The Treatment of Intra-articular Calcaneus Fractures with Severe Soft Tissue Damage with a Hinged External Fixator or Internal Stabilization: Long-term Results

Besch, Lutz; Waldschmidt, Jan Soeren; Daniels-Wredenhagen, Mark; Varoga, Deike; Mueller, Michael; Hilgert, Ralf-Erik; Mathiak, Guenther; Oestern, Stefanie; Lippross, Sebastian; Seekamp, Andreas

doi:10.1053/j.jfas.2009.07.019

« Previous Next »Journal of Foot and Ankle Surgery
Volume 49, Issue 1 , Pages 8-15, January 2010

The Treatment of Intra-articular Calcaneus Fractures with Severe Soft Tissue Damage with a Hinged External Fixator or Internal Stabilization: Long-term Results

Lutz Besch, MD, PhD
- Consultant Surgeons, Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Address correspondence to: Lutz Besch, MD, Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 7, 24105 Kiel, Germany.
Jan Soeren Waldschmidt, MD
- External Consultant, Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
Mark Daniels-Wredenhagen, MD, MA
- Resident, Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
Deike Varoga, MD, PhD
- Consultant Surgeons, Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
Michael Mueller, MD
- Consultant Surgeons, Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
Ralf-Erik Hilgert, MD
- External Consultant, Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
Guenther Mathiak, MD, PhD
- External Consultant, Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
Stefanie Oestern, MD
- Resident, Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
Sebastian Lippross, MD
- Resident, Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
Andreas Seekamp, MD, PhD
- Director, Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany

Abstract

We developed a hinged external fixator for the treatment of dislocated intra-articular calcaneus fractures with severe soft tissue damage. The external fixation was performed with a known external fixator system. The screw insertion points were biomechanically tested by defining a virtual rotation axis through the center of the talus to allow early active motion in the ankle joint. Long-term follow-up was performed after an average of 7.3 years. Results were graded with the American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographs were reviewed according to Sanders classification. Four open fractures and 33 cases with extremely swollen soft tissue, blisters, or compartment syndromes were treated. In 24 cases (64.9%), the hinged fixator was the final method of treatment (group I). A change to open reduction with internal fixation was performed in 13 fractures (35.1%) when soft tissue problems were minimal (group II). There were no late amputations, osteomyelitis, or malunions. According to Sanders classification, group I consisted of 14 type II, 8 type III, and 2 type IV fractures. Pin loosening or pin infection was seen in 4 cases, but there was no redislocation. The Böhler's angle improved in 43%, gaps in the posterior facet were closed in 41%, and any shortening or deviation of the axis was corrected in 82% of the cases. The AOFAS score for the group averaged 66.5. According to Sanders classification, group II consisted of 8 type II and 5 type III fractures. The Böhler's angle improved in 88%, and gaps in the posterior facet were closed in 87%. Any shortening or deviation of the axis was corrected in 95%, and the AOFAS score averaged 61.3. Significant differences in patient outcome scores between open reduction with internal fixation and hinged fixator were not found. P value was > .05. The hinged external fixator frame can be used in all calcaneus fracture types without soft tissue limitation. The hinged fixator allows early movement in the ankle joint, the risk of infection is minimized, and secondary plate fixation remains possible.

Level of Clinical Evidence: 2

Keywords: joint depression fracture, ORIF, outcome, surgery, trauma