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External fixation in intra-articular fractures of the calcaneus: Is it a valid option as definitive treatment?

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

The therapeutic management of calcaneal fractures is currently a major source of controversy in the literature. There is no consensus on the need to treat these injuries conservatively or surgically, nor on the criteria for deciding one option or the other. Although the gold standard has classically been the open approach and osteosynthesis, there are currently minimally invasive techniques that also report good results. Our objective is to present our results and experience with the MBA® Orthofix external fixator in a series of cases of calcaneal fractures.

Methods

We performed a retrospective observational study in our center, between the years 2019 and 2021, of Sanders types II–IV calcaneal fractures operated with MBA® Orthofix external fixator. We recorded a total of 38 patients, 42 fractures. We registered demographic information, intraoperative, postoperative, radiological and functional parameters, using the American Orthopedic Foot and Ankle Society (AOFAS), Manchester-Oxford Foot Questionnaire (MOXFQ), EQ-5D and VAS scales.

Results

A total of 26 men and 12 women were included, and the median age was 38 years. Mean follow-up was 24,4 months (6, 8–40, 1). The average time to surgery was 7 days and partial loading was started at 2.5 weeks after external fixation, which was removed at 9.2 weeks. The average Böhler angle correction was 7, 4°, Gissane − 12,2°, length 2 mm and calcaneal width was reduced by 5 mm. We recorded two superficial infections, one peroneal entrapment and three subtalar arthrodesis due to post-traumatic osteoarthritis. The AOFAS obtained was 79.1 + / − 15.7 points, MOXFQ 20.1 + / − 16.1 points, EQ-5D 0.84 + / − 0.2 and VAS 3.3 + / − 1.9.

Conclusion

The external fixator is an excellent surgical alternative for complex articular fractures of the calcaneus, obtaining clinical and radiological results comparable to other osteosynthesis techniques and significantly reducing soft tissue complications.

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References

  1. Ortu S, Brusoni M, Pisanu F, Caggiari G, Ciurlia E, Bienati F et al (2020) Functional and radiological outcomes in displaced heel fractures: open reduction and internal fixation versus external fixation. Orthop Rev (Pavia) 12(2):83–86

    Article  Google Scholar 

  2. Ojeda-Jiménez J, Rendón-Díaz D, Martín-Vélez P, González-Martín D, Boluda-Mengod J, Méndez-Ojeda M et al (2020) Surgically treated calcaneal joint fractures: What does postoperative computed tomography give us? Rev Esp Cir Ortop Traumatol 64(6):393–400

    Google Scholar 

  3. Correoso Castellanos S, García Galvez A, Lajara Marco F, Blay DE (2019) Intra-articular calcaneal fractures. Do locking plates keep the reduction better than conventional plates? Rev Esp Cir Ortop Traumatol. 63(6):383–388

    CAS  Google Scholar 

  4. Ågren H, Mukka S, Tullberg T, Wretenberg P, Sayed-Noor AS (2014) Factors affecting long-term treatment results of displaced intraarticular calcaneal fractures: a post hoc analysis of a prospective, randomized Controlled Multicenter Trial. J Orthop Trauma 28:564–568

    Article  PubMed  Google Scholar 

  5. Wei N, Yuwen P, Liu W, Zhu Y, Chang W, Feng C et al (2017) Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a meta-analysis of current evidence base. Medicine 96:e9027

    Article  PubMed  PubMed Central  Google Scholar 

  6. Meena S, Kumar Gangary S, Sharma P (2016) Review article: operative versus non-operative treatment for displaced intra-articular calcaneal fracture: a meta-analysis of randomised controlled trials. J Orthop Surg 24(3):411–416

    Article  Google Scholar 

  7. Heather EG, Zide JR (2017) Current controversies in management of calcaneus fractures. Orthop Clin N Am 48:91–103

    Article  Google Scholar 

  8. Luo X, Li Q, He S, He S (2016) Operative versus nonoperative treatment for displaced intra-articular calcaneal fractures: a meta-analysis of randomized controlled trials. J Foot Ankle Surg 55:821–828

    Article  PubMed  Google Scholar 

  9. Ågren 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 Joint Surg 95(15):1351–1357

    Article  PubMed  Google Scholar 

  10. Magnan B, Bortolazzi R, Marangon A, Marino M, Dall’oca C, Bartolozzi P et al (2006) External fixation for displaced intra-articular fractures of the calcaneum. J Bone Joint Surg 88(B):1474–1479

    Article  Google Scholar 

  11. Jiang N, Lin QR, Diao XC, Wu L, Yu B (2012) Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base. Int Orthop 36:1615–1622

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bruce J, Sutherland A (2013) Surgical versus conservative interventions for displaced intra-articular calcaneal fractures (Review). Cochrane Database Syst Rev (1):CD008628. https://doi.org/10.1002/14651858.CD008628.pub2

  13. Baliga SM, Sutherland A, Bruce J (2010) Surgical versus conservative interventions for displaced intra-articular calcaneal fractures (Protocol). Cochrane Database Syst Rev (8):CD008628. https://doi.org/10.1002/14651858.CD008628

  14. Radnay CS, Clare MP, Sanders RW (2009) Subtalar fusion after displaced intra-articular calcaneal fractures: Does initial operative treatment matter? J Bone Joint Surg 7(3):541–546

    Article  Google Scholar 

  15. Allegra PR, Rivera S, Desai SS, Aiyer A, Kaplan J, Gross CE (2020) Intra-articular calcaneus fractures: current concepts review. Foot Ankle Orthop 5:2473011420927334

    Article  PubMed  PubMed Central  Google Scholar 

  16. van Hoeve S, Poeze M (2016) Outcome of minimally invasive open and percutaneous techniques for repair of calcaneal fractures: a systematic review. J Foot Ankle Surg 55(6):1256–1263

    Article  PubMed  Google Scholar 

  17. Corina G, Mori C, Vicenti G, Galante VN, Conserva V, Speciale D et al (2014) Heel displaced intra-articular fractures treated with mini-calcaneal external fixator. Injury 45(S6):S64-71

    Article  PubMed  Google Scholar 

  18. Sharr PJ, Mangupli MM, Winson IG, Buckley RE (2016) Current management options for displaced intra-articular calcaneal fractures: non-operative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. A contemporary review. Foot Ankle Surg 22:1–8

    Article  CAS  PubMed  Google Scholar 

  19. Liu Y, Li Z, Li H, Zhang Y, Wang P (2015) Protective effect of surgery against early subtalar arthrodesis in displaced intra-articular calcaneal fractures. Medicine 94:e1984

    Article  PubMed  PubMed Central  Google Scholar 

  20. Roukis TS, Wünschel M, Lutz HP, Kirschner P, Zgonis T (2008) Treatment of displaced intra-articular calcaneal fractures with triangular tube-to-bar external fixation: long-term clinical follow-up and radiographic analysis. Clin Podiatr Med Surg 25:285–299

    Article  PubMed  Google Scholar 

  21. Hsu AR, Anderson RB, Cohen BE (2015) Advances in surgical management of intra-articular calcaneus fractures. J Am Acad Orthop Surg 23:399–407

    Article  PubMed  Google Scholar 

  22. Wang J, Qin S, Wang T, Liu J, Wang Z (2021) Comparison of the curative effect of percutaneous reduction with plastic calcaneal forceps combined with medial external fixation in the treatment of intra-articular calcaneal fractures. Orthop Surg 13(8):2344–2354

    Article  PubMed  PubMed Central  Google Scholar 

  23. Pan M, Chal L, Xue F, Ding L, Tang G, Lv B (2017) Comparisons of external fixator combined with limited internal fixation and open reduction and internal fixation for Sanders type 2 calcaneal fractures. Finite element analysis and clinical outcome. Bone Joint Res. 6(7):433–438

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kissel CG, Husain ZS, Cottom JM, Scott RT, Vest J (2011) Early clinical and radiographic outcomes after treatment of displaced intra-articular calcaneal fractures using delta-frame external fixator construct. J Foot Ankle Surg 50(2):135–140

    Article  PubMed  Google Scholar 

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This study did not receive any funding.

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Authors and Affiliations

  1. Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain

    P. Checa-Betegón

  2. Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain

    P. Checa-Betegón, J. Valle-Cruz, S. Llanos-Sanz & J. García-Coiradas

  3. Complejo Hospitalario de Navarrra., C. de Irunlarrea, 3, 31008, Pamplona, Spain

    C. Miguel-Miguel

  4. Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain

    J. Sánchez-del-Saz

Authors
  1. P. Checa-Betegón
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  2. J. Valle-Cruz
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  3. S. Llanos-Sanz
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  4. C. Miguel-Miguel
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  6. J. García-Coiradas
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Correspondence to P. Checa-Betegón.

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Checa-Betegón, P., Valle-Cruz, J., Llanos-Sanz, S. et al. External fixation in intra-articular fractures of the calcaneus: Is it a valid option as definitive treatment?. Eur J Orthop Surg Traumatol 34, 201–208 (2024). https://doi.org/10.1007/s00590-023-03621-y

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  • DOI: https://doi.org/10.1007/s00590-023-03621-y

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