Fri., 10/9/09 Pilon/Foot & Ankle, Paper #61, 4:57 pm OTA-2009
Treatment of Displaced Intra-Articular Calcaneal Fractures with Closed Reduction and Percutaneous Screw Fixation
(FDA=Non-U.S. research conducted within guidelines of my country)
Tijmen Tomesen, BA(n); Jan Biert, MD, PhD(n);
Jan Paul M. Frölke, MD, PhD (10-BIOMET Travel Grant for OTA 2009);
Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
Purpose: Surgical treatment of displaced, intra-articular fractures of the calcaneal bone is a standard procedure in many institutions. To avoid soft-tissue complications, several minimally invasive procedures have been introduced. The aim of this study was to assess our practice of percutaneous treatment according to Forgon and Zadravecz in patients with displaced intra-articular calcaneal fractures. We hypothesized that closed reduction and percutaneous screw fixation is safe and effective for the management of intra-articular calcaneal fractures.
Methods: A consecutive series of 45 patients with 47 displaced intra-articular calcaneal fractures were reviewed who underwent percutaneous cannulated screw fixation (Biomet) according to Forgon and Zadravecz between 1998 and 2007. Pain, functional outcome, range of motion, and change in footwear were evaluated. To quantify pain and functional disability, the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Maryland foot score were used. All patients also completed a general health outcome form (Short Form-36 [SF-36]) and a visual analog scale (VAS) for patient satisfaction.
Results: After a mean follow-up period of 60 months, the mean scores of the AOFAS score and the Maryland foot score were 83 and 86 points out of 100, respectively. The score on the SF-36 was 76 points, and the score on the VAS was 7.9 points out of 10. The average sagittal range of motion was 82% compared with the contralateral foot, and the average subtalar range of motion was 56%. 37 patients (82%) were able to wear normal shoes. Wound infections were observed in 6 cases, of which 2 infections (4%) remained superficial and 4 resulted in deep wound infections (9%). Another 22 patients (47%) required a second procedure for hardware removal for pain around the location of the screws.
Conclusions: At a mean follow-up period of 5 years, closed reduction and percutaneous screw fixation of intra-articular calcaneal fractures result in excellent functional outcome scores and a low rate of infectious complications and late subtalar arthrodesis. A disadvantage may be that almost half of these patients ended up with hardware removal.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant