Abstract
Intra-articular calcaneal fractures represent an ongoing challenge for the orthopedic
community, with the benefits of the previous “gold standard” treatment of open reduction
and internal fixation having been called into question in several large randomized
controlled trials. Fine wire circular fixation may represent a useful alternative
treatment for these injuries, combining minimally invasive application with rigid
fixation, which allows the possibility of early weight bearing We performed a systematic
review of published studies that used circular fixation for calcaneal fractures and
recorded functional outcomes at follow-up. In a total of 11 studies with 255 calcaneal
fractures for which there was follow-up, our inclusion criteria were met: 8.2% of
fractures were bilateral, 11.9% of fractures were open fractures, and 12.6% of patients
had multiple orthopedic injuries. Functional outcomes were assessed with the use of
a variety of tools across the different studies, but outcomes compared favorably with
those seen with open reduction and internal fixation. Although pin site infections
were common (22.6%), serious complications, including deep infection (0.8%), wound
infection (1.6%), and complex regional pain syndrome (0.8%), were exceedingly rare.
The results suggest that this is a viable alternative treatment for calcaneal fractures,
but higher-quality randomized controlled trials are required before the technique
can enter mainstream use.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Calcaneal fractures in the industrial patient.Foot Ankle Int. 2000; 21: 896‒905
- Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures.Foot Ankle Int. 1998; 19: 856‒861
- Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures.J Orthop Trauma. 1999; 13: 369‒372
- Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures.J Bone Joint Surg Am. 2002; 84: 1733‒1744
- Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective randomized controlled multicenter trial.J Bone Joint Surg Am. 2013; 95: 1351‒1357
- Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial.BMJ. 2014; 349: 4483
- Operative versus nonoperative treatment for displaced intra-articular calcaneal fractures: a meta-analysis of randomized controlled trials.J Foot Ankle Surg. 2016; 55: 816‒823
- Sinus tarsi approach (STA) versus extensile lateral approach (ELA) for treatment of closed displaced intra-articular calcaneal fractures (DIACF): a meta-analysis.Orthop Traumatol Surg Res. 2018; 104: 239‒244
- Outcome of minimally invasive and percutaneous techniques for repair of calcaneal fractures: a systematic review.J Foot Ankle Surg. 2016; 55: 1256‒1263
- Calcaneal fracture controversies. Can we put Humpty Dumpty together again?.Orthop Clin N Am. 1989; 20: 665‒677
- Closed reduction and external fixation of calcaneus fractures and tarsometatarsal fracture-dislocations using the Ilizarov apparatus.Unfallchirurg. 1992; 95 ([in German]): 541‒546
- Ilizarov treatment of severely comminuted calcaneus fractures and crush injuries of the foot.Techn Orthop. 1996; 11: 174‒181
- The use of Ilizarov technique and other types of external fixation for the treatment of intra-articular calcaneal fractures.Clin Podiatr Med Surg. 2006; 23: 343‒353
- The Ilizarov apparatus in the treatment of thalamic fractures of the calcaneus.Italian J Orthop Trauma. 1989; 15: 302‒314
- Open reduction and circular external fixation of intraarticular calcaneal fractures.Clin Orthop Rel Res. 1993; 290: 125‒131
- Reduction techniques with Ilizarov frame for calcaneal fractures.Techn Orthop. 2002; 17: 185‒196
- Management of displaced intraarticular calcaneal fractures by using external ring fixation, minimally invasive open reduction and early weightbearing.J Foot Ankle Surg. 2004; 43: 43‒50
- A modified technique for the treatment of intra-articular calcaneal fractures with the use of the Ilizarov apparatus.Eur J Orthop Surg Traumatol. 2005; 15: 122‒128
- Calcaneal fractures: indirect reduction and external fixation.Foot Ankle Int. 2006; 27: 494‒499
- Early experience in the management of fractures of the calcaneus by Ilizarov external fixation.Med J Cairo Univ. 2009; 77: 279‒285
- Management of calcaneal fractures using the Ilizarov external fixator.Acta Orthop Belg. 2009; 75: 51‒56
