Advertisement

International Orthopaedics

, Volume 43, Issue 12, pp 2839–2847 | Cite as

Three-dimensional computed tomography analysis and functional results of calcaneal fractures treated by an intramedullary nail

  • Antoine Fourgeaux
  • John Estens
  • Thierry Fabre
  • Olivier Laffenetre
  • Julien Lucas y HernandezEmail author
Original Paper
  • 79 Downloads

Abstract

Background

Intramedullary calcaneal nailing is used to treat displaced intra-articular calcaneal fractures.

The main goal of the study was to assess the reduction of tomography and secondary goals were patient functional scores and complication rates.

Methods

The functional outcome and restoration of the radiographic parameters were evaluated post-operatively, at three months, at one year, and at the last follow-up. The morphology of the posterior facet was evaluated post-operatively, at one year and at the last follow-up by CTs.

Results

Twenty-six patients were included. The mean follow-up was 2.8 years. The mean AOFAS-AHS was 79 at the last follow-up. The mean calcaneal height index and length rose respectively from 0.44 to 0.86 and 83 to 87 mm, and the width decreased from 50 to 46 mm.

Conclusion

The radiographic parameters were restored. The AOFAS-AHS was comparable with other series. This study confirms the efficiency of this procedure with lower rate of complications.

Keywords

Calcaneus fracture Internal fixation Articular fracture Locking nail Closed reduction Operative procedure 

Notes

Compliance with ethical standards

Conflict of interest

Dr. Fourgeaux, Dr. Estens, Pr Fabre, and Dr. Laffenetre declare that they have no conflict of interest.

Dr. Lucas y Hernandez reports consultancy for FH orthopedics during the conduct of the study.

