Top PDF Short term outcome of open reduction and internal fixation with plating in displaced intra articular calcaneal fractures

Short term outcome of open reduction and internal fixation with plating in displaced intra articular calcaneal fractures

Short term outcome of open reduction and internal fixation with plating in displaced intra articular calcaneal fractures

dimensional anatomy of calcaneus and various classification schemes were propounded. Bohler and Essex-Lopresti were instrumental in explaining the anatomical and surgical prospects in the calcaneum fractures. With the fascinating advances in diagnostics like computer tomography, these fractures can now be analyzed and classified in a much better way. A computer tomography-based classification propounded by Sanders is commonly used nowadays. Due to refining of the meticulous surgical techniques, the surgical methods are now being routinely adopted for the management of these fractures. However, it is well accepted that there is a long learning curve. 4 Currently, open reduction and internal
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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

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

operative treatment when Böhler’s angle was optimally restored >10 degrees [25]. Slightly different from Paul’s study, Buckley et al. reported a markedly good functional outcome at a long-term follow ups in patients with re- stored Böhler’s angle >15 degrees in both operative and conservative group [20]. In Makki’s study, restoration of Böhler’s angle ≥30 degrees was associated with a better outcome based upon the data of 47 patients [24]. And vice versa, poor functional outcome can be seen in pa- tients without restoration of Böhler’s angle. Janzen et al. reported that a loss of Böhler’s angle measured at follow ups was associated with a poor clinical outcome [30]. Paley and Hall [31] found that the ratio of Böhler’s angle of the injured side to the normal side was significantly lower in patients with unsatisfactory outcomes and con- cluded that a decrease in this ratio was a negative prog- nostic factor. However, Hutchinson, Kundel, Ibrahim and Mauffrey held the opposite opinion that there was no correlation at all between Böhler’s angle measured at follow-ups and the final functional outcomes in neither operative nor conservative group [14,22,26,32]. More interestingly, Loucks et al. reported that although Böhler’s
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Original Article Assessment of the curative effects of open reduction and internal fixation with bone grafting on calcaneal displaced intra-articular fractures

Original Article Assessment of the curative effects of open reduction and internal fixation with bone grafting on calcaneal displaced intra-articular fractures

Abstract: Objective: The aim of this study was to compare the curative effects between open reduction and internal fixation with bone grafting and non-surgical treatment of calcaneal displaced intra-articular fractures. Methods: Data concerning 113 patients with closed calcaneal fractures, treated in Dongying People’s Hospital from February 2011 to January 2013, were retrospectively analyzed. Specifically, there was complete follow up data for 79 of the patients, in accord with inclusion criteria. Patients were divided into two groups based on different modes of treat- ment, including 37 cases in the surgical treatment group and 42 cases in the non-surgical treatment group. After treatment, patients were followed up in the clinic and Imaging Department for at least five years, until January 12, 2018. Patient foot function recovery was assessed with ankle hindfoot scores of American Orthopaedic Foot & Ankle Society (AOFAS). Bohler and Gissane angles were measured by reexamining lateral X-ray films of calcaneus. Post-treatment near-term complications (incision infections or necrosis of surrounding skin and plantar fascial com- partment syndrome) and long-term complications (subtalar arthritis) were recorded in detail. Results: Differences between the baseline data (sex ratio, age, Sanders typing, Bohler angle, Gissane angle, injury cause, etc.) of the two groups of patients were not statistically significant (all P>0.05). One year after treatment and at the time of last follow up, the surgical group’s Bohler and Gissane angles were superior to those of the non-surgical group, with statistically significant differences (all P<0.05). One year after treatment and at the time of last follow up, AOFAS ankle hindfoot scores of both groups increased compared with those upon admission, with statistically significant differences (all P<0.05). Moreover, AOFAS scores of the surgical group were higher than the non-surgical group, with statistically
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Extensile lateral versus sinus tarsi approach for displaced, intra-articular calcaneal fractures: a meta-analysis

Extensile lateral versus sinus tarsi approach for displaced, intra-articular calcaneal fractures: a meta-analysis

