, 2017, 102 patients who wore a calcaneal fracture brace (group A) and 82 patients who wore a postoperative short leg cast (group B) were randomly chosen for this study. Radiological changes and clinical factors were compared between the two groups. After swelling at the surgical site decreased, a special calcaneal brace was applied to patients in group A. They were allowed to perform early weight bearing and joint motion. Patients in group B were immobilized in a short leg cast and were told to avoid weight bearing for 6 weeks. In each group, the Böhler's angle and Gissane's angle were measured and compared using postoperative and final follow-up radiographs. Pain (measured using a visual analogue scale [VAS]) and ankle joint range of motion (dorsiflexion, plantar flexion, eversion, and inversion) were measured serially until the final follow-up visit.
RESULTS
There were no significant differences in the Böhler's angle or Gissane's angle between the two groups as measured postoperatively and at the final follow-up (paired t-test). Differences in the VAS pain score and eversion were also statistically nonsignificant between the two groups. However, group A had a significantly higher range of dorsiflexion (p = 0.021), plantar flexion (p = 0.012), and inversion (p = 0.045) of the ankle than group B (independent t-test).
CONCLUSIONS
Application of the calcaneal fracture brace after open reduction and internal fixation of a calcaneal fracture not only maintained the fracture reduction but allowed for greater joint motion than the short leg cast. Thus, the calcaneal fracture brace can be considered an effective postoperative management option that enables early resumption of daily activities and facilitates postoperative joint motion.

Keyword

Calcaneus; Braces; Weight-bearing; Joints; Motion

MeSH Terms

Ankle
Ankle Joint
Braces*
Calcaneus
Exercise
Follow-Up Studies
Humans
Joints
Leg
Paralysis
Pressure Ulcer
Range of Motion, Articular
Splints
Treatment Outcome*
Weight-Bearing

Figure

• 

  Fig. 1 A specially designed brace to be worn postoperatively by patients with calcaneal fractures. The brace prevents weight bearing on the fracture site because the heel does not touch the ground. (A) The brace. (B) Wight-bearing areas (arrows). (C) The brace in use.

• 

  Fig. 2 Radiographs showing the tuber angle of Böhler (A) and the crucial angle of Gissane (B).

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  Fig. 3 Gait analysis using the F-Scan System (ver. 6.34; Tekscan, Boston, MA, USA). The area and region of the foot are the same in (A) and (B). (A) With the specially designed brace. (B) With the short leg cast.

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