The treatment of intra-articular calcaneus fractures with severe soft tissue damage with a hinged external fixator or internal stabilization: long-term results. Essex-Lopresti describedthe following twocalcaneus fracture subtypes - talus become dorsiflexed; - fracture classification: Highly comminuted. 2018 Apr 24. - soft tissue injury: Results After Percutaneous and Arthroscopically Assisted Osteosynthesis of Calcaneal Fractures. Bruce D. Browner. J Bone Joint Surg Am. Become a Gold Supporter and see no third-party ads. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Peripheral Vascular Disease Treatment is nonoperative versus operative based on fracture displacement and alignment, associated soft tissue injury, and patient risk factors. A complete blood count (CBC), blood. [QxMD MEDLINE Link]. ROWE CLASSICATION FOR CALCANEAL FRACTURE Flashcards by Nicholas de Guzman | Brainscape Brainscape Find Flashcards Why It Works Educators Cotton FJ, Henderson FF. [QxMD MEDLINE Link]. Please enable it to take advantage of the complete set of features! {"url":"/signup-modal-props.json?lang=us"}, Skalski M, Weerakkody Y, Yu Jin T, et al. Avulsion-type fracture of calcaneus, sustained when patient fell 6 ft from ladder onto solid ground. Am J Surg. (3) 1. - historical treatment has included closed reduction (Bohler) w/ distraction and medial lateral compression; This classification is based on the number of intraarticular fracture lines and their location on semicoronal CT images. Long-Term Functional Outcomes After Operative Treatment for Intra-Articular Fractures of the Calcaneus Bookshelf Res. 1993 May. [24] At 1 year, group 1 had a mean Maryland Foot Score (MFS) of 79 and an American Orthopaedic Foot and Ankle Society (AOFAS) score of 77.37, whereas group 2 had an MFS of 84.4 and and AOFAS score of 86.1. a) Without displacement 110 West Rd., Suite 227
Fractures of the calcaneus. - compartment syndrome deep central compartment is involved most often in calcaneal frx; Percutaneous Cannulated Screw Fixation vs. Plating With Minimally Invasive Longitudinal Approach After Closed Reduction for Intra-Articular Tongue-Type Calcaneal Fractures: A Retrospective Cohort Study. Foot Ankle Int. Results using a prognostic computed tomography scan classification. Zhong L, Xu Y, Wang Y, Liu Y, Huang Q. Application of medial column classification in treatment of intra-articular calcaneal fractures. We will eventually. (2006) ISBN: 9783540262275 -. Thermann H, Krettek C, Hfner T, Schratt HE, Albrecht K, Tscherne H. Management of calcaneal fractures in adults. Please. - frx of contra-lateral foot; 20 (2):168-75. Practitioner. Calcaneus injuries represent 2% of all fractures seen in adults. Mondors sign bruising from malleoli to sole of foot common in calcaneus fractures. Cochrane Database Syst Rev. -Bruce Ziran/P. Lack of first rocker sagittal plane block The bone distractor apaprently retracted the soft-tissue flap, helped reduce the articular and tuberosity fragment, and improved visualization by distracting the posterior talocalcaneal joint. No soft-tissue complications occurred, and none of the 18 patients followed for more than 1 year progressed to subtalar fusion. 27 (5):317-23. J Foot Ankle Surg. - may need to be supplemented by orthotic support with a custom-molded insole, rocker-bottom shoe, or ankle-foot orthosis; [QxMD MEDLINE Link]. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. The mechanism of injury in calcaneus fractures typically involves a high-energy axial load applied to the heel, which drives the talus downward onto the calcaneus. 1993 May. - primary frx line: - most of these involve the posterior facet (but can involve anterior and middle facets); Foot Ankle Clin. The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2and ~60% of all tarsal fractures 3. 'https://flow.aquaplatform.com/ajs.php':'http://flow.aquaplatform.com/ajs.php'); Type 4. A critical analysis of results and prognostic factors. Surgeon experience Signs & symptoms Compartment syndrome - common!! document.write (" 2 mm displacement, posterior facet displacement >2 to 3 mm, flattening of Bohler angle, or varus malalignment of the tuberosity, anterior process fracture with >25% involvement of calcaneocuboid joint, wait 10-14 days until swelling and blisters resolve and wrinkle sign present 10-14 days, no benefit to early surgery due to significant soft tissue swelling, displaced tuberosity fractures with posterior skin compromise should be addressed urgently, number of intra-articular fragments and the, surgical treatment decreases the risk of post-traumatic arthritis, age > 50 (similar outcomes with surgical and nonsurgical treatment), initial Bhler's angle <0 (these injuries do poorly regardless of treatment), lower Bhler angles suggest greater energy absorbed, open fractures (significant soft tissue injury and engery absorbed), bilateral calcaneal fractures (significant gait problems following bilateral injuries), factors associated with most likely need for a secondary subtalar fusion, male worker's compensation patient who participates in heavy labor work with an initial Bhler angle less than 0 degrees, standard short-leg cast for calcaneal stress fractures, standard short-leg cast applied with mild equinus, windowed over posterior heel to allow for frequent skin checks, requires close follow-up to determine if pull of gastrocnemius-soleus dispaces fracture, weekly cast changes are necessary due to high incidence of skin complications, high incidence of vascular insufficiency and diabetes in this population, ideal for poor soft tissue coverage or patients with peripheral vascular disease, Steinmann pin placed into the fracture site anteromedially-to-posterolateral to leverage fragments into place, additional K-wires and Steinmann pins are placed from posterior-to-anterior and lateral-to-medial to secure remaining bone fragments, calcaneal transfixin pin can be used to distract fracture, percutaneus tamps and elevators can be used to raise the articular