[Fractures of the anterior process of the calcaneus]

S Ochman, J Evers, M J Raschke
Operative Orthopädie und Traumatologie 2013, 25 (6): 579-91

OBJECTIVE: Anatomical repositioning of isolated fractures of the anterior process of the calcaneus. Internal fixation for sufficiently large fragment sizes, for small fragments and evidence of instability of the calcaneocuboid (CC) joint in association with Chopart luxation fractures, transfixation of the CC joint.

INDICATIONS: Dislocated fragments and intra-articular fractures (contraindication to open repositing: critical soft tissue relationships) and temporary stabilization for Chopart luxation fractures.

CONTRAINDICATIONS: Infections and peripheral arterial occlusive disease (pAOD).

SURGICAL TECHNIQUE: Supine position especially with accompanying injuries or placing in a side position for isolated fractures. Anterolateral access, fine repositioning by manipulation of the fragments with Kirschner wires, control of joint repositioning, definitive internal fixation with small fragments or miniscrews. For fragments not to be addressed, resection if necessary and transfixation with Kirschner wires.

POSTOPERATIVE MANAGEMENT: Movement exercises of the ankle joint from postoperative day 1. From day 2 mobilization with partial loading of the affected leg with 20 kg for 6-8 weeks. After transfixation, removal of the wires after 6 weeks and gradually increased loading. After subsidence of postoperative edema, patients can wear their own shoes or if necessary use a walker.

RESULTS: Isolated fractures of the the anterior process of the calcaneus are rare and often initially overlooked injuries of the foot. In the literature there are only few case descriptions. From November 2009 to June 2011 a total of 5 isolated dislocated fractures of the anterior process with large fragments (type III), of which 3 were initially overlooked, were treated by osteosynthesis. In all cases the exact diagnosis could only be confirmed by computed tomography. In the follow-up after 2 years and 5 months all patients showed consolidation of the fractures, especially those with delayed therapy. Clinically all patients had recovered full function with no evidence of posttraumatic arthrosis. In this small case series extended diagnostics in cases of suitable fracture mechanisms seems to be reasonable in order not to overlook rare fractures of the calcaneus. Operative therapy by anatomical repositioning and internal fixation of fractures of the anterior process of the calcaneus is a suitable therapy for treatment of these rare injuries.

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