Sanders Type IIC Tongue-Type Fractures of the Calcaneus: Is Percutaneous Surgery the Treatment of Choice? Short-Term Functional and Radiographic Evaluation
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Published:
Jun 25, 2022
Keywords:
Calcaneus, minimally invasive procedure, percutaneous treatment, fractures, approach, complications
Main Article Content
Abstract
Objective: Our research aims to describe the functional and radiographic outcomes and complications of percutaneous surgery in Sanders type IIC tongue-type calcaneal fractures.
Materials and Methods: 9 articular displaced calcaneus fractures in 9 patients were evaluated with lateral and anteroposterior radiographs and preoperative axial computerized tomography. Non-weight-bearing foot radiographs -lateral and anteroposterior- were taken in the immediate postoperative period, and weight-bearing radiographs were taken at the sixth and twelfth weeks, and when finishing follow-up. Böhler's angle was measured, and subtalar and calcaneocuboid osteoarthritis grade was quantified. The AOFAS score, wound complications, neurological injuries, and the need for additional surgeries such as hardware removal and subtalar arthrodesis were considered.
Results: 3 women and 6 men complied with follow-up during 21.1 months. The patients’ average age was 42, +-12. The preoperative Böhler angle was 7° (+-6.2°) and the final postoperative angle was 33.6° (+-4.1).(p<0.00001). Subtalar range of motion presented a minor restriction in every patient. Neither subtalar nor calcaneocuboid osteoarthritis was observed. The AOFAS score was good in 4 patients and excellent in 5 of them. 100% of the patients presented good and excellent outcomes. We did not record wound infections or complications.
Conclusion: Percutaneous surgery in Sanders type IIC tongue-type calcaneal fractures allows us to reach a significant reduction with good functional outcomes and minor soft-tissue complications.
Materials and Methods: 9 articular displaced calcaneus fractures in 9 patients were evaluated with lateral and anteroposterior radiographs and preoperative axial computerized tomography. Non-weight-bearing foot radiographs -lateral and anteroposterior- were taken in the immediate postoperative period, and weight-bearing radiographs were taken at the sixth and twelfth weeks, and when finishing follow-up. Böhler's angle was measured, and subtalar and calcaneocuboid osteoarthritis grade was quantified. The AOFAS score, wound complications, neurological injuries, and the need for additional surgeries such as hardware removal and subtalar arthrodesis were considered.
Results: 3 women and 6 men complied with follow-up during 21.1 months. The patients’ average age was 42, +-12. The preoperative Böhler angle was 7° (+-6.2°) and the final postoperative angle was 33.6° (+-4.1).(p<0.00001). Subtalar range of motion presented a minor restriction in every patient. Neither subtalar nor calcaneocuboid osteoarthritis was observed. The AOFAS score was good in 4 patients and excellent in 5 of them. 100% of the patients presented good and excellent outcomes. We did not record wound infections or complications.
Conclusion: Percutaneous surgery in Sanders type IIC tongue-type calcaneal fractures allows us to reach a significant reduction with good functional outcomes and minor soft-tissue complications.
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How to Cite
Seletti, M., & Baravalle, J. (2022). Sanders Type IIC Tongue-Type Fractures of the Calcaneus: Is Percutaneous Surgery the Treatment of Choice? Short-Term Functional and Radiographic Evaluation. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(3), 307-315. https://doi.org/10.15417/issn.1852-7434.2022.87.3.1504
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Clinical Research
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References
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https://doi.org/10.1053/j.jfas.2003.11.010
2. Tscherne H, Zwipp H. Calcaneal fractures. En: Tsherne H, Schatzker J. Major fractures of the pilon the talus and
the calcaneus: Current concepts in treatment. Berlin: Springer-Verlag; 1993:153.
3. Benirschke SK, Kramer PA. Wound healing complications in closed and open calcaneal fractures. J Orthop Trauma 2004;18:1-6. https://doi.org/10.1097/00005131-200401000-00001
4. Ebraheim NA, Elgafy H. Sinus tarsi approach with transarticular fixation for displaced intra-articular fractures of the calcaneus. Foot Ankle Int 2000;21:105-3. https://doi.org/10.1177/107110070002100203
5. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the anklehindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349–53. https://doi.org/10.1177/107110079401500701
6. 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(6):740-3. https://doi.org/10.1053/j.jfas.2014.03.018
7. 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;290:87–95. PMID: 8472475
8. Looijen RC, Misselyn D, Backes M. Identification of postoperative step-offs and gaps with Broden’s view following open reduction and internal fixation of calcaneal fractures. Foot Ankle Int 2019;40(7):797-802.
