J Korean Foot Ankle Soc.  2021 Sep;25(3):133-140. 10.14193/jkfas.2021.25.3.133.

Results in Operative Treatment of Open Calcaneal Fracture

• Kim BR
• Lee JY
• Cha D

• KMID: 2520104
• DOI: http://doi.org/10.14193/jkfas.2021.25.3.133

Abstract

Purpose
This paper reports the surgical treatment results of open calcaneal fractures performed at the author’s clinics focusing on open calcaneal fractures to help understand the appropriate treatment and realistic outcomes.
Materials and Methods
This study was conducted on 22 cases out of 30 patients who visited the hospital from February 2009 to December 2019 and were followed up for more than one year. In open fractures, the fracture was classified using the Gustilo-Anderson classification and was evaluated using the soft tissue status at the time of visit. Intra-articular calcaneal fractures were classified using Sanders classification. The radiological parameters were measured for the Böhler angle, Gissane angle, calcaneal length, height, and width before and after surgery, and at the last follow-up. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and investigated complications. In addition, statistical analysis of the incidence and associated factors of posttraumatic arthritis was conducted.
Results
In all cases, the surgical treatment was performed by minimally invasive surgery. The AOFAS ankle-hindfoot scale conducted for a clinical evaluation of the final follow-up was averaged 72.5 points. In the classification of open fractures, the Gustilo-Anderson classification type IIIA was the most common, and the Sanders type III was the most common. Of the 22 cases after surgery, 15 cases had complications, 11 cases had posttraumatic arthritis, eight cases had an infection, and 4 cases had both complications. Only the Sanders classification showed a statistically significant correlation with the incidence of posttraumatic osteoarthritis (p-value 0.032).
Conclusion
In treating open calcaneal fractures, internal fixation by a minimally invasive approach showed relatively satisfactory results. However, follow-up research will be needed, including the results of a long-term follow-up through a large number of cases and comparative studies with other surgical methods.

Keyword

Calcaneus; Fractures; Open; Surgical procedure

Figure

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  Figure. 1 (A~D) Postoperative radiographs. The definitive fixation using Steinmann pin and 4.0-, 6.5-cannulated screws was performed. Postoperative X-ray (A: Ankle lateral view, B: Calcaneal axial view, C: Brodens view), Böhler angle, and Gissane angle have recovered. (D) Computed tomography after 6 months of surgery (semicoronal view) shows well reducted articular surface.

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  Figure. 2 Preoperative radiographs. Preoperative X-ray (A: ankle lateral view, B: calcaneal axial view, C: Brodens view), It is joint depressive calcaneal fracture. The posterior joint surface is depressive and lateral wall is bulging on calcaneal axial view. (D) Preoperative computed tomography (semicoronal view) shows joint depressive type. Sander type IIIAB calcaneal fracture.

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  Figure. 3 Radiologic assessment. (A) Ankle lateral X-ray. Gissane angle, Böhler angle, and Gissane angle are formed by the downward and upward slopes of the calcaneal superior surface. Böhler angle is composed of a line drawn from the highest point of the anterior process of the calcaneus to the highest point of the posterior facet and a line drawn tangential to the superior edge of the tuberosity. (B) Ankle lateral X-ray: calcaneal height, calcaneal length. The calcaneal height and calcaneal length were measured at the highest and lowest length and the longest length from anterior to posterior in the lateral X-ray. (C) Calcaneal axial view. Calcaneal width calcaneal width measures the widest width including sustentaculum tali on calcaneal axial view.

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