References

  1. 1.
    Agren PH, Wretenberg P, Sayed-Noor AS (2013) Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Jt Surg Am 95:1351–1357.  https://doi.org/10.2106/JBJS.L.00759 CrossRefGoogle Scholar
  2. 2.
    Bruce J, Sutherland A (2013) Surgical versus conservative interventions for displaced intra-articular calcaneal fractures. Cochrane Database Syst Rev CD008628.  https://doi.org/10.1002/14651858.CD008628.pub2
  3. 3.
    Buckley R, Leighton R, Sanders D et al (2014) Open reduction and internal fixation compared with ORIF and primary subtalar arthrodesis for treatment of Sanders type IV calcaneal fractures: a randomized multicenter trial. J Orthop Trauma 28:577–583.  https://doi.org/10.1097/BOT.0000000000000191 CrossRefPubMedGoogle Scholar
  4. 4.
    Buckley RE, Tough S (2004) Displaced intra-articular calcaneal fractures. J Am Acad Orthop Surg 12:172–178CrossRefGoogle Scholar
  5. 5.
    Gougoulias N, Khanna A, McBride DJ, Maffulli N (2009) Management of calcaneal fractures: systematic review of randomized trials. Br Med Bull 92:153–167.  https://doi.org/10.1093/bmb/ldp030 CrossRefPubMedGoogle Scholar
  6. 6.
    Randle JA, Kreder HJ, Stephen D et al (2000) Should calcaneal fractures be treated surgically? A meta-analysis Clin Orthop Relat Res:217–227CrossRefGoogle Scholar
  7. 7.
    Buckley R, Tough S, McCormack R et al (2002) Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Jt Surg Am 84-A:1733–1744CrossRefGoogle Scholar
  8. 8.
    Griffin D, Parsons N, Shaw E et al (2014) Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ 349:g4483CrossRefGoogle Scholar
  9. 9.
    Abidi NA, Dhawan S, Gruen GS et al (1998) Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures. Foot Ankle Int 19:856–861.  https://doi.org/10.1177/107110079801901211 CrossRefPubMedGoogle Scholar
  10. 10.
    Simon P, Goldzak M, Eschler A, Mittlmeier T (2015) Reduction and internal fixation of displaced intra-articular calcaneal fractures with a locking nail: a prospective study of sixty nine cases. Int Orthop 39:2061–2067.  https://doi.org/10.1007/s00264-015-2816-5 CrossRefPubMedGoogle Scholar
  11. 11.
    Neri T, Barthelemy R, Tourne Y (2017) Radiologic analysis of hindfoot alignment: comparison of Meary, long axial, and hindfoot alignment views. Orthop Traumatol Surg Res 103:1211–1216.  https://doi.org/10.1016/j.otsr.2017.08.014 CrossRefPubMedGoogle Scholar
  12. 12.
    Goldzak M, Simon P, Mittlmeier T et al (2014) Primary stability of an intramedullary calcaneal nail and an angular stable calcaneal plate in a biomechanical testing model of intraarticular calcaneal fracture. Injury 45(Suppl 1):S49–S53.  https://doi.org/10.1016/j.injury.2013.10.031 CrossRefPubMedGoogle Scholar
  13. 13.
    Sanders R, Vaupel ZM, Erdogan M, Downes K (2014) Operative treatment of displaced intraarticular calcaneal fractures: long-term (10-20 years) results in 108 fractures using a prognostic CT classification. J Orthop Trauma 28:551–563.  https://doi.org/10.1097/BOT.0000000000000169 CrossRefPubMedGoogle Scholar
  14. 14.
    Falis M, Pyszel K (2016) Treatment of displaced intra-articular calcaneal fractures by intramedullary nail. Preliminary report. Ortop Traumatol Rehabil 18:141–147.  https://doi.org/10.5604/15093492.1205021 CrossRefPubMedGoogle Scholar
  15. 15.
    Roll C, Schirmbeck J, Muller F et al (2016) Value of 3D reconstructions of CT scans for calcaneal fracture assessment. Foot Ankle Int 37:1211–1217.  https://doi.org/10.1177/1071100716660824 CrossRefPubMedGoogle Scholar
  16. 16.
    Qiang M, Chen Y, Jia X et al (2017) Post-operative radiological predictors of satisfying outcomes occurring after intra-articular calcaneal fractures: a three dimensional CT quantitative evaluation. Int Orthop 41:1945–1951.  https://doi.org/10.1007/s00264-017-3577-0 CrossRefPubMedGoogle Scholar
  17. 17.
    Alexandridis G, Gunning AC, van Olden GDJ et al (2018) Association of pre-treatment radiographic characteristics of calcaneal fractures on patient-reported outcomes. Int Orthop 42:2231–2241.  https://doi.org/10.1007/s00264-018-3852-8 CrossRefPubMedGoogle Scholar
  18. 18.
    Kurozumi T, Jinno Y, Sato T et al (2003) Open reduction for intra-articular calcaneal fractures: evaluation using computed tomography. Foot Ankle Int 24:942–948.  https://doi.org/10.1177/107110070302401214 CrossRefPubMedGoogle Scholar
  19. 19.
    Eichinger M, Brunner A, Stofferin H et al (2018) Screw tip augmentation leads to improved primary stability in the minimally invasive treatment of displaced intra-articular fractures of the calcaneus: a biomechanical study. Int Orthop.  https://doi.org/10.1007/s00264-018-4171-9 CrossRefGoogle Scholar
  20. 20.
    Nelson JD, McIff TE, Moodie PG et al (2010) Biomechanical stability of intramedullary technique for fixation of joint depressed calcaneus fracture. Foot Ankle Int 31:229–235.  https://doi.org/10.3113/FAI.2010.0229 CrossRefPubMedGoogle Scholar
  21. 21.
    Wang Yi-min the 4th People’s Hospital of Shenzhen D of TO (2014) Finite element analysis of calcaneus stress distributions with variant heights. J Clin Rehabil Tissue Eng Res 6742_6746Google Scholar
  22. 22.
    Barrick B, Joyce DA, Werner FW, Iannolo M (2017) Effect of calcaneus fracture gap without step-off on stress distribution across the subtalar joint. Foot Ankle Int 38:298–303.  https://doi.org/10.1177/1071100716678808 CrossRefPubMedGoogle Scholar
  23. 23.
    Rammelt S, Zwipp H (2004) Calcaneus fractures: facts, controversies and recent developments. Injury 35:443–461.  https://doi.org/10.1016/j.injury.2003.10.006 CrossRefPubMedGoogle Scholar
  24. 24.
    Howard JL, Buckley R, McCormack R et al (2003) Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma 17:241–249CrossRefGoogle Scholar
  25. 25.
    Krannitz KW, Fong HW, Fallat LM, Kish J (2009) The effect of cigarette smoking on radiographic bone healing after elective foot surgery. J Foot Ankle Surg 48:525–527.  https://doi.org/10.1053/j.jfas.2009.04.008 CrossRefPubMedGoogle Scholar
  26. 26.
    Nasell H, Ottosson C, Tornqvist H et al (2011) The impact of smoking on complications after operatively treated ankle fractures--a follow-up study of 906 patients. J Orthop Trauma 25:748–755.  https://doi.org/10.1097/BOT.0b013e318213f217 CrossRefPubMedGoogle Scholar
  27. 27.
    Renovell-Ferrer P, Berto-Marti X, Diranzo-Garcia J et al (2017) Functional outcome after calcaneus fractures: a comparison between polytrauma patients and isolated fractures. Injury 48(Suppl 6):S91–S95.  https://doi.org/10.1016/S0020-1383(17)30801-X CrossRefPubMedGoogle Scholar
  28. 28.
    Hammond AW, Crist BD (2013) Percutaneous treatment of high-risk patients with intra-articular calcaneus fractures: a case series. Injury 44:1483–1485.  https://doi.org/10.1016/j.injury.2013.01.033 CrossRefPubMedGoogle Scholar
  29. 29.
    Carow JB, Carow J, Gueorguiev B et al (2018) Soft tissue micro-circulation in the healthy hindfoot: a cross-sectional study with focus on lateral surgical approaches to the calcaneus. Int Orthop 42:2705–2713.  https://doi.org/10.1007/s00264-018-4031-7 CrossRefPubMedGoogle Scholar
  30. 30.
    Liu Y, Li Z, Li H et al (2015) Protective effect of surgery against early subtalar arthrodesis in displaced intra-articular calcaneal fractures: a meta-analysis. Med 94:e1984–e1980.  https://doi.org/10.1097/MD.0000000000001984 CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.Bordeaux Hospital UniversityBordeaux cedexFrance
  2. 2.The Maitland HospitalMaitlandAustralia
  3. 3.Lake Macquarie Private HospitalsGatesheadAustralia
  4. 4.Blomet clinicParisFrance

Personalised recommendations