Advertisement

Circular External Fixator Assisted Open Reduction Combined With Locking Plate Fixation for Intra-articular Comminuted Fractures of the Calcaneus

Published:November 02, 2022DOI:https://doi.org/10.1053/j.jfas.2022.10.009

      ABSTRACT

      Comminuted fractures of the calcaneus are relatively common and generally require surgical treatment. The quality of fracture reduction is crucial. The extended lateral approach (ELA) can better expose the fracture end and facilitate the reduction of the fracture, while it has a higher risk of postoperative skin complications. In this study, the ELA was adopted, and the calcaneal comminuted fractures were treated with circular external fixator assisted reduction to achieve the purpose of good reduction of the fracture and fewer skin complications. During 64 months, a total of 61 cases of unilateral calcaneal fractures were treated by the same surgeon and followed up for 19.28 ± 5.28 months. During the operation, a circular external fixator was employed to fix the midfoot and the distal end of the tibia, and the calcaneal tubercle; then, the calcaneal tubercle was distracted to restore the 3-dimensional structure of the calcaneus. The ELA was utilized to reduce the articular surface fracture. The fracture was fixated with a locking plate. Postoperative radiographs were regularly reviewed. Meanwhile, Böhler's angle and Gissane's angle were measured. Visual analogue scale and American Orthopedic Foot and Ankle Society Score assessments were performed at the final follow-up. All fractures healed. The mean preoperative Böhler's angle was 9.3 ± 10.1 degrees; the mean Gissane's angle was 110.5 ± 14.7 degrees; the immediate postoperative mean Böhler's angle was 31.3 ± 5.5 degrees; mean Gissane's angle was 110.9 ± 5.9 degrees. Local superficial necrosis of surgical incision occurred in 2 cases, which healed well after dressing changes. Skin necrosis appeared in 1 case, where debridement and local flap transfer were performed. At the final follow-up, the mean visual analogue scale score was 1.48 ± 1.30, and the mean American Orthopedic Foot and Ankle Society Score was 90.16 ± 7.19. The ELA combined with a circular external fixator to assist in the reduction of calcaneal fractures achieved good reduction quality and effectively reduced postoperative complications.

