Usefulness of Treatment with 6.5 mm Cancellous Screw and Steinmann Pin Fixation for Calcaneal Joint Depression Fracture

Gi-Soo Lee; Chan Kang; Deuk-Soo Hwang; Chang-Kyun Noh; Gi-Young Lee

doi:10.14193/jkfas.2015.19.1.11

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Lee, Kang, Hwang, Noh, and Lee: Usefulness of Treatment with 6.5 mm Cancellous Screw and Steinmann Pin Fixation for Calcaneal Joint Depression Fracture

Original Article

J Korean Foot Ankle Soc 2015;19(1):11-17.

Published online: 19 January 2015

DOI: https://doi.org/10.14193/jkfas.2015.19.1.11

Usefulness of Treatment with 6.5 mm Cancellous Screw and Steinmann Pin Fixation for Calcaneal Joint Depression Fracture

Gi-Soo Lee^*, Chan Kang, Deuk-Soo Hwang, Chang-Kyun Noh, Gi-Young Lee

Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea

^*Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea

Corresponding Author: Chan Kang Department of Orthopedic Surgery, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea Tel: 82-42-338-2438, Fax: 82-42-338-2482, E-mail: faschan@daum.net

Received 24 October 20148 January 2015 Accepted 9 February 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To report the radiographic and clinical results of 6.5 mm cancellous full threaded buttress screw or Steinmann pin fixation to maintain a reduction of calcaneal posterior facet depression fracture.

Materials and Methods:

From June 2009 to June 2012, 50 consecutive cases with calcaneal joint depression fracture that underwent open reduction and screw or pin fixation were enrolled in this study. A 6.5 mm cancellous full threaded screw was inserted from the posteroinferior aspect of the calcaneal tuberosity to the posterior facet (group A) or Steinman pin was inserted from the posterosuperior aspect of the calcaneal tuberosity to the calcaneocuboidal joint (group B). Both preoperative and postoperative Bohler and Gissane angles were measured radiographically, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale on the final follow-up were assessed.

Results:

The mean age of patients was 44.1 years, and the mean follow-up period was 27.2 months. According to the Sanders classification, 28 cases were type II and 22 cases were type III. In Sanders type II, Bohler and Gissane angles improved significantly from 10.1^° and 126.2^° preoperatively to 27.2^° and 117.1^°, respectively, in the immediate postoperative radiograph, and at the final follow-up, 26.6^° and 118.6^°, respectively. In Sanders type III, Bohler and Gissane angles improved significantly from 5.0^° and 129.8^° to 29.9^° and 119.3^°, respectively, in the immediate postoperative radiograph, and 26.9^° and 120.2^° at the final follow-up. All cases achieved bony union, and the average period until complete union was 13.3 weeks. AOFAS ankle-hindfoot scale was 82.6 in Sanders type II and 77.3 in Sanders type III at the final follow-up.

Conclusion:

A 6.5 mm cancellous full threaded buttress screw or Steinman pin fixation is a noninvasive treatment method with a merit of being able to maintain the bearing capacity of the posterior facet comparable to plate fixation.

Keywords: Calcaneus, Intra-articular fractures, 6.5 mm cancellous screw, Steinmann pin

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Figure 1.

Measurement of Bohler and Gissane angles. (A) Bohler angle is measured by the intersection of a line drawn from most cephalic point on tuberosity to highest point of posterior facet with a line from highest point of posterior facet to most cephalic part of posterior process of calcaneus. (B) Gissane angle is measured by the intersection of a line drawn from the highest point of the posterior articular facet to the highest point of the posterior tuberosity and a line from the former to the highest point on the anterior articular facet.

Figure 2.

Beginning from 2.5 cm superior to lateral malleolus tip, which is the midpoint between malleolus and Achilles tendon, the incision continues obliquely and distally toward 1 cm below the lateral malleolus tip, sinus tarsi, and dorsolateral aspect of the talonavicular joint.

Figure 3.

Operative method. (A) A 6.5 mm cancellous buttress screw should be inserted from posteroinferior aspect of calcaneal tuberosity to the posterior facet (arrow). (B) Steinmann pins should be inserted from posterosuperior aspect of calcaneal tuberosity to the calcaneocuboid joint (arrow).

