Prod'homme M, Pour Jafar S, Zogakis P, Stutz P
Orthopedic Surgery Department, Riviera-Chablais Hospital, Montreux, Switzerland.
Case Rep Orthop. 2018 Apr 26;2018:7909184. doi: 10.1155/2018/7909184. eCollection 2018.
Treatment of displaced intra-articular fractures of the calcaneus remains a challenge for the orthopaedic surgeon. Conservative therapy is known to produce functional impairment. Surgical approach is plagued by soft-tissue complications and insufficient fracture reduction. We describe a minimally invasive technique that will hopefully improve these issues. We want to present our first experience through two cases. The first was a 46-year-old man who presented with a Sanders type IIBC calcaneal fracture, and the second was a 86-year-old woman with a type IIIBC calcaneal fracture. We introduced 2 Schanz screws in the talus and the calcaneus. After distraction, we introduced an inflatable balloon inside the calcaneus. By inflating the balloon, the articular surface was reduced by lifting it up. Then bone cement was injected in order to maintain the reduction. Additional screw fixation was used in the young patient. Postoperative imaging showed good congruence of the subtalar joint without leakage of cement, for the two cases. After 2 months, the patients had no pain and were without soft-tissue complications. We advocate this technique to perform a minimally invasive reduction and fixation of intra-articular calcaneal fractures because it preserves soft-tissues and provides good clinical results with early weight-bearing.
跟骨关节内移位骨折的治疗对骨科医生来说仍然是一项挑战。众所周知，保守治疗会导致功能障碍。手术入路存在软组织并发症和骨折复位不充分的问题。我们描述了一种微创技术，有望改善这些问题。我们想通过两个病例介绍我们的首次经验。第一个病例是一名46岁男性，患有Sanders IIBC型跟骨骨折，第二个病例是一名86岁女性，患有IIIBC型跟骨骨折。我们在距骨和跟骨中置入2枚斯氏针。牵引后，我们在跟骨内置入一个可充气球囊。通过给球囊充气，将关节面抬起从而实现复位。然后注入骨水泥以维持复位。年轻患者还采用了额外的螺钉固定。术后影像学检查显示，两例患者的距下关节均对位良好，且骨水泥无渗漏。2个月后，患者无疼痛，也没有软组织并发症。我们提倡采用这种技术对跟骨关节内骨折进行微创复位和固定，因为它能保护软组织，并能在早期负重的情况下取得良好的临床效果。