https://doi.org/10.1177/1071100719840812
9. Böhler L. Diagnosis, pathology, and treatment of fractures of the os calcis. J Bone Joint Surg 1931;13:75-89.
10. Weber M, Lehmann O, Sagesser D, Krause F. Limited open reduction and internal fixation of displaced
intraarticular fractures of the calcaneum. J Bone Joint Surg Br 2008;90:1608-16. https://doi.org/10.1302/0301-620x.90b12.20638
11. Paley D, Hall H. Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors. J
Bone Joint Surg Am 1993;75:342-54. https://doi.org/10.2106/00004623-199303000-00005
12. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection,
1999. Am J Infect Control 1999;27:97–134. https://doi.org/10.1086/501620
13. Buckley R, Tough S, McCormack PG, Leighton R, Petrie D, Galpin R. Operative compared with nonoperative
treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am 2002;84:1733–44. https://doi.org/10.2106/00004623-200210000-00001
14. Thordarson DB, Krieger LE. Operative vs. nonoperative treatment of intraarticular fractures of the calcaneus: A prospective randomized trial. Foot Ankle Int 1996;17:2-9. https://doi.org/10.1177/107110079601700102
15. Rammelt S, Heineck J, Barthel S, Zwipp H. Percutaneous fixation of intraarticular calcaneus fractures. Techn Foot Ankle Surg 2009;8:70-6. https://doi.org/10.1097/BTF.0b013e3181a77f71
16. Abdelgaid S. Closed reduction and percutaneous cannulated screws fixation of displaced intra-articular calcaneus fractures. Foot Ankle Surg 2012;18:164–79. https://doi.org/10.1016/j.fas.2011.07.005
17. DeWall M, Henderson C, McKinley T, Phelps T, Dolan L, Marsh JL. Percutaneous reduction and fixation of
displaced intra-articular calcaneus fractures. J Orthop Trauma 2010;24:466–76. https://doi.org/10.1097/bot.0b013e3181defd74
18. Rammelt S, Amlang M, Barthel S, Gavlik JM, Zwipp H. Percutaneous treatment of less severe intraarticular
calcaneal fractures. Clin Orthop Relat Res 2010;468(4):983-90. https://doi.org/10.1007/s11999-009-0964-x
19. Abidi NA, Dhawan S, Gruen GS, Vogt MT, Conti SF. Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures. Foot Ankle Int 1998;19:856–61. https://doi.org/10.1177/107110079801901211
20. Tornetta P 3rd. Percutaneous treatment of calcaneal fractures. Clin Orthop Relat Res 2000;375:91–6.
https://doi.org/10.1097/00003086-200006000-00011
21. Buch J, Blauensteiner W, Scherafati T, Vischer HM, Fischer W. Conservative treatment of calcaneus fracture versus repositioning and percutaneous bore wire fixation. A comparison of 2 methods. Unfallchirurg 1989;92:595–603. PMID: 2609162. [En alemán]
22. Schepers T. Sinus tarsi approach with screws-only fixation for displaced intra-articular calcaneal fractures. Clin
Podiatr Med Surg 2019;36(2):211–24. https://doi.org/10.1016/j.cpm.2018.10.004
23. Nelson JD, McIff TE, Moodie PG, Iverson JL, Horton GA. Biomechanical stability of intramedullary technique for fixation of joint depressed calcaneus fracture. Foot Ankle Int 2010;31:229–35. https://doi.org/10.3113/fai.2010.0229
24. Stulik J, Stehlik J, Rysavy M, Wozniak A. Minimally-invasive treatment of intra-articular fractures of the
calcaneum. J Bone Joint Surg Br 2006;88:1634–41. https://doi.org/10.1302/0301-620x.88b12.17379
25. Schepers T, Vogels LM, Schipper IB, Patka P. Percutaneous reduction and fixation of intraarticular calcaneal
fractures. Oper Orthop Traumatol 2008;20:168–75. https://doi.org/10.1007/s00064-008-1239-5
https://doi.org/10.1053/j.jfas.2003.11.010
2. Tscherne H, Zwipp H. Calcaneal fractures. En: Tsherne H, Schatzker J. Major fractures of the pilon the talus and
the calcaneus: Current concepts in treatment. Berlin: Springer-Verlag; 1993:153.
