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

Sueng-Hwan Jo; Jun-Young Lee; Sang-Ho Ha; Sung-Won Cho; Sang-Ha Park

doi:10.12671/jkfs.2013.26.2.126

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Jo, Lee, Ha, Cho, and Park: The Result Treated by Open Reduction and Internal Fixation with Minimally Invasive Technique in Joint Depressive Calcaneal Fracture

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2013; 26(2): 126-132.

Published online: 22 April 2013

DOI: https://doi.org/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

Sueng-Hwan Jo, M.D., Jun-Young Lee, M.D., Sang-Ho Ha, M.D., Sung-Won Cho, M.D., Sang-Ha Park, 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, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, leejy88@chosun.ac.kr

Received 19 July 2012 Revised 17 September 2012 Accepted 14 January 2013

(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

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 (Böhler 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 7.9° to 19.8° in the Böhler 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.

Keywords: Calcaneus fracture, Joint depressive Intra-articular fracture, Minimally invasive technique

Figures and Tables

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.

Fig. 2

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

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.

Table 1

Dermographic Data of the Patients

F/U: Follow up.

Table 2

Dermographic Data of the Patients Classified by Cause and Accompanied Injury

Table 3

The Result of Radiologic Assessment

Table 4

The Result of Clinical Assessment of AOFAS Score and VAS

AOFAS: American Orthopaedic Foot and Ankle Society, VAS: Visual Analog Scale.

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