Table 1.

Demographic Data of Patients

Variable	Group A	Group B	p-value
Number of patients	32	18
Mean age (yr)	44.5 (21∼63)	43.5 (24∼61)	0.593
Gender (male)	22	10	0.869
Affected foot (right)	14	9	0.612
Smoker	10	4	0.245

Values are presented as number or mean (range). Group A: a 6.5 mm cancellous full threaded screw inserted from the posteroinferior aspect of the calcaneal tuberosity to the posterior facet Group B: Steinman pin inserted from the posterosuperior aspect of the calcaneal tuberosity to the calcaneocuboidal joint.

Table 2.

Comparison between Preoperative and Postoperative Bohler and Gissane Angles in Sanders Type II Calcaneus Fractures (n=28)

Angle	Preoperative	Postoperative	Final follow-up	p-value^*	p-value^†
Bohler angle	10.1^°±4.4^°	27.2^°±2.2^°	26.6^°±2.5^°	0.009	0.845
Gissane angle	126.2^°±5.5^°	117.1^°±3.2^°	118.6^°±4.4^°	0.011	0.385

^* Values are presented as mean±standard deviation. Comparison between preoperative and postoperative Bohler and Gissane angles.

^† Comparison between postoperative and final follow-up Bohler and Gissane angles.

Table 3.

Comparison between Preoperative and Postoperative Bohler and Gissane Angles in Sanders Type III Calcaneus Fractures (n=22)

Angle	Preoperative	Postoperative	Final follow-up	p-value^*	p-value^†
Bohler angle	5.0^°±3.4^°	29.9^°±3.1^°	26.9^°±3.0^°	0.001	0.557
Gissane angle	129.8^°±9.5^°	119.3^°±8.7^°	120.2^°±12.0^°	0.004	0.985

Values are presented as mean±standard deviation. *Comparison between preoperative and postoperative Bohler and Gissane angles.

^† Comparison between postoperative and final follow-up Bohler and Gissane angles.

Table 4.

Comparison between Postoperative and Final Follow-up Bohler Angles for Group A and B in Sanders Classification Type II and III Calcaneus Fractures

Type	Group A (n=32)		Group B (n=18)
Type	Postoperative	Final follow-up	Postoperative	Final follow-up	p-value
Type II (n=28)	28.7^°±2.5^°	27.8^°±2.2^°	24.5^°±2.1^°	24.4^°±1.8^°	0.727
Type III (n=22)	32.9^°±4.7^°	28.7^°±3.5^°	24.7^°±3.9^°	23.7^°±7.5^°	0.825

Values are presented as mean±standard deviation. Group A: a 6.5 mm cancellous full threaded screw inserted from the posteroinferior aspect of the calcaneal tuberosity to the posterior facet; Group B Steinman pin inserted from the posterosuperior aspect of the calcaneal tuberosity to the calcaneocuboidal joint.

Table 5.

Comparison between Postoperative and Final Follow-up Gissane Angle of Group A and B in Sanders Classification Type II and III Calcaneus Fractures

Type	Group A (n=32)		Group B (n=18)
Type	Postoperative	Final follow-up	Postoperative	Final follow-up	p-value
Type II (n=28)	117.2^°±1.9^°	118.9^°±2.1^°	116.8^°±2.0^°	118.1^°±1.8^°	0.862
Type III (n=22)	118.9^°±2.0^°	120.7^°±2.5^°	120.0^°±6.0^°	119.3^°±5.8^°	0.740

Table 6.

Comparison of AOFAS Ankle-Hindfoot Scale between Group A and B in Sanders Classification Type II and III Calcaneus Fractures

Type	Group A (n=32)	Group B (n=18)	p-value
Type II (n=28)	82.5±4.6	82.7±5.8	0.960
Type III (n=22)	76.2±3.7	79.3±4.2	0.796

Values are presented as mean±standard deviation. Group A: a 6.5 mm cancellous full threaded screw inserted from the posteroinferior aspect of the calcaneal tuberosity to the posterior facet; Group B: Steinman pin inserted from the posterosuperior aspect of the calcaneal tuberosity to the calcaneocuboidal joint. AOFAS: American Orthopaedic Foot and Ankle Society.

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