- The use of circular fine wire frames for the treatment of displaced intra-articular calcaneal fractures.J Orthop Traumatol. 2009; 10: 9‒15
- Closed reduction of displaced intra-articular calcaneal fractures using Ilizarov frame.J Limb Lengthening Reconstr. 2017; 3: 57‒64
- Management of calcaneal fracture using the Ilizarov technique.Clin Orthop Rel Res. 2004; 439: 215‒220
- Calcaneal fractures: indirect reduction and external Ilizarov Fixator.Orthop Proc. 2011; 93-B: 125
- Joint preservation of the osteoarthritic ankle using distraction arthroplasty.Foot Ankle Int. 2009; 30: 318‒325
- Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle?.J Bone Joint Surg Br. 1995; 77: 720‒725
- Bohler's angle in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study.BMC Surg. 2013; 13: 40
- Subtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter? Surgical technique.J Bone Joint Surg Am. 2010; 92: 32‒43
- Early weight bearing of calcaneal fractures fixated with locked plates: a radiographic review.Foot Ankle Spec. 2010; 3: 320‒323
- Early weight bearing of calcaneal fractures treated by intraoperative 3D-fluoroscopy and locked-screw plate fixation.Open Orthop J. 2009; 3: 69‒74
- Weight-bearing recommendations after operative fracture treatment-fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole.Int Orthop. 2017; 41: 1507‒1512
- A new continuous gait analysis system for ankle fracture aftercare.Unfallchirurg. 2018; 121: 293‒299
- Weight bearing compliance after foot and ankle surgery.Foot Ankle Orthop. 2016; 1
- Treatment of bilateral open calcaneal fractures with Ilizarov frames.Injury. 2005; 36: 1488‒1490
- Treatment of ipsilateral high energy tibial plateau and calcaneal fractures by a circular wire fixator: a case report.Cases J. 2009; 2: 7869
- The below-the-ankle circular frame: a new technique for the treatment of displaced calcaneal fractures.J Foot Ankle Surg. 2006; 45: 295‒299
- Anatomic considerations for safe placement of calcaneal pins.Clin Orthop Relat Res. 1996; 332: 254‒259
- A cadaveric study of the medial relations of the calcaneum.Foot Ankle Surg. 2000; 6: 169‒173
- The “safe zone” in medial percutaneous calcaneal pin placement.Clin Anat. 2009; 22: 523‒529
- Calcaneal traction pin placement simplified: a cadaveric study.Foot Ankle Int. 2011; 32: 651‒655
- Circular frame fixation for calcaneal fractures risks injury to the medial neurovascular structures: a cadaveric description.Injury. 2016; 47: 2700‒2705
- Monoaxial external fixation of the calcaneus: an anatomical study assessing the safety of monoaxial pin insertion.Injury. 2016; 47: 2091‒2096
- Postoperative complications after closed calcaneus fracture treated by open reduction and internal fixation: a review.J Intern Med Res. 2014; 42: 17‒25
- External fixation for displaced intra-articular fractures of the calcaneum.J Bone Joint Surg Br. 2006; 88: 1474‒1479
- Heel displaced intra-articular fractures treated with mini-calcaneal external fixator.Injury. 2014; 45: 64‒71
- Temporising external fixation of calcaneus fractures prior to definitive plate fixation: a case series.Injury. 2015; 46: 19‒22
- Medial external fixation for staged treatment of closed calcaneus fractures: surgical technique and case series.J Orthop Surg. 2017; 25: 1‒8
- Treatment of displaced intra-articular calcaneal fractures with triangular tube-to-bar external fixation: Long-term clinical follow-up and radiographic analysis.Clin Podiatr Med Surg. 2008; 25: 285‒299
- The treatment of intra-articular calcaneus fractures with severe soft tissue damage with a hinged external fixator or internal stabilization: long-term results.J Foot Ankle Surg. 2010; 49: 8‒15
- Early clinical and radiographic outcomes after treatment of displaced intra-articular calcaneal fractures using delta-frame external fixator construct.J Foot Ankle Surg. 2011; 50: 135‒140
- Treatment of displaced intra-articular calcaneal fractures with combined transarticular external fixation and minimal internal fixation.Foot Ankle Int. 2013; 34: 91‒98
- Technique for minimally invasive reduction of calcaneal fractures using small bilateral external fixation.J Foot Ankle Surg. 2014; 53: 376‒382
Article info
Publication history
Published online: May 23, 2019
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.
