Minimally invasive treatment of calcaneal fractures by subtalar arthroscopy with posterior approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DONG Fu ¹ , LU Chun ¹ , ZHU Jinrong ¹ , LI Yunfeng ¹ ,  MI Kun ²

1. Department of Orthopaedics, Beihai People’s Hospital of Guangxi Province, Beihai Guangxi, 536000, P.R.China;
2. The Second Department of Orthopaedics, the First Affiliated Hospital, University of Guangxi Traditional Chinese Medicine, Nanning Guangxi, 530000, P.R.China;

Corresponding author：

MI Kun, Email: 13878896660@163.com

Keywords：

Calcaneal fracture; arthroscopy; closed reduction; internal fixation; minimally invasive technique

DOI：

10.7507/1002-1892.201608001

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Objective To evaluate the results of arthroscopically-assisted closed reduction and percutaneous screw fixation by posterior approach to subtalar joint for calcaneal fractures of Essex-Lopresti tongue type, Sanders IIA, IIB, and IIIAB. Methods Sixteen patients with unilateral calcaneal fracture were treated with arthroscopically-assisted closed reduction and percutaneous screw fixation by posterior approach to subtalar joint between June 2012 and June 2015. There were 13 males and 3 females with an average age of 37.8 years (range, 18-65 years). The injury causes included falling from height in 10 cases and traffic accident in 6 cases. Of 16 cases, 4 were classified as Essex-Lopresti tongue type, 5 as Sanders IIA, 4 as Sanders IIB, and 3 as Sanders IIIAB. The interval of injury and operation was 4-8 days (mean, 5.94 days). The Böhler angle, Gissane angle, and width of calcaneus were measured before and after operation. American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate the ankle function at 12 months after operation. Results Primary healing of incision was obtained in all cases, and no complications of infection, necrosis, and osseous fascia compartment syndrome occurred. The patients were followed up 12-15 months (mean, 13.63 months). The X-ray films showed that fracture line disappeared at 6 months after operation; the patients had no tenderness or percussion pain, no breakage or loosening of internal fixation, no varus calcaneus tuberosity, no subtalar joint fusion, and no compression symptoms of peroneal tendons. Achilles tendon irritation occurred in 2 cases, and disappeared after removal of internal fixation; traumatic arthritis occurred in 2 cases, and was relieved after removal of internal fixation. The Böhler angle, Gissane angle, and calcaneal width were significantly improved at 3 days and 6 months after operation when compared with preoperative ones (P<0.05). The loss of the above indexes was observed at 6 months, showing no significant difference between at 3 days and 6 months (P>0.05). The AOFAS score results were excellent in 11 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 87.5%. Conclusion It has the advantages of little trauma, less complication, and good function recovery to use arthroscopically-assited closed reduction and percutaneous screw fixation by posterior approach to subtalar joint for calcaneal fractures of Essex-Lopresti tongue type, Sanders IIA, Sanders IIB, and Sanders IIIAB.

Citation： DONGFu, LUChun, ZHUJinrong, LIYunfeng, MIKun. Minimally invasive treatment of calcaneal fractures by subtalar arthroscopy with posterior approach. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(1): 36-41. doi: 10.7507/1002-1892.201608001 Copy

1.	de Muinck Keizer RJ, Backes M, Dingemans SA, et al. Post-traumatic subtalar osteoarthritis: which grading system should we use? Int Orthop, 2016, 40(9): 1981-1985.
2.	Viláy Rico J, Jiménez Díaz V, Bravo Giménez B, et al. Results of Arthroscopic Subtalar Arthrodesis for Adult-Acquired Flatfoot Deformity vs Posttraumatic Arthritis. Foot Ankle Int, 2016, 37(2): 198-204.
3.	范江荣, 蔡林, 郑勇. 跟骨骨折的分型和治疗进展. 中国矫形外科杂志, 2010, 18(2): 124-127.
4.	王传忠, 郑奋, 周海林, 等. 跟骨骨折开放复位切口感染的原因分析. 骨与关节损伤杂志, 2004, 19(8): 566-567.
5.	Sivakumar BS, Wong P, Dick CG, et al. Arthroscopic reduction and percutaneous fixation of selected calcaneus fractures: surgical technique and early results. J Orthop Trauma, 2014, 28(10): 569-576.
6.	Rungprai C, Phisitkul P, Femino JE, et al. Outcomes and Complications After Open Versus Posterior Arthroscopic Subtalar Arthrodesis in 121 Patients. J Bone Joint Surg (Am), 2016, 98(8): 636-646.
7.	Waseem M. The use of subtalar arthroscopy in open reduction and internal fixation of intra-articular calcaneal fractures. Injury, 2003, 34(6): 475-476.
8.	赵津刚. 跟骨骨折治疗现状. 医学综述, 2011, 17(13): 1993-1995.
9.	Backes M, Schep NW, Luitse JS, et al. Erratum to: The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures. Arch Orthop Trauma Surg, 2015, 135(8): 1053.
10.	Rammelt S, Amlang M, Barthel S, et al. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res, 2010, 468(4): 983-990.
11.	李学金, 李群, 张知博, 等. 跟骨关节内骨折钢板内固定与克氏针内固定的比较. 中国修复重建外科杂志, 2008, 22(4): 459-462.
12.	俞光荣, 周家钤, 燕晓宇, 等. 距下关节镜辅助下闭合复位经皮螺钉内固定治疗跟骨关节内骨折. 中华骨科杂志, 2006, 26(2): 73-77.
13.	Ahmad T, Muhammad ZA, Humayunmatin B, et al. Calcaneal fractures: An audit of radiological outcome. J Pak Med Assoc, 2015, 65(11 Suppl 3): S171-174.
14.	Woon CY, Chong KW, Yeo W, et al. Subtalar arthroscopy and flurosocopy in percutaneous fixation of intra-articular calcaneal fractures: the best of both worlds. J Trauma, 2011, 71(4): 917-925.
15.	Hegde A, Mathias LJ, Ballal A, et al. A Prospective Study on Radiological and Functional Outcome of Displaced Tongue Type Intra-Articular Calcaneal Fractures Treated by Percutaneous Screw Fixation. J Clin Diagn Res, 2016, 10(2): RC01-4.
16.	Schuberth JM, Cobb MD, Talarico RH. Minimally invasive arthroscopic-assisted reduction with percutaneous fixation in the management of intra-articular calcaneal fractures: a review of 24 cases. J Foot Ankle Surg, 2009, 48(3): 315-322.
17.	Schoepp C, Rixen D. Arthroscopy-guided fracture management. Ankle joint and calcaneus. Unfallchirurg, 2013, 116(4): 318-325.
18.	Labronici PJ, Reder VR, de Araujo Marins Filho GF, et al. Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques. Rev Bras Ortop, 2016, 51(2): 208-213.
19.	Lee KB, Park CH, Seon JK, et al. Arthroscopic subtalar arthrodesis using a posterior 2-portal approach in the prone position. Arthroscopy, 2010, 26(2): 230-238.
20.	Ballard DH, Campbell KJ, Blanton LE, et al. Tendon entrapments and dislocations in ankle and hindfoot fractures: evaluation with multidetector computed tomography. Emerg Radiol, 2016, 23(4): 357-363.

