The subtalar distraction bone block arthrodesis following the late complications of calcaneal fractures: A systematic review

Introduction: The late complications following a displaced intra-articular calcaneal fractures includes painful arthrosis for which a subtalar fusion might be considered. In case of malalignment due to loss of height and varus deformity a reconstructive arthrodesis is necessary. The primary aim of the current review study was to assess the functional outcome of the subtalar distraction bone block arthrodesis in the management of late complications of displaced intra-articular calcaneal fractures. Methods: The literature was searched for studies in which a subtalar distraction bone block arthrodesis was used in the management of persistent complaints following a displaced intra-articular calcaneal fractures, after its first description in 1988 up to November 1st 2011. The methodological quality of the included studies was assessed using the Coleman Methodology Score. Results: Twenty-one studies reporting on 456 patients were identified. In 93 percent the procedure was a salvage procedures following the late complications of a calcaneal fracture (372 cases). Duration of follow-up ranged from 21 to 108 months (average 40 months). Union rates were reported with an overall average of 96% (range 83-100%). The average modified AOFAS score (maximum 94 points) was 73 points at final follow-up (range 64-83 points). Six studies reported pre- and post-reconstruction AOFAS outcome scores with an average increase of 44.2 points. Wound complications occurred in approximately 6%. With the exception of one study all were level 4 retrospective case series, with an average Coleman Methodology Score of 55 (range 41-79) points. Conclusions: The subtalar distraction bone block arthrodesis is a technically demanding procedure which, in the right hands, provides an overall good result. This is reflected in a significant increase in outcome scores post-operatively. Although most complications are considered minor, there are several pitfalls which should be recognized and avoided

The primary arthrodesis for severely comminuted intra-articular fractures of the calcaneus: A systematic review

Background: Although open reduction and internal fixation via the extended lateral approach is currently considered gold-standard, severely comminuted calcaneal fractures might not be amendable for reconstruction. The primary aim of the current review study was to assess the functional outcome of the primary arthrodesis in the management of comminuted displaced intra-articular calcaneal fractures. Methods: The literature was searched for studies published between January 1st 1990 and December 1st 2010, to identify studies in which a primary arthrodesis was utilized for the treatment of displaced intra-articular calcaneal fractures between. The methodological quality of the included studies was assessed using the Coleman Methodology Score. Results: Seven case series and one abstract were identified, reporting on 120 patients with 128 severely comminuted calcaneal fractures. Average follow-up time was 28 months and union rate 97%. Functional outcome was assessed using the modified AOFAS score in seven studies; with a weighted average of 77.4 (range 72.4-88). One study reported a 75% good to excellent outcome on the Paley score. Three studies reported on return to work, ranging from 75 to 100%. Overall reported wound complications occurred in 19.4%. The average Coleman Methodology Score was 56 (range 38-68) points. Conclusions: The primary arthrodesis for the treatment of Sanders type-IV comminuted displaced intra-articular calcaneal fractures provides overall good results considering the severe nature of the injury. Therefore, in the process of choosing the best treatment modality for a severely comminuted calcaneal fracture, the primary arthrodesis should receive full consideration

Displaced Intra-articular Fractures of the Calcaneus: with an emphasis on minimally invasive surgery

Displaced intra-articular calcaneal fractures are complex injuries. Classically these fractures are treated with open reduction and internal fixation (ORIF) or conservatively. When comparing these two treatment modalities, ORIF has a significantly higher rate of wound complications and conservative management has a significantly higher rate of secondary fusions. Therefore a minimally invasive surgical procedure was introduced at the Erasmus MC in 1998, combining the benefits of both techniques. The aim of this thesis was threefold: 1. To set a basis for improved translatability of outcome in future trials. 2. To determine the outcome of percutaneous reduction and internal fixation using the modified method of Forgon and Zadravecz. 3. To determine the best practice for delayed complications after displaced-intra-articular calcaneal fractures. Important conclusions were: 1. Uniformity in treatment of intra-articular calcaneal fractures More uniformity can been obtained in the evaluation of displaced intra-articular calcaneal fractures. The classification systems by Crosby and by Sanders are the most frequently applied out of the 64 available fracture classifications, and show the best interobserver agreement. The standard radiographs show little correlation with outcome. Out of 34 different outcome scoring systems the AOFAS and the MFS are the most useful. 2. Percutaneous treatment of intra-articular calcaneal fractures Minimal invasive surgery, according to Forgon and Zadravecz, for displaced intra-articular calcaneal fractures, provides overall good to excellent result in 71 to 90% of patients. 3. Management of late complications In case of persistent complaints a subtalar arthrodesis provides equal results compared to a triple arthrodesis. Smoking was a definite risk factor for a failing arthrodesis

Intra-articulaire calcaneusfracturen

ABSTRACT About 0.6% of all fractures is an intra-articular calcaneal fracture. Patients often have additional injuries, and returning to work can take up to one year. The diagnostics consist of plain, lateral and axial, radiographs of the calcaneus. In addition a CT-scan is performed in three planes. Because of the lack of a standardised classification and disease specific outcome-scores there is no agreement on the best treatment modality. More randomised controlled trials are mandatory in the future to determine the best treatment modality for the different types of intra-articular calcaneal fractures

Het klieven van de buigpees bij ulcera van de tenen

Meer dan 25% van alle diabetische voetproblemen wordt veroorzaakt door ulcera. De genezingskans met een conservatief beleid is laag, waarbij ruim tweederde van de ulcera na twintig weken nog niet genezen is. Ondanks dat de recidiefkans en de amputatiekans afnemen bij een multidisciplinaire aanpak van diabetische voetulcera, worden voor beiden nog percentages van boven de 80% gerapporteerd. Meer dan 50% van alle diabetische voetulcera bevindt zich ter hoogte van de tenen. Bij een groot deel hiervan ligt een anatomische standsafwijking (klauw- of hamerteen) aan ten grondsla

Influence of approach and implant on reduction accuracy and stability in Lisfranc fracture-dislocation at the tarsometatarsal joint

Background: Besides early diagnosis, an anatomical and stable reduction is paramount for obtaining a favorable outcome. The current study looked at the influence that the type of approach for tarsometatarsal injuries has on the accuracy of the reduction and the effect that the type of fixation has on stabili