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[Open reduction and plate fixation (ORIF LCP) for treatment of bilateral calcaneal fractures]

J Zeman, J Matějka, T Matějka, M Salášek, P Zeman, P Nepraš
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca 2013, 80 (2): 142-7
23562259

PURPOSE OF THE STUDY: Calcaneal fractures are frequent injuries which may interfere with the patient's daily activities for a long time. They usually occur as the result of an axial load causing impaction of the talus into the calcaneus. They can also be bilateral. Falls and jumps from height are the most frequent causes.

MATERIAL AND METHODS: Between August 2005 and December 2011, the method of open reduction and internal fixation (ORIF) with a calcaneal locking compression plate (LCP) was used to treat 98 patients with 114 calcaneal fractures. Of these, 16 were bilateral fractures found in two women and 14 men. In each patient, plain lateral and axial X-ray films of the calcaneus were taken on the day of injury. Computer tomography (CT) scans in the sagittal, transverse and coronary planes were obtained. Based on these, the fractures were classified as type I to type IV according to the Sanders system. The patients with type II and type III calcaneal fractures were indicated for ORIF treatment. The results were evaluated using the Rowe score.

RESULTS: The most frequent cause of fracture was a fall or a jump from height, which was recorded in 81 patients. Bilateral fractures were found in 16 patients. Of the 98 patients, excellent results were in 31, good in 39, satisfactory in 20 and poor in eight patients, as assessed with the Rowe score. Unilateral fractures achieved excellent results in 28, good in 35, satisfactory in 15 and poor in four patients. The results in bilateral fractures were excellent in three, good in four, satisfactory in five and poor in four patients. Early post-operative complications were recorded in a total of 24 patients, of whom 13 had unilateral and 11 had bilateral fractures.

DISCUSSION: The Sanders classification based on CT examination is used as an indication scheme in our department. Type II and type III fractures are indicated for ORIF treatment. A calcaneal LCP and an extended lateral approach are preferred. This allows for an almost perfect view of the fracture, an accurate reduction of the subtalar and calcaneocuboid joints and a stable internal fixation. In the patients with bilateral fractures, the occurrence of complications, multiple trauma and associated injuries was significantly higher. Also, they had less satisfactory results than the patients with unilateral fractures.

CONCLUSIONS: The surgical treatment of intra-articular fractures using open reduction from the extended lateral approach and internal fixation with a calcaneal LCP has achieved good results. CT scans are necessary for the diagnosis, fracture classification and indication for a surgical procedure. The timing of surgery plays a decisive role. Open fractures and fractures associated with severe soft tissue injury are treated urgently, other fractures at an appropriate time. Our results showed a significantly higher rate of complications in the patients with bilateral calcaneal fractures, as compared with the patients with unilateral fractures, as well as less satisfactory outcomes. High-energy trauma resulting in bilateral fractures predisposes to comminuted fractures with dislocation, which leads to more serious damage to subtalar joint function.

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