In December 2016, a search was conducted on the PubMed and MEDLINE databases using the keywords displaced intra-articular calcaneal fracture, open reduc- tion and internal fixation, sinus tarsi approach, extensile lateral approach, minimally invasive and percutaneous. The references of the articles found were also reviewed to identify additional studies for inclusion. Studies were included in the meta-analysis if they met the following criteria: (1) sample population at skeletal maturity, (2) sample size > 1 (i.e. not a case study) and (3) investigated outcome measures (both quantitative and qualitative) between ORIF and minimally invasive fixation. Studies that included patients with bilateral or concurrent injur- ies secondary to trauma were not excluded from the meta-analysis due to the high rate of associated injuries
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Comparative study of operative and non operative management of intra- articular calcaneal fractures – a prospective study

Comparative study of operative and non operative management of intra- articular calcaneal fractures – a prospective study

Introduction: Calcaneum is the most frequently fractured tarsal bone. These fractures result in long term disability with potential economic impact on the patient. Historically treatment of intra articular calcaneum fractures has varied from non-operative management with or without closed reduction to open reduction with internal fixation by various surgical approaches to primary Arthrodesis. In the past two decades with advent of CT scan, better implants and improved methods of fixation Operative treatment has now gained much popularity.
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Funcutional Outcome of Intra-Articular Joint Depressed Fractures of Calcaneum Treated by Lateral Plating- A Case Series of 35 Patients Followed For an Average Duration of 24 Months

Funcutional Outcome of Intra-Articular Joint Depressed Fractures of Calcaneum Treated by Lateral Plating- A Case Series of 35 Patients Followed For an Average Duration of 24 Months

(a) Patient Selection: This is a retrospective review of case series 30 intra-articular joint depressed fractures of calcaneum that came to our institute from April,2013 to August,2016. All the patients had joint depressed type of fracture according to Essex-Lopresti classification and had Sander’s type ranging from Type 1 to Type 4.There were 27 males and 3 females with age range from 20-60 years. All the injuries were due to road traffic accident {RTA}.32 fractures were closed and 3 were compound Grade 1 (Gustilo- Anderson type). 21 patients had right sided calcaneal fracture whereas 11 patients had left side and 3 patient had bilateral calcaneal fracture. The mean time from injury to surgery was 5 days after confirming the “wrinkle test”. All the patients were operated by open reduction and internal fixation with a plate. Patients with more than 3 week old or general conditions precluding surgery were excluded. The mean follow up duration was 24 months(range11 to 36 months). The procedure was performed in lateral position. A pre-operative planning after studying the x-rays {antero-posterior view, lateral view, Harris axial view(Fig 1(b)), Brodens view (Fig 1(a))}, CT scan and the 3-D reconstruction was done. The major fragments were labeled and the set of instruments
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Surgical treatment of displaced intra-articular calcaneal fractures: is bone grafting necessary?

Surgical treatment of displaced intra-articular calcaneal fractures: is bone grafting necessary?

The primary limitation of the present study is that it is a retrospective investigation, and not all of the patient details relating to operative time, blood loss, and pain severity were available. Despite these limitations, this study pro- vides evidence that the use of bone grafting along with internal fixation in the treatment of intra-articular calcaneal fractures leads to better restoration of Bohler’s angle and the prevention of late collapse. Thus, in intra-articular calcaneal fractures, if the space created after open reduc- tion is large, bone grafts may be considered as a treatment option. Also, in this study, patients with bone grafts were able to return to full weight-bearing earlier. However, the intermediate and long-term efficacy outcomes in the two groups were similar, which means that patients with intra- articular calcaneal fractures that are treated without bone grafting have functional outcomes as good as patients with such fractures that are treated with bone grafting.
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Operative versus non operative treatment for closed, displaced, intra articular fractures of the calcaneus : randomised controlled trial

Operative versus non operative treatment for closed, displaced, intra articular fractures of the calcaneus : randomised controlled trial

Surgical treatment of typical, closed, displaced calcaneal fractures does not improve outcome when compared with non-operative treatment, and leads to an increase in serious complications. We found no difference in patient reported outcome at two years between those treated by open reduction and internal fixation and those treated non-operatively. There was also no treatment effect on any of the secondary outcome measures at any time point, including subjective and objective measures, which reinforces our main result. We had anticipated benefit in at least some of these measures, but there were no differences in patient reported general health, quality of life, or ability to return to work. Ranges of movement of the injured hind foot were no different between treatment groups, and even heel width (a commonly suggested reason for surgery, to facilitate shoe fitting) was the same. Walking speed and five different metrics of gait also showed no difference at two years after injury.
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Minimally invasive reduction and percutaneous
fixation versus open reduction and internal
fixation for displaced intra articular calcaneal
fractures : a systematic review of the literature

Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra articular calcaneal fractures : a systematic review of the literature

The literature search identified three RCTs and six com- parative studies, which directly compared the results of the two methods of fixation. Basic demographic data of the included studies is summarized in Tables 1 and 2. All the studies were approved by the relevant ethics commit- tees and Institutional Review Board (IRB) of the individual institutions where they were performed and essential ethi- cal standards were followed. 13,14,16,18,22,30-33 Informed con-

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Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra Articular  Fractures

Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra Articular Fractures

Objectives: This study compared the clinical and radiological outcomes of two different methods for the treatment of distal radial intra-articular frac- tures. Patients and Methods: Forty-six patients with distal radius intra-arti- cular fractures were divided into two groups. Group I included 24 patients with type C fracture treated by external fixator augmented by percutaneous K-wires. Group II included 22 patients with type C fracture treated by volar locked distal radial plate augmented by K-wires. Two patients had complex injuries necessitating double plating (sandwich). All patients were evaluated clinically by Mayo Wrist Score and radiologically by Sarmiento’s radiological score. Results: Both groups reported good personal satisfaction according to Mayo Wrist Score, and the results were not statistically different between the two groups. In Group I, 19 patients (79.2%) had excellent radiological out- come and five patients (20.9%) had good radiological outcome according to Sarmiento’s radiological score. In Group II, 20 patients (90.9%) had excellent outcome, and two (9.1%) had good radiological outcome; there was no or in- significant deformity. Conclusions: Complex distal radial fractures can be treated either by external fixation (ligamentotaxis) or by locked pre-contoured plating. The clinical outcome of plating and external fixator in our study did not show any statistically significant difference. The radiological outcome had no correlation with the clinical outcome.
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Study of Functional Outcome in Calcaneal Fractures, Managed Conservatively and Open Reduction and Internal Fixation with Plate

Study of Functional Outcome in Calcaneal Fractures, Managed Conservatively and Open Reduction and Internal Fixation with Plate

used for classifying intra articular fractures.12 intra articular fractures(50%) which included Sanders type-I, poor local condition, medically unfit patients, peripheral vascular isease and patients who are unwilling for surgery have been treated conservatively with limb elevation and immobilization in plaster for 8 weeks. 12 intra articular fractures(50%) were fixed internally under fluoroscopic guidance on an average in 10 days of injury once wrinkle sign is positive. The aim of treatment was to achieve articular surface reconstruction, to restore height, width of axis of heel by performing primary osteosynthesis
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Comparison of two surgical approaches for displaced intra articular calcaneal fractures: sinus tarsi versus extensile lateral approach

Comparison of two surgical approaches for displaced intra articular calcaneal fractures: sinus tarsi versus extensile lateral approach

Methods: This retrospective cohort study was performed from 2004 to 2011. Open reduction and internal fixation using the sinus tarsi and extensile lateral approach was studied in 100 cases (40 sinus tarsi and 60 extensile lateral) with displaced intra-articular calcaneal fractures. All patients were evaluated both clinically and radiologically. Results: Median Böhler and Gissane angle were improved to 26.5 degree (4.6 to 45), 115.5 degree (101.2 to 127.4) in the sinus tarsi group and 25.3 degree (3.7 to 44.6), 119.0 degree (73.5 to 145.6) in extensile lateral group at the final follow-up, respectively. Median calcaneal height, length, and width in the sinus tarsi and extensile lateral groups showed improvement to 45.1 mm (23.2 to 54.1), 75.9 mm (64.9 to 90.3), 37.6 mm (29.2 to 53.9) and 46.5 mm (32.7 to 59.5), 76.1 mm (67.3 to 97.9), 39.3 mm (29.2 to 47.8) at the final follow-up, respectively. Median AOFAS score was checked to 90 points (76 to 94) in the sinus tarsi group and 86 points (76 to 94) in the extensile lateral group at the final follow-up. No significant differences in clinical and radiologic outcomes were observed between the two groups. However, wound complication rate (13.3%) in the extensile lateral group was significantly higher compared to the sinus tarsi group ( p -value = 0.022).
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Analysis of functional outcome of Muller's Type A and C fractures distal femur using locking compression condylar plate: A Prospective study

Analysis of functional outcome of Muller's Type A and C fractures distal femur using locking compression condylar plate: A Prospective study

Fractures of the distal femur are complex injuries. They can produce significant long term disability. They account for 7% of all femoral fractures. If hip Fractures are excluded, 31% of femoral fractures involve distal portion. Although open reduction and internal fixation with plate and screws has Become a standard method of treatment for many types of fractures, the Management of comminuted, intra articular distal femoral fractures still remains Complex and challenging to the orthopaedic surgeon. Many of these fractures are the result of high energy trauma which generates severe soft tissue damage and articular and metaphyseal communition.
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Surgical Treatment of Calcaneal Comminuted Intrarticular Fractures: Long Term Follow Up

Surgical Treatment of Calcaneal Comminuted Intrarticular Fractures: Long Term Follow Up

The preferred treatment of the intra-articular fractures of the calcaneus is still controversial. While the conserva- tive treatment was the previous gold standard, open reduction and internal fixation by calcaneal plate became gradually more popular, although it is technically demanding. Recently more studies compared the two methods of treatment showing more advantage for the surgical treatment [5] [9].

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Internal plate fixation versus plaster in displaced complete articular distal radius fractures, a randomised controlled trial

Internal plate fixation versus plaster in displaced complete articular distal radius fractures, a randomised controlled trial

Methods/Design: This multicentre randomised controlled trial will randomise between open reduction and internal plate fixation (intervention group) and closed reduction and plaster immobilisation (control group). All consecutive adult patients from 18 to 65 years with a displaced intra-articular distal radius fracture (AO/OTA type C), which has been adequately reduced at the Emergency Department according to the Dutch National Guidelines, are eligible for inclusion in this study. The primary outcome is function and pain of the wrist assessed with the Patient-Rated Wrist Evaluation score (PRWE). Secondary outcomes are the Disability of the Arm, Shoulder and Hand score (DASH), pain, quality of life (SF-36), range of motion, grip strength, radiological parameters, complications, crossovers and cost-effectiveness of both treatments. A total of 90 patients will be included in this study.
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Physical Inactivity: A Social Burden

Physical Inactivity: A Social Burden

A prospective quantitative descriptive cohort study was carried out over 2 years, from January 2016 to January 2018, in all consecutive cases of closed displaced intra-articular fractures of calcaneum in skeletally mature patients that presented to the Department of Orthopaedics at Dr. R.N. Cooper muncipal general hospital, Juhu, Mumbai.. Out of total 30 cases of calcaneal fractures that were managed during the study period, 25 cases were eligible for the study and 20 cases were available for final follow up. Open calcaneal fractures, patients unwilling for the operative management, skeletally immature patients, cases managed conservatively were excluded from the study. Written informed consent was obtained from all patients to be managed with ORIF with LBCP. The data were recorded in proforma including: epidemiological information, fracture details from X-rays and CT scans, preoperative, perioperative, and postoperative details including wound condition.Fractures classified using sanders classification. Routine investigations carried out to get fitness for surgery. Patients underwent Open reduction and internal fixation with locking branched calcaneal plate through extensile lateral approach under spinal anaesthesia. Post- operative physiotherapy followed according to protocol. Patients will be followed up at 6 weekly interval until fracture union. Clinical evaluation done by using Maryland foot scoring system. Radiological evaluation done by using Boehlers angle and Critical angle of Gissane on Lateral radiographs of calcaneum. Functional outcome was recorded at every followup after 12 wks of surgery.
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Displaced Intra‑Articular Calcaneal Fractures Treated with Open Reduction and Internal fixation and Bone Void Filling with an Injectable Calcium Sulfate/Hydroxyapatite Bone Graft Substitute: A Series of 18 Patients

Displaced Intra‑Articular Calcaneal Fractures Treated with Open Reduction and Internal fixation and Bone Void Filling with an Injectable Calcium Sulfate/Hydroxyapatite Bone Graft Substitute: A Series of 18 Patients

iBONE VOID FILLER, BONESUPPORT AB, Lund, Sweden) in internal fixation of calcaneal fractures. Methods: The records of patients presenting with calcaneal fractures type Sanders III and IV and treated with internal fixation plus BGS were reviewed. Radiographs were analyzed using different measurements (including Böhler’s angle and calcaneal facet height). The clinical outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle‑Hindfoot Scale. Results: A total of 20 fractures were available for radiographic and clinical examination at a minimum follow‑up of 12 months. No decrease in Böhler’s angle was recorded in six fractures, a reduction of <5° in 6 and of more than 5° in 8 fractures. In all fractures, the BGS was completely resorbed at 12 months on radiographs. The AOFAS score was on an average 89.8 (range, 68–99) at 1‑year follow‑up and indicated an excellent outcome in 11, a good outcome in 8, and a fair outcome in 1 fracture. Conclusions: The study results support the use of an injectable, in situ hardening calcium sulfate/hydroxyapatite BGS in DIACFs. The BGS is easy and safe to use as an augment to open reduction and internal fixation.
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Original Article Minimally invasive reduction of the medial wall shortening and misalignment in calcaneal fractures with intraoperative percutaneous traction using an external fixator