      Keywords

      Level of Clinical Evidence

      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 access
      One-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 Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Scammell BE.
        Calcaneal fractures.
        BMJ. 2014; 349: g4779
        • Griffin D
        • Parsons N
        • Shaw E
        • Kulikov Y
        • Hutchinson C
        • Thorogood M
        • Lamb SE
        • Investigators UKHFT
        Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomized controlled trial.
        BMJ. 2014; 349: g4483
        • Veltman ES
        • Doornberg JN
        • Stufkens SA
        • Luitse JS
        • van den Bekerom MP.
        Long-term outcomes of 1,730 calcaneal fractures: systematic review of the literature.
        J Foot Ankle Surg. 2013; 52: 486
        • De Boer AS
        • Van Lieshout EM
        • Den Hartog D
        • Weerts B
        • Verhofstad MH
        • Schepers T
        Functional outcome and patient satisfaction after displaced intra-articular calcaneal fractures: a comparison among open, percutaneous, and nonoperative treatment.
        J Foot Ankle Surg. 2015; 54: 298
        • Su Y
        • Chen W
        • Zhang T
        • Wu X
        • Wu Z
        • Zhang Y.
        Bohler's angle's role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study.
        BMC surgery. 2013; 13: 40
        • Persson J
        • Peters S
        • Haddadin S
        • O'Loughlin PF
        • Krettek C
        • Gaulke R.
        The prognostic value of radiologic parameters for long-term outcome assessment after an isolated unilateral calcaneus fracture.
        Technol Health Care. 2015; 23: 285
        • Grun W
        • Molund M
        • Nilsen F
        • Stodle AH.
        Results after percutaneous and arthroscopically assisted osteosynthesis of calcaneal fractures.
        Foot Ankle Int. 2020; 41: 689
        • Cao L
        • Weng W
        • Song S
        • Mao N
        • Li H
        • Cai Y
        • Zhou Q
        • Su J
        Surgical treatment of calcaneal fractures of Sanders type II and III by a minimally invasive technique using a locking plate.
        J Foot Ankle Surg. 2015; 54: 76
        • Dayton P
        • Feilmeier M
        • Hensley NL.
        Technique for minimally invasive reduction of calcaneal fractures using small bilateral external fixation.
        J Foot Ankle Surg. 2014; 53: 376
        • Borowsky KA.
        Two case reports of a technique of medial external fixation in calcaneal fractures: indirect control of the sustentacular fragment.
        Foot Ankle Int. 1996; 17: 210
        • Elgamal TA
        • Tanagho AE
        • Ferdinand RD.
        Temporary external fixation facilitates open reduction and internal fixation of intra-articular calcaneal fractures.
        Acta orthopaedica Belgica. 2013; 79: 738
        • Yao H
        • Lu H
        • Zhao H
        • Lv L
        • Hou G.
        Open reduction assisted with an external fixator and internal fixation with calcaneal locking plate for intra-articular calcaneal fractures.
        Foot Ankle Int. 2017; 38: 1107
        • Sanders R
        • Fortin P
        • DiPasquale T
        • Walling A.
        Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification.
        Clin Orthop Relat Res. 1993; 87: 87-95
        • Bibbo C
        • Ehrlich DA
        • Nguyen HM
        • Levin LS
        • Kovach SJ.
        Low wound complication rates for the lateral extensile approach for calcaneal ORIF when the lateral calcaneal artery is patent.
        Foot Ankle Int. 2014; 35: 650
        • De Groot R
        • Frima AJ
        • Schepers T
        • Roerdink WH.
        Complications following the extended lateral approach for calcaneal fractures do not influence mid- to long-term outcome.
        Injury. 2013; 44: 1596
        • Biggi F
        • Di Fabio S
        • D'Antimo C
        • Isoni F
        • Salfi C
        • Trevisani S
        Percutaneous calcaneoplasty in displaced intraarticular calcaneal fractures.
        J Orthop Traumatol. 2013; 14: 307
        • Sivakumar BS
        • Wong P
        • Dick CG
        • Steer RA
        • Tetsworth K.
        Arthroscopic reduction and percutaneous fixation of selected calcaneus fractures: surgical technique and early results.
        J Orthop Trauma. 2014; 28: 569
        • Wallin KJ
        • Cozzetto D
        • Russell L
        • Hallare DA
        • Lee DK.
        Evidence-based rationale for percutaneous fixation technique of displaced intra-articular calcaneal fractures: a systematic review of clinical outcomes.
        J Foot Ankle Surg. 2014; 53: 740
        • Zhang T
        • Su Y
        • Chen W
        • Zhang Q
        • Wu Z
        • Zhang Y.
        Displaced intra-articular calcaneal fractures treated in a minimally invasive fashion: longitudinal approach versus sinus tarsi approach.
        J Bone Joint Surg Am. 2014; 96: 302
        • Wang C
        • Xu C
        • Li M
        • Li H
        • Xiao H
        • Zhong D
        • Liu H.
        Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: a retrospective study.
        BMC Musculoskelet Disord. 2020; 21: 407
        • Jimenez-Almonte JH
        • King JD
        • Luo TD
        • Aneja A
        • Moghadamian E.
        Classifications in brief: sanders classification of intraarticular fractures of the calcaneus.
        Clin Orthop Relat Res. 2019; 477: 467
        • McGarvey WC
        • Burris MW
        • Clanton TO
        • Melissinos EG.
        Calcaneal fractures: indirect reduction and external fixation.
        Foot Ankle Int. 2006; 27: 494
        • Gür E
        • Ateşalp S
        • Başbozkurt M
        • Aydoğan N
        • Erler K.
        Treatment of complex calcaneal fractures with bony defects from land mine blast injuries with a circular external fixator.
        Foot Ankle Int. 1999; 20: 37
        • Zgonis T
        • Roukis TS
        • Polyzois VD.
        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
        • Wang B
        • Zhang X
        • Huo Y
        • Liu W
        • Wang W
        • Shao X.
        Calcaneal lengthening for partial traumatic loss of the calcaneus.
        Injury. 2019; 50: 796
        • Isaacs JD
        • Baba M
        • Huang P
        • Symes M
        • Guzman M
        • Nandapalan H
        • Moopanar T
        • Marchalleck S
        • Szomor Z.
        The diagnostic accuracy of Bohler's angle in fractures of the calcaneus.
        J Emerg Med. 2013; 45: 879
        • Singh AK
        • Vinay K.
        Surgical treatment of displaced intra-articular calcaneal fractures: is bone grafting necessary?.
        J Orthop Traumatol. 2013; 14: 299
        • Makki D
        • Alnajjar HM
        • Walkay S
        • Ramkumar U
        • Watson AJ
        • Allen PW.
        Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases.
        J Bone Joint Surg Br. 2010; 92: 693
        • Clare MP
        • Crawford WS.
        Managing complications of calcaneus fractures.
        Foot Ankle Clin. 2017; 22: 105
        • Yu X
        • Pang QJ
        • Chen L
        • Yang CC
        • Chen XJ.
        Postoperative complications after closed calcaneus fracture treated by open reduction and internal fixation: a review.
        J Int Med Res. 2014; 42: 17
        • Hyer CF
        • Atway S
        • Berlet GC
        • Lee TH.
        Early weight bearing of calcaneal fractures fixated with locked plates: a radiographic review.
        Foot Ankle Spec. 2010; 3: 320
        • Johal HS
        • Buckley RE
        • Le IL
        • Leighton RK.
        A prospective randomized controlled trial of a bioresorbable calcium phosphate paste (alpha-BSM) in treatment of displaced intra-articular calcaneal fractures.
        J Trauma. 2009; 67: 875
        • Rak V
        • Ira D
        • Masek M.
        Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications.
        Indian J Orthop. 2009; 43: 271