Posts

Evaluation of Radiological and Functional Outcome of Calcaneum Fractures using Essex-Lopresti Technique of Reduction

Vol 3 | Issue 2 | Sep -Dec 2017 | page: 28-30 | Atul A Kharat, Sandeep R Biraris, Pramod P Chikhalikar, Sheran Ali, G Krishna Naresh Goud


Author: Atul A Kharat [1], Sandeep R Biraris [2], Pramod P Chikhalikar [3], Sheran Ali [1], G Krishna Naresh Goud [2].

[1]Department of Orthopaedics, Pad. Dr D Y Patil Medical College & Hospital, Nerul, Navi Mumbai.
[2]Department of Orthopaedics, Mumbai Port Trust Hospital, Wadala (E), Mumbai.
[3]Department of Orthopaedics, Pad. Dr D Y Patil Medical College, Pune.

Address of Correspondence
Dr. Sandeep R Biraris,
Department of Orthopaedics, Mumbai Port Trust Hospital, Wadala (E), Mumbai, Maharashtra-400037.
Email: drsandeeprb@gmail.com


Learning Points for this Article: This articles states about various treatment modalities about management of the calcaneum fractures, it shows that non-displaced fractures can be treated conservatively and also Bohler’s and Gissane’s angles should be maintained post-operatively to have a good functional outcome.


Abstract

Background: Calcaneum fractures account for approximately 2% of all fractures, with displaced intra-articular fractures comprising 60-75% of these injuries of which 10% have associated spine fractures and 26% are associated with other extremity injuