Monday, April 18, 2011

Early Clinical and Radiographic Outcomes after Treatment of Displaced Intra-articular Calcaneal Fractures Using Delta-Frame External Fixator Construct

Charles G. Kissel, DPM, FACFAS 1, Zeeshan S. Husain, DPM, FACFAS 2, James M. Cottom, DPM, FACFAS 3Ryan T. Scott, DPM 4, Joshua Vest, DPM 5

Intra-articular calcaneal fractures are associated with high morbidity, persistent pain, and long-term disability. This retrospective study assesses early clinical and radiographic postoperative findings of intra-articular calcaneal fractures following treatment by ligamentotaxis using a delta frame construct with a large frag- ment external fixator. Minimally invasive percutaneous reduction of calcaneal fractures is an alternative treatment for Sanders type II, III, and IV fractures. Ten patients from the Detroit Medical Center were followed between January 2002 and December 2004 for follow-up over a mean of 353.5 ` 85.45 days postoperatively. The mean age of the patients was 45.8 ` 12.3 years. There were 2 patients with Sanders type IIA, 3 patients with type IIIAB, 1 patient with type IIIAC, and 4 patients with type IV fracture patterns. The results demon- strated that the mean calcaneal width decreased, the calcaneal height increased, and the calcaneal length increased when comparing preoperative to postoperative measurements. Bohlers angle increased from 20.8 ` 8.27 preoperatively to 25.7 ` 5.21 postoperatively, and Gissanes angle decreased from 127.4 ` 45.22 preoperatively to 111.2 ` 39.38 postoperatively. The posterior facet step-off on CT examination reduced from 2.6 ` 0.82 mm preoperatively to 0.4 ` 0.26 mm postoperatively. The mean postoperative total subtalar joint range of motion was 19.0 ` 4.5 on the affected side and 34.4 ` 4.58 on the contralateral foot. The mean Maryland Foot score was 85.8 ` 6.41 in the 10 patients. With the exception of the change from preoperative to postoperative Bohlers angle, and the comparison of the ipsilateral (side of the fracture) to contralateral resting calcaneal stance position, all of the comparisons revealed statistically significant (P .05) differences. The authors conclude that the delta frame construct is a viable alternative method to open reduction and internal fixation for treating intra-articular calcaneal fractures.

Level of Clinical Evidence:
Keywords: distraction frame heel ligamentotaxis trauma

1 Detroit Medical Center PM&S-36 Residency Program Director, Detroit, MI 
2 Detroit Medical Center PM&S-36 Assistant Residency Director, Detroit, MI 
3 Submitted during residency, Detroit Medical Center PM&S-36, Detroit, MI 
4 Submitted during residency, Detroit Medical Center PM&S-36, Detroit, MI 
5 Submitted during residency, Detroit Medical Center PM&S-36, Detroit, MI

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