Skip Navigation
Skip to contents

J Musculoskelet Trauma : Journal of Musculoskeletal Trauma

Search
Advanced Search
OPEN ACCESS
mobile search button mobile menu button

Articles

Page Path
HOME > J Musculoskelet Trauma > Volume 32(3); 2019 > Article
Original Article Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach
Hong Ki Park, Jae Yoon Ko, Seung Kwan Lee, Jong Min Baik
Journal of Musculoskeletal Trauma 2019;32(3):135-142.
DOI: https://doi.org/10.12671/jkfs.2019.32.3.135
Published online: July 31, 2019
Department of Orthopedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea. bbaik98@gmail.com

prev next
  • 41 Views
  • 0 Download
  • 1 Crossref
  • 0 Scopus
prev next
Full Article

Download PDF Download PDF

Abstract

PURPOSE
As the functional demands for activities in elderly patients are increasing according to their life extension, the need for surgical treatment is also increasing in elderly patients with displaced intra-articular calcaneal fractures. In addition to the extensile lateral approach (ELA), which is a surgical procedure that showed good results on intra-articular calcaneal fractures, the minimally invasive approach (MIA) also showed an outstanding result. This study compared the radiological and clinical results of intraarticular calcaneus fractures in elderly patients in two groups: ELA and MIA.
MATERIALS AND METHODS
Thirty patients aged over 65 years with intra-articular calcaneus fractures, who could be followed-up more than 14 months, were included in this study. Thirteen patients of the MIA group and 17 patients of the ELA group were analyzed retrospectively using radiological and clinical assessments.
RESULTS
No significant difference in union time, posterior facet reduction accuracy, subtalar osteoarthritis frequency, Bohler angle, calcaneal width, American Orthopaedic Foot and Ankle Society score, visual analogue scale score, 36-item short form survey, and foot function index was observed between the two groups. The p-value of the average height of the calcaneus correction, average length of calcaneal correction, and average loss of correction length were <0.001, 0.005, and 0.015, respectively. The incidence of complications, including soft tissue necrosis and bone infection, were 23.1% in the ELA group and none in the MIA group.
CONCLUSION
The clinical outcomes were similar in the two groups. The degree of reduction of fracture showed a better result in the MIA group than the ELA group. Furthermore, there were no complications in the MIA group, whereas the ELA group showed some complications.


J Korean Fract Soc. 2019 Jul;32(3):135-142. Korean.
Published online Jul 24, 2019.
https://doi.org/10.12671/jkfs.2019.32.3.135
Copyright © 2019 The Korean Fracture Society. All rights reserved.
Original Article

Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach

Hong-Ki Park, M.D., Ph.D., Jae-Yoon Ko, M.D., Seung-Kwan Lee, M.D. and Jong-Min Baik, M.D.
    • Department of Orthopedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
  • Correspondence to: Jong-Min Baik, M.D. Department of Orthopedic Surgery, Gil Medical Center, Gachon University College of Medicine, 21 Namdongdaero 774beon-gil, Namdong-gu, Incheon 21565, Korea. Tel: +82-32-460-3384, Fax: +82-32-423-3384, Email: bbaik98@gmail.com
Received December 31, 2018; Revised January 29, 2019; Accepted May 27, 2019.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

As the functional demands for activities in elderly patients are increasing according to their life extension, the need for surgical treatment is also increasing in elderly patients with displaced intra-articular calcaneal fractures. In addition to the extensile lateral approach (ELA), which is a surgical procedure that showed good results on intra-articular calcaneal fractures, the minimally invasive approach (MIA) also showed an outstanding result. This study compared the radiological and clinical results of intraarticular calcaneus fractures in elderly patients in two groups: ELA and MIA.

Materials and Methods

Thirty patients aged over 65 years with intra-articular calcaneus fractures, who could be followed-up more than 14 months, were included in this study. Thirteen patients of the MIA group and 17 patients of the ELA group were analyzed retrospectively using radiological and clinical assessments.

Results

No significant difference in union time, posterior facet reduction accuracy, subtalar osteoarthritis frequency, Bohler angle, calcaneal width, American Orthopaedic Foot and Ankle Society score, visual analogue scale score, 36-item short form survey, and foot function index was observed between the two groups. The p-value of the average height of the calcaneus correction, average length of calcaneal correction, and average loss of correction length were <0.001, 0.005, and 0.015, respectively. The incidence of complications, including soft tissue necrosis and bone infection, were 23.1% in the ELA group and none in the MIA group.

Conclusion

The clinical outcomes were similar in the two groups. The degree of reduction of fracture showed a better result in the MIA group than the ELA group. Furthermore, there were no complications in the MIA group, whereas the ELA group showed some complications.

Keywords
Calcaneus, Displaced intraarticular calcaneal fracture, Extensile lateral approach, Minimally invasive approach

Figures

Fig. 1
Minimally invasive approach. (A, C, E) Lateral radiographs of the calcaneus. (B, D, F) Axial radiographs of the calcaneus.

Fig. 2
Extensile lateral approach. (A) Lateral radiograph of the calcaneus. (B) Axial radiograph of the calcaneus.

Fig. 3
(A) Lateral radiograph of the calcaneus shows measurements of the Böhler angle, calcaneal height, calcaneal length. (B) Axial radiograph of the calcaneus shows measurements of the calcaneal width.

Tables

Table 1
Comparison of the Demographic Data and Clinical Outcome between the Treatment Groups

Table 2
Comparison of the Radiologic Outcomes between the Treatment Groups

Notes

Financial support:None.