1. de Muinck Keizer RJ, Backes M, Dingemans SA, et al. Post-traumatic subtalar osteoarthritis: which grading system should we use? Int Orthop, 2016, 40(9): 1981-1985.
2. Viláy Rico J, Jiménez Díaz V, Bravo Giménez B, et al. Results of Arthroscopic Subtalar Arthrodesis for Adult-Acquired Flatfoot Deformity vs Posttraumatic Arthritis. Foot Ankle Int, 2016, 37(2): 198-204.
3. 范江荣, 蔡林, 郑勇. 跟骨骨折的分型和治疗进展. 中国矫形外科杂志, 2010, 18(2): 124-127.
4. 王传忠, 郑奋, 周海林, 等. 跟骨骨折开放复位切口感染的原因分析. 骨与关节损伤杂志, 2004, 19(8): 566-567.
5. Sivakumar BS, Wong P, Dick CG, et al. Arthroscopic reduction and percutaneous fixation of selected calcaneus fractures: surgical technique and early results. J Orthop Trauma, 2014, 28(10): 569-576.
6. Rungprai C, Phisitkul P, Femino JE, et al. Outcomes and Complications After Open Versus Posterior Arthroscopic Subtalar Arthrodesis in 121 Patients. J Bone Joint Surg (Am), 2016, 98(8): 636-646.
7. Waseem M. The use of subtalar arthroscopy in open reduction and internal fixation of intra-articular calcaneal fractures. Injury, 2003, 34(6): 475-476.
8. 赵津刚. 跟骨骨折治疗现状. 医学综述, 2011, 17(13): 1993-1995.
9. Backes M, Schep NW, Luitse JS, et al. Erratum to: The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures. Arch Orthop Trauma Surg, 2015, 135(8): 1053.
10. Rammelt S, Amlang M, Barthel S, et al. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res, 2010, 468(4): 983-990.
11. 李学金, 李群, 张知博, 等. 跟骨关节内骨折钢板内固定与克氏针内固定的比较. 中国修复重建外科杂志, 2008, 22(4): 459-462.
12. 俞光荣, 周家钤, 燕晓宇, 等. 距下关节镜辅助下闭合复位经皮螺钉内固定治疗跟骨关节内骨折. 中华骨科杂志, 2006, 26(2): 73-77.
13. Ahmad T, Muhammad ZA, Humayunmatin B, et al. Calcaneal fractures: An audit of radiological outcome. J Pak Med Assoc, 2015, 65(11 Suppl 3): S171-174.
14. Woon CY, Chong KW, Yeo W, et al. Subtalar arthroscopy and flurosocopy in percutaneous fixation of intra-articular calcaneal fractures: the best of both worlds. J Trauma, 2011, 71(4): 917-925.
15. Hegde A, Mathias LJ, Ballal A, et al. A Prospective Study on Radiological and Functional Outcome of Displaced Tongue Type Intra-Articular Calcaneal Fractures Treated by Percutaneous Screw Fixation. J Clin Diagn Res, 2016, 10(2): RC01-4.
16. Schuberth JM, Cobb MD, Talarico RH. Minimally invasive arthroscopic-assisted reduction with percutaneous fixation in the management of intra-articular calcaneal fractures: a review of 24 cases. J Foot Ankle Surg, 2009, 48(3): 315-322.
17. Schoepp C, Rixen D. Arthroscopy-guided fracture management. Ankle joint and calcaneus. Unfallchirurg, 2013, 116(4): 318-325.
18. Labronici PJ, Reder VR, de Araujo Marins Filho GF, et al. Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques. Rev Bras Ortop, 2016, 51(2): 208-213.
19. Lee KB, Park CH, Seon JK, et al. Arthroscopic subtalar arthrodesis using a posterior 2-portal approach in the prone position. Arthroscopy, 2010, 26(2): 230-238.
20. Ballard DH, Campbell KJ, Blanton LE, et al. Tendon entrapments and dislocations in ankle and hindfoot fractures: evaluation with multidetector computed tomography. Emerg Radiol, 2016, 23(4): 357-363.

Chinese Journal of Reparative and Reconstructive Surgery

Minimally invasive treatment of calcaneal fractures by subtalar arthroscopy with posterior approach

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