surface, pins are cut flush with the skin and removed 8-10 weeks post-op, can be combined with distracting external fixator, pins placed in calcaneal tuberosity, cuboid, and distal tibia, restor calcaneal height, width, and alignment, can be combined with percutaneous cannulated screws, extensile lateral L-shaped incision is most popular, vertical portion inbetween posterio fibula and achilles tendon, horizontal portion in line with 5th metatarsal base, a more inferior incision protects the sural nerve, provides access to the calcaneocuboid and subtalar joints, full-thickness skin, soft tissue, and periosteal flaps are developed, lateral calcaneal branch of peroneal artery, superior flap contains the calcaneofibular ligaments and peroneal tendon sheath, sural nerve and peroneal tendons are retracted superiorly, fracture opened and medial wall reduced going medial to lateral, reduction confirmed indirectly via fluoroscopy, tuberosity reduction is done under direct visualization, manual traction, Schanz pins, and minidistractors, height and length of tuberosity is recreated, definitive fixation with plates and screws, restore Bhler's angle and calcaneal height, minimally invasive incision that minimizes soft tissue dissesction, reduces wound complications associated with extensile lateral incision, allows direct visualization of the posterior facet, anterolateral fragment, and lateral wall, same incision can be utilized for secondary subtalar arthrodesis or peroneal tendon debridement, patient placed in lateral decubitus position, incision made in line with the tip of the fibula and the base of the 4th metatarsal, extensor digitorum brevis retracted cephalad to expose sinus tarsi and posterior facet, Schanz pin inserted percutaneously in posteroinferior tuberosity going from lateral to medial, provides distraction and aids with reduction, fibrous debris and fat removed from sinus tarsi, small elevator or lamina spreader placed under posterior facet fragment to aid in reduction, K-wires inserted for provisional fixation aimed towards the sustentaculum, two screw are placed lateral-to-medial to engage sustentaculum and support facet, one large fully threaded screw from posterior-to-anterior to support axial length of calcaneus, low-profile plate is applied underneath a well developed soft tissue envelope with screws engaging anterolateral and tuberosity fragments, nonweight bearing for 6-8 weeks post-op with ankle range-of-motion exercises beginning 2 weeks post-op, manipulate the heel to increase the calcaneal varus deformity, manipulate the heel to correct the varus deformity with a valgus reduction, stabilize the reduction with percutaneous K-wires or open fixation as described above, arthroscopic-assisted reduction and internal fixation, improved visualization of articular surface and carilage lesions, increased swelling from fluid extravasation, can be combined with sinus tarsi approach, patient positioned in lateral decubitus position, fluoroscopy unit positioned posterior and oblique to patient, anterolateral and posterolateral portals are used to visualize posterior facet, loose bodies and cartilage fragments are removed with a shaver, Freer elevator is introduced into one of the portal sites and used to elevate the posterior facet, Schanz pin to control tuberosity fragment, cannulated screws from the posterior aspect of the calcaneal tuberosity to the anterior aspect of the calcaneus, lateral-to-medial screws placed in sustentaculum, buttress screw from the posterior aspect of the calcaneal tuberosity to the subchondral bone of the posterior facet, posterior approach for calcaneal tuberosity fractures, fracture fragment is mobilized and debrided, plantar flexion of foot aids with reduction, presence of gastrocnemius tightness may preclude reduction, Strayer procedure may be performed to aid in reduction, figure-of-8 tension-band wire passed around ends of K-wires or cannulated screws, Krackow sutures passing through bone tunnels, restricted weight bearing for 6 weeks followed by progression of weight bearing an additional 6 weeks, performed in highly comminuted Sanders IV intraarticular fractures, high rate of secondary fusion after ORIF with these injuries, avoids added treatment costs and decreases time off from work, can be performed through an extensile lateral or sinus tarsi approach, fracture reduction is perfromed in a similar fashion as ORIF, articular cartilage of the subtalar joint denuded to bleeding subchondral bone, cannulated compression screws are placed from the posterio calcaneal tuberosity to the talar dome, lateral fixation plate applied to hold reduction, increased risk in smokers, diabetics, and open injuries, may consider nonoperative treatment in these patients, tongue type fractures at high risk (>20%) for posterior skin necrosis, should be splinted in 30 degrees of planarflexion to relieve soft tissue tension, keep all hardware away from the corner of the incision, delayed wound healing is the most common complication, can be addressed with ankle bracing (gauntlet type), NSAIDs, injections, and physical therapy, may require bone block subtalar arthrodesis to address loss of calcaneal height, important when there are symptoms of anterior ankle impingement, Lateral impingement with peroneal irritation, at risk with placement of lateral to medial screws, especially at level of sustentaculum tali (constant fragment), loss of height, widening, and lateral impingement, distraction bone block subtalar arthrodesis, incongruous subtalar joint/post-traumatic DJD, results from posterior talar collapse into the posterior calcaneus, Lateral exostosis with no subtalar arthritis, Lateral exostosis with subtalar arthritis, Lateral exostosis, subtalar arthritis, and varus malunion, increased due to mechanism (fall from height), smoking, and early surgery, lateral soft tissue trauma increases the rate of complication, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries.
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