Conflict of interests:None.

References

    1. Järvholm U, Körner L, Thorén O, Wiklund LM. Fractures of the calcaneus. A comparison of open and closed treatment. Acta Orthop Scand 1984;55:652–656.
    1. Su J, Cao X. Can operations achieve good outcomes in elderly patients with Sanders II–III calcaneal fractures? Medicine (Baltimore) 2017;96:e7553
    1. Gaskill T, Schweitzer K, Nunley J. Comparison of surgical outcomes of intra-articular calcaneal fractures by age. J Bone Joint Surg Am 2010;92:2884–2889.
    1. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am 2000;82:225–250.
    1. Basile A. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures in elderly patients. J Foot Ankle Surg 2010;49:25–32.
    1. Herscovici D Jr, Widmaier J, Scaduto JM, Sanders RW, Walling A. Operative treatment of calcaneal fractures in elderly patients. J Bone Joint Surg Am 2005;87:1260–1264.
    1. Hatzokos I, Karataglis D, Papadopoulos P, Dimitriou C, Christodoulou A, Pournaras J. Treatment of intra-articular comminuted os calcis fractures. Orthopedics 2006;29:25–29.
    1. Khorbi A, Chebil M, Ben Maitigue M, et al. [Screw fixation without bone graft of calcaneal joint fractures: 35 cases]. Rev Chir Orthop Reparatrice Appar Mot 2006;92:45–51.
      French.
    1. McGarvey WC, Burris MW, Clanton TO, Melissinos EG. Calcaneal fractures: indirect reduction and external fixation. Foot Ankle Int 2006;27:494–499.
    1. Schepers T, Patka P. Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: current concepts' review. Arch Orthop Trauma Surg 2009;129:1677–1683.
    1. Mittlmeier T, Morlock MM, Hertlein H, et al. Analysis of morphology and gait function after intraarticular calcaneal fracture. J Orthop Trauma 1993;7:303–310.
    1. Benirschke SK, Sangeorzan BJ. Extensive intraarticular fractures of the foot. Surgical management of calcaneal fractures. Clin Orthop Relat Res 1993;(292):128–134.
    1. Boack DH, Wichelhaus A, Mittlmeier T, Hoffmann R, Haas NP. [Therapy of dislocated calcaneus joint fracture with the AO calcaneus plate]. Chirurg 1998;69:1214–1223.
      German.
    1. Letournel E. Open treatment of acute calcaneal fractures. Clin Orthop Relat Res 1993;(290):60–67.
    1. Zwipp H, Tscherne H, Thermann H, Weber T. Osteosynthesis of displaced intraarticular fractures of the calcaneus. Results in 123 cases. Clin Orthop Relat Res 1993;(290):76–86.
    1. Dhillon MS, Bali K, Prabhakar S. Controversies in calcaneus fracture management: a systematic review of the literature. Musculoskelet Surg 2011;95:171–181.
    1. Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma 1999;13:369–372.
    1. Burdeaux BD. Reduction of calcaneal fractures by the McReynolds medial approach technique and its experimental basis. Clin Orthop Relat Res 1983;(177):87–103.
    1. Mann RA. Arthrodesis of the foot and ankle. In: Coughlin MJ, Mann RA, Saltzman CL, editors. Surgery of the foot and ankle. Vol 1. 8th ed. Philadelphia: Mosby; 2007. pp. 1091-1123.
    1. Kline AJ, Anderson RB, Davis WH, Jones CP, Cohen BE. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int 2013;34:773–780.
    1. Weber M, Lehmann O, Sägesser D, Krause F. Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. J Bone Joint Surg Br 2008;90:1608–1616.
    1. Hospodar P, Guzman C, Johnson P, Uhl R. Treatment of displaced calcaneus fractures using a minimally invasive sinus tarsi approach. Orthopedics 2008;31:1112.
    1. 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;67:875–882.
    1. Longino D, Buckley RE. Bone graft in the operative treatment of displaced intraarticular calcaneal fractures: is it helpful? J Orthop Trauma 2001;15:280–286.
    1. 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 Surg 2013;13:40.
    1. Gonzalez TA, Lucas RC, Miller TJ, Gitajn IL, Zurakowski D, Kwon JY. Posterior facet settling and changes in Bohler's angle in operatively and nonoperatively treated calcaneus fractures. Foot Ankle Int 2015;36:1297–1309.
    1. Backes M, Dorr MC, Luitse JS, Goslings JC, Schepers T. Predicting loss of height in surgically treated displaced intra-articular fractures of the calcaneus. Int Orthop 2016;40:513–518.
    1. Stulik J, Stehlik J, Rysavy M, Wozniak A. Minimally-invasive treatment of intra-articular fractures of the calcaneum. J Bone Joint Surg Br 2006;88:1634–1641.
    1. 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.
    1. Ceccarelli F, Calderazzi F, Pedrazzi G. Is there a relation between AOFAS ankle-hindfoot score and SF-36 in evaluation of Achilles r uptures t reated by percutaneous technique? J Foot Ankle Surg 2014;53:16–21.
  • PubReader PubReader
  • Cite
    CITE
    export Copy Download
    Close
    Download Citation
    Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
    Format:
    • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
    • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
    Include:
    • Citation for the content below
    Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach
    J Korean Fract Soc. 2019;32(3):135-142.   Published online July 31, 2019
    DOI: https://doi.org/10.12671/jkfs.2019.32.3.135
    Close
J Musculoskelet Trauma : Journal of Musculoskeletal Trauma
© The Korean Fracture Society.
Close layer
TOP