M Pompach1, M Carda2, M Amlang3, H Zwipp3. 1. Unfallchirurgie, Krankenhaus der Region Pardubice AG, Krankenhaus Pardubice, Pardubice, Tschechische Republik. m.pompach@gmail.com. 2. Unfallchirurgie, Krankenhaus der Region Pardubice AG, Krankenhaus Pardubice, Pardubice, Tschechische Republik. 3. Universitäts Centrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland.
Abstract
OBJECTIVE: Anatomic reconstruction of the posterior facet by primary stabilization of the calcaneal fracture with a locking nail. INDICATIONS: All intraarticular calcaneal fractures and unstable two-part fractures independent of the degree of closed/open soft tissue trauma. CONTRAINDICATIONS: High perioperative risk, soft tissue infection, beak fracture (type II fracture) and still open apophysis. SURGICAL TECHNIQUE: Anatomic reduction of the posterior facet using a sinus tarsi approach. Reduction and temporary fixation of the sustentacular, tuberosity, and anterior process fragments with 1.8-2.0 mm Kirschner wires. Thereafter, the C-Nail (calcaneus nail) is introduced with its guiding device stabilizing the sustentacular, tuberostity, and anterior process fragments through its three guiding arms with 6 or 7 locking screws. POSTOPERATIVE MANAGEMENT: Passive and active motion starts on postoperative day 2. Lymph drains help reduce swelling. Partial weightbearing with 20 kg for 6-8 weeks in the patient's own shoes is recommended. X‑ray controls are done at 4 and 8 weeks as well as after 6 and 12 months. RESULTS: A total of 107 calcaneal fractures treated with the C-Nail between 2011 and 2014 were evaluated according to the AOFAS score 6 months and 1 year after surgery. The measured values were on average 93.0 (range 65-100) points at 6 months and 94.1 (range 75-100) points 12 months after the surgery. Böhler's angle with initial traumatic values of 6.2° (-30 to +13°) improved postoperatively to 31.8°, after 3 months slightly decreased to 29.6°, and after 12 months to 28.3°. There were 2 cases of superficial wound necrosis (1.9 %) and 1 case a deep infection (0.93 %) with need of early C-Nail removal.
OBJECTIVE: Anatomic reconstruction of the posterior facet by primary stabilization of the calcaneal fracture with a locking nail. INDICATIONS: All intraarticular calcaneal fractures and unstable two-part fractures independent of the degree of closed/open soft tissue trauma. CONTRAINDICATIONS: High perioperative risk, soft tissue infection, beak fracture (type II fracture) and still open apophysis. SURGICAL TECHNIQUE: Anatomic reduction of the posterior facet using a sinus tarsi approach. Reduction and temporary fixation of the sustentacular, tuberosity, and anterior process fragments with 1.8-2.0 mm Kirschner wires. Thereafter, the C-Nail (calcaneus nail) is introduced with its guiding device stabilizing the sustentacular, tuberostity, and anterior process fragments through its three guiding arms with 6 or 7 locking screws. POSTOPERATIVE MANAGEMENT: Passive and active motion starts on postoperative day 2. Lymph drains help reduce swelling. Partial weightbearing with 20 kg for 6-8 weeks in the patient's own shoes is recommended. X‑ray controls are done at 4 and 8 weeks as well as after 6 and 12 months. RESULTS: A total of 107 calcaneal fractures treated with the C-Nail between 2011 and 2014 were evaluated according to the AOFAS score 6 months and 1 year after surgery. The measured values were on average 93.0 (range 65-100) points at 6 months and 94.1 (range 75-100) points 12 months after the surgery. Böhler's angle with initial traumatic values of 6.2° (-30 to +13°) improved postoperatively to 31.8°, after 3 months slightly decreased to 29.6°, and after 12 months to 28.3°. There were 2 cases of superficial wound necrosis (1.9 %) and 1 case a deep infection (0.93 %) with need of early C-Nail removal.
Entities:
Keywords:
Bone nails; Calcaneus; Foot; Fracture fixation; Operative procedures