A modified technique for the treatment of intra-articular calcaneal fractures with the use of the Ilizarov apparatus

Abstract

The management of intra-articular calcaneal fractures during the past years has been ranged from the nihilistic approach of no active treatment to open reduction and internal fixation (ORIF) or even to early subtalar arthrodesis. The management of such fractures with the use of circular external fixators in a closed fashion or in combination with minimal approach is demonstrated in our study. The midterm results of 36 intra-articular calcaneal fractures treated between 1996 and 2003 with the use of the Ilizarov apparatus according to our modified operative strategy are presented. In treating calcaneal fractures, the classic Essex-Lopresti classification into depression and tongue type has been proved very useful in our hands. While the depression-type fractures can be reduced through skeletal traction and the above-mentioned minimal approach, tongue-type fractures can cause difficulties in reducing and especially maintaining the reduction of the tongue fragment. Especially for these fractures, a combined technique was applied by reducing the fracture with Steinmann pins according to the Essex-Lopresti method and incorporating them into the Ilizarov apparatus. This technique appears to be a lot easier and more accurate than the alternative “bent-wire technique” for reducing and holding down a tongue fragment. The original Essex-Lopresti manipulation alone with plaster immobilization does not allow weight bearing and is associated with regional osteoporosis. Apart from the Essex-Lopresti classification, the material was also categorized by the widely accepted Sanders CT classification for comparison of our results to those of the literature. The SF-36 patient-oriented general health status questionnaire was utilized before, during, and after the treatment period to assess patients’ satisfaction levels. We propose this operative strategy as an option for the treatment of all calcaneal fractures. Le traitement des fractures articulaires du calcanéus fait appel au traitement fonctionnel, à la réduction ostéosynthèse à foyer ouvert, voire à l’arthrodèse sous-talienne primitive. Les auteurs rapportent une série de 36 fractures traitées par fixateur d’Ilizarov entre 1996 et 2003. Fondée sur la classification d’Essex Lopresti, ils précisent leur technique dans les fractures thalamo-tubérositaires et dans les fractures enfoncement. Ils étudient le degré de satisfaction du patient par rapport au traitement choisi grâce au questionnaire SF 36, utilisé avant, pendant et après l’application du fixateur.

DOI: 10.1007/s00590-005-0223-0

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Cite this paper

@article{Polyzois2005AMT, title={A modified technique for the treatment of intra-articular calcaneal fractures with the use of the Ilizarov apparatus}, author={Vasilios D. Polyzois and Thomas J. Zgonis and Theodoros B. Grivas and Spyridon J. Plessas and Vasilios D. Nicolaidis and Dimitrios S. Korres}, journal={European Journal of Orthopaedic Surgery & Traumatology}, year={2005}, volume={15}, pages={122-128} }