Treatment of Intra-articular Calcaneal Fractures Using Minimally Invasive Sinus Tarsi Approach in Diabetic Patients

Hong-Moon Sohn; Sang-Ho Ha; Sang-Hong Lee; Jun-Young Lee; Jeong-Ho Kim; Sang-Jun Lee

doi:10.12671/jkfs.2008.21.3.195

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Sohn, Ha, Lee, Lee, Kim, and Lee: Treatment of Intra-articular Calcaneal Fractures Using Minimally Invasive Sinus Tarsi Approach in Diabetic Patients

Original Article

Journal of the Korean Fracture Society 2008; 21(3): 195-199.

Published online: 31 July 2008

DOI: https://doi.org/10.12671/jkfs.2008.21.3.195

Treatment of Intra-articular Calcaneal Fractures Using Minimally Invasive Sinus Tarsi Approach in Diabetic Patients

Hong-Moon Sohn, M.D., Sang-Ho Ha, M.D., Sang-Hong Lee, M.D., Jun-Young Lee, M.D., Jeong-Ho Kim, M.D., Sang-Jun Lee, M.D.

Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea.

Address reprint requests to: Jun-Young Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 588, Seosuk-dong, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, leejy88@chosun.ac.kr

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Wound problems occur in 5~30% of intra-articular calcaneal fractures following operation. Diabetes mellitus, large incisions and abundant dissection can increase the risk of wound problems that may require skin graft or other additional care. The authors used minimally invasive technique to treat intra-articular calcaneal fractures in diabetic patients and evaluated the results and complications of this method.

Materials and Methods

Between January 2002 and July 2005, 12 patients with intra-articular calcaneal fractures who had underlying diabetes mellitus were treated using minimally invasive technique with a modified sinus tarsi approach. The patients had an average age of 47 years (39~67) and were followed an average of 19 months (13~32). The mean period between injury and operation was 8 days (5~14). Crutch assisted partial weight bearing was advised for an average of 7.3 weeks (6~9) and full weight bearing was allowed after average of 9.3 weeks (7~11).

Results

According to AOFAS scale for ankle and hindfoot, patients had the following results: excellent - 1 patient (8%), good - 9 patients (75%), fair - 1 patient (8%), unsatisfied - 1 patient (8%). Bone union was achieved in all cases and there were no events of deep infection or skin necrosis.

Conclusion

Treating intra-articular calcaneal fractures by minimally invasive technique is an excellent operative method for patients with diabetes mellitus, as this method can minimize soft tissue incision and resulting deep infection and skin necrosis.

Keywords: Intraarticular calcaneal fracture, Diabetes mellitus, Minimally invasive sinus tarsi approach

Figures and Tables

Fig. 1

(A) Initial ankle lateral X-ray and semicoronal CT scan of a 39 year-old man with inatraarticular calcaneal fracture demonstrating displaced lateral posterior facet fragment.

(B) Intra-operative photograph demonstrating posterior facet reduced with traction bow (left), and fixated with temporary 1.4 mm K-wires (right).

(C) Intra-operative lateral C-arm image demonstrating posterior facet reduced and stabilized with K-wire.

(D) At 12 months after operation, good alignment and union was achieved.

Table 1

Patients data

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