MANAGEMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES WITH REDUCTION AND PERCUTANEOUS FIXATION
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 58
Abstract
BACKGROUND Calcaneum, the largest and strongest cancellous tarsal bone is very well designed to bear the body weight. It endures a lot of daily activity stresses. The bone is unique in that it is actually hard on the outside and because of sparse trabeculae, soft on the inside, making it prone to impaction of articular surface, fragmentation and collapse on a high-velocity impact to the heel mostly during fall from height. The aim of this study is to report techniques and results of percutaneous fixation of intra-articular calcaneal fractures. MATERIALS AND METHODS Between July 2011 to August 2013, 40 intra-articular calcaneal fractures in 36 patients were treated by closed reduction and percutaneous fixation using partially threaded cancellous screws. Postoperatively range of motion exercises were begun on postoperative day 1 in a removable POP splint. Patients were followed at 6 wks., 12 wks., 24 wks. and 52 wks. and then 6 monthly. At each followup, a thorough clinical evaluation and standard radiographic assessment was carried out. Patients were kept nonweightbearing for initial 6 weeks and gradually mobilised from touchdown weightbearing with support to full weightbearing over the next 6-12 wks. Overall assessment including measurement of Bohler’s angle, range of motion at ankle and subtalar joint, ability to wear normal shoes, return to original job and Maryland foot scoring was done at a mean 16 months’ followup (range 12-24 months). RESULTS After a mean followup of 16 months, the mean Maryland foot score was 82 points (maximum 100 points). Bohler’s angle measured a mean 28 degrees (range 20-45 degrees). More than 80% of patients were able to wear normal shoes and return to their original job. Good to excellent range of motion at ankle and subtalar joints was obtained in most cases. Local wound infection occurred in 3 patients (8.3%). All three were successfully treated with local debridement, regular dressings and IV antibiotics. A total of 12 patients required removal of hardware either due to infection or due to palpable or painful screw heads. Three patients required subtalar arthrodesis due to persistent ankle pain but only after fracture healing and hardware removal. CONCLUSION We consider that closed reduction and percutaneous fixation of intra-articular calcaneal fractures with cancellous screws is an excellent treatment option producing good clinical and functional results with minimal complications.
Authors and Affiliations
Kishan Gopal Nama, Ram Khiladi Meena, Shiv Bhagwan Sharma
Keywords
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- EP ID EP226204
- DOI 10.14260/Jemds/2017/930
- Views 91
- Downloads 0
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