|
Year |
2003 |
|---|---|
|
Question Number |
18. |
|
Category |
Musculoskeletal Trauma |
Question
While open reduction and internal fixation as a treatment of calcaneal fractures has gained greater acceptance in the last two decades, closed reduction and pinning (Essex-Lopresti type technique) is felt to yield satisfactory outcomes in which of the following fracture patterns?
1- Lateral process
2- Anterior process
3- Tongue-type
4- Comminuted posterior facet
5- Joint depression type
Figures
Answer (click for answer)
Answer: C
The treatment of intraarticular calcaneal fractures is controversial.. The results of ORIF, , are only slightly better than those of nonoperative management. Currently, ORIF of the calcaneus is most commonly performed through an extended lateral approach that uses a large full-thickness flap. This technique has been associated with partial flap necrosis, which can delay rehabilitation, and with deep infection, which can lead to catastrophic failure.
In this study by Tornetta, twenty-six consecutive patients with calcaneal fractures had an attempted percutaneous reduction. Twenty-three of the twenty-six feet had an acceptable reduction, and the remaining three were treated with ORIF. The first seventeen cases were stabilized by two Steinmann pins, which were removed at ten to twelve weeks. The last six cases were fixed with two cannulated 6.5-millimeter screws, which were left in place. Early motion was encouraged in all cases
Of the twenty-three patients with an acceptable reduction, twenty had no angulation between the posterior facet of the talus and the calcaneus, three had <5 degrees. The tuberosity reduction was <5 degrees in seventeen cases and <10 degrees in all cases. The calcaneal height was restored to normal in twenty cases, and the width (axial view) averaged 119 percent of the contralateral side. Follow-up averaged 2.9 years. Using the Maryland foot score there were twelve (55 percent) excellent, seven (32 percent) good, and three (13 percent) fair results.
Conclusions: The Essex-Lopresti spike reduction is a useful method for the treatment of tongue-type Sanders type 2C fractures of the calcaneus. Results are superior to those in previous series of intraarticular fractures treated with ORIF.
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