Original Article Minimally invasive reduction of the medial wall shortening and misalignment in calcaneal fractures with intraoperative percutaneous traction using an external fixator

Abstract: Objective: To evaluate the outcomes of the application of intraoperative percutaneous traction using an external fixator for the reduction of medial wall shortening and misalignment in calcaneal fractures. Methods: From December 2011 to December 2013, 23 Sanders type III or type IV calcaneal fractures with medial wall shortening and misalignment in 22 patients were reduced with open reduction and internal fixation combined with intraopera- tive percutaneous traction. Bohler’s angle, Gissane’s angle, calcaneal height and calcaneal width were measured before surgery, after reduction with common technique and after reduction with the external fixator, respectively. At every follow-up visit, clinical outcomes were evaluated by the Maryland Foot Score. Results: Bohler’s angle, Gis- sane’s angle, calcaneal height and calcaneal width were improved after reduction with common technique (P < 0.05). Whereas, reduction with the external fixator improved Bohler’s angle, Gissane’s angle and calcaneal width further compared with reduction with common technique (P < 0.05). During the follow-up period, associate soft tissue-related complications were observed in one case. At the final follow-up visit, clinical outcomes of eleven of thirteen Sanders type III fractures (84.62%) and eight of ten Sanders type IV fractures (80%) were considered excel- lent or good according to the Maryland Foot Score. Conclusion: Intraoperative percutaneous traction using an exter- nal fixator represents a safe and effective method for the reduction of medial wall shortening and misalignment that cannot be well reduced through the lateral approach. The combined use of intraoperative percutaneous traction and open reduction and internal fixation through the extended lateral approach for complex displaced intra-articular calcaneal fractures ensures desirable clinical outcomes.
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Spontaneous ::union:: of Femoral Neck Stress Fracture without Surgery

Spontaneous ::union:: of Femoral Neck Stress Fracture without Surgery

Femoral neck fractures are serious injuries that are associated with high mortality and morbidity. Considerable controversy still exists for best treatment of non-displaced (Garden I and Garden II) fractures. Our case is a 34-year-old woman with Garden type II femoral neck fracture, who refused all surgical options and willingly ignored her problem. The patient received subcutaneous injections of 20 mcg Teriparatidefor 6 weeks. 3 months later she returned to our center with uneventful recovery of her fracture. Although rigid internal fixation of femoral neck fractures has long been the cornerstone of treatment, especially in non- impacted cases, non-operative management does not mean a poor result.
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Is Wound Complication a Deterrent to Lateral Extensile Approach in Calcaneus Fracture?

Is Wound Complication a Deterrent to Lateral Extensile Approach in Calcaneus Fracture?

Introduction: The lateral extensile approach has been a widely accepted sur- gical approach in treatment of intraarticular calcaneal fracture. It provides good exposure for fixation by correcting the hindfoot varus, fracture reduction and restores calcaneal height but it has a high wound complication rate. Methods and materials: 36 intraarticular calcaneal fractures (Sanders II, III and IV) treated using the lateral extensile approach in 34 patients presenting between 2015 and 2018 were retrospectively reviewed. Wound complication in the early stage (day 1 to day 3), intermediate (2 weeks) and late (6 weeks) were docu- mented. Results: We found early (Day 1 - Day 3) infection rate of 5.6%, in- termediate (2 weeks) at 17.6% and late wound complication (6 weeks) at 2.9%. Conclusion: Lateral expansile approach is a reliable surgical exposure for frac- ture reduction of calcaneal fractures with acceptable wound related complica- tion rate. Minimally invasive techniques and the sinus tarsi approach are be- ing used for less comminuted fractures, but those techniques are technically more demanding. Smoking, long duration of surgery and soft tissue handling also play a role in increasing wound complication rates.
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