Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, 740 S. Limestone, Suite K401, Lexington, KY, USA.
Department of Orthopaedic Surgery, Mercy Health St. Vincent Medical Center, Toledo, OH, USA.
Eur J Orthop Surg Traumatol. 2024 Aug;34(6):3355-3363. doi: 10.1007/s00590-024-03879-w. Epub 2024 Jun 3.
Displaced intra-articular calcaneus fractures (DIACFs) are difficult injuries to treat and are often encountered by orthopedic surgeons. For DIACFs treated nonoperatively or with open reduction internal fixation (ORIF), a common complication is painful subtalar arthritis and the need for a secondary subtalar fusion, which prolongs the overall recovery time. One treatment option to address this sequela involves ORIF with subtalar fusion as the primary treatment. We describe a reproducible, minimally invasive surgical technique for primary ORIF with subtalar fusion when the calcaneal tuberosity is amendable to cannulated screw fixation to treat these complex calcaneal fractures. Our technique offers advantages compared to other techniques in that it avoids screw traffic, allows easy bony compression of the subtalar joint, and minimizes soft tissue damage via percutaneous screw fixation. Fourteen fractured calcanei in 12 patients underwent our technique and all achieved bony union with a median time to fusion of 107.5 days (range, 54-530 days). Eight patients returned to work with the remaining 4 patients having an unknown work status at last follow-up, although 2 of these 4 patients resumed normal activities. Only 1 patient experienced a complication, which was an infection after achieving bony union, and was treated with successful hardware removal and our infection protocol. Overall, we conclude our surgical technique offers a successful option in the treatment of DIACFs when the calcaneal tuberosity is amendable to cannulated screw fixation.
距下关节内跟骨骨折(DIACFs)是一种难以治疗的损伤,常被骨科医生遇到。对于未经手术治疗或接受切开复位内固定(ORIF)治疗的 DIACFs,常见的并发症是疼痛性距下关节炎和需要进行二次距下融合,这会延长整体康复时间。一种解决这种后遗症的治疗选择是将 ORIF 与距下融合作为主要治疗方法。我们描述了一种可重复的微创外科技术,用于治疗可接受空心螺钉固定的跟骨结节的复杂跟骨骨折的初次 ORIF 与距下融合。与其他技术相比,我们的技术具有优势,因为它避免了螺钉穿行,允许轻松进行距下关节的骨压缩,并通过经皮螺钉固定最大限度地减少软组织损伤。12 名患者的 14 例骨折跟骨采用了我们的技术,所有患者均达到骨性愈合,融合的中位数时间为 107.5 天(范围 54-530 天)。8 名患者恢复工作,其余 4 名患者在最后一次随访时工作状况未知,尽管其中 2 名患者恢复了正常活动。只有 1 名患者出现并发症,即达到骨性愈合后感染,经成功去除内固定物和我们的感染方案治疗后得到治愈。总的来说,我们得出结论,当跟骨结节可接受空心螺钉固定时,我们的手术技术是 DIACFs 的一种成功治疗选择。