3. Benirschke SK, Kramer PA. Wound healing complications in closed and open calcaneal fractures. J Orthop Trauma 2004;18:1-6. https://doi.org/10.1097/00005131-200401000-00001
4. Ebraheim NA, Elgafy H. Sinus tarsi approach with transarticular fixation for displaced intra-articular fractures of the calcaneus. Foot Ankle Int 2000;21:105-3. https://doi.org/10.1177/107110070002100203
5. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the anklehindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349–53. https://doi.org/10.1177/107110079401500701
6. 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(6):740-3. https://doi.org/10.1053/j.jfas.2014.03.018
7. 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;290:87–95. PMID: 8472475
8. Looijen RC, Misselyn D, Backes M. Identification of postoperative step-offs and gaps with Broden’s view following open reduction and internal fixation of calcaneal fractures. Foot Ankle Int 2019;40(7):797-802.
https://doi.org/10.1177/1071100719840812
9. Böhler L. Diagnosis, pathology, and treatment of fractures of the os calcis. J Bone Joint Surg 1931;13:75-89.
10. Weber M, Lehmann O, Sagesser D, Krause F. Limited open reduction and internal fixation of displaced
intraarticular fractures of the calcaneum. J Bone Joint Surg Br 2008;90:1608-16. https://doi.org/10.1302/0301-620x.90b12.20638
11. Paley D, Hall H. Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors. J
Bone Joint Surg Am 1993;75:342-54. https://doi.org/10.2106/00004623-199303000-00005
12. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection,
1999. Am J Infect Control 1999;27:97–134. https://doi.org/10.1086/501620
13. Buckley R, Tough S, McCormack PG, Leighton R, Petrie D, Galpin R. Operative compared with nonoperative
treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am 2002;84:1733–44. https://doi.org/10.2106/00004623-200210000-00001
14. Thordarson DB, Krieger LE. Operative vs. nonoperative treatment of intraarticular fractures of the calcaneus: A prospective randomized trial. Foot Ankle Int 1996;17:2-9. https://doi.org/10.1177/107110079601700102
15. Rammelt S, Heineck J, Barthel S, Zwipp H. Percutaneous fixation of intraarticular calcaneus fractures. Techn Foot Ankle Surg 2009;8:70-6. https://doi.org/10.1097/BTF.0b013e3181a77f71
16. Abdelgaid S. Closed reduction and percutaneous cannulated screws fixation of displaced intra-articular calcaneus fractures. Foot Ankle Surg 2012;18:164–79. https://doi.org/10.1016/j.fas.2011.07.005
17. DeWall M, Henderson C, McKinley T, Phelps T, Dolan L, Marsh JL. Percutaneous reduction and fixation of
displaced intra-articular calcaneus fractures. J Orthop Trauma 2010;24:466–76. https://doi.org/10.1097/bot.0b013e3181defd74
18. Rammelt S, Amlang M, Barthel S, Gavlik JM, Zwipp H. Percutaneous treatment of less severe intraarticular
calcaneal fractures. Clin Orthop Relat Res 2010;468(4):983-90. https://doi.org/10.1007/s11999-009-0964-x
19. Abidi NA, Dhawan S, Gruen GS, Vogt MT, Conti SF. Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures. Foot Ankle Int 1998;19:856–61. https://doi.org/10.1177/107110079801901211
20. Tornetta P 3rd. Percutaneous treatment of calcaneal fractures. Clin Orthop Relat Res 2000;375:91–6.
https://doi.org/10.1097/00003086-200006000-00011
21. Buch J, Blauensteiner W, Scherafati T, Vischer HM, Fischer W. Conservative treatment of calcaneus fracture versus repositioning and percutaneous bore wire fixation. A comparison of 2 methods. Unfallchirurg 1989;92:595–603. PMID: 2609162. [En alemán]
22. Schepers T. Sinus tarsi approach with screws-only fixation for displaced intra-articular calcaneal fractures. Clin
Podiatr Med Surg 2019;36(2):211–24. https://doi.org/10.1016/j.cpm.2018.10.004
23. Nelson JD, McIff TE, Moodie PG, Iverson JL, Horton GA. Biomechanical stability of intramedullary technique for fixation of joint depressed calcaneus fracture. Foot Ankle Int 2010;31:229–35. https://doi.org/10.3113/fai.2010.0229
24. Stulik J, Stehlik J, Rysavy M, Wozniak A. Minimally-invasive treatment of intra-articular fractures of the
calcaneum. J Bone Joint Surg Br 2006;88:1634–41. https://doi.org/10.1302/0301-620x.88b12.17379
25. Schepers T, Vogels LM, Schipper IB, Patka P. Percutaneous reduction and fixation of intraarticular calcaneal
fractures. Oper Orthop Traumatol 2008;20:168–75. https://doi.org/10.1007/s00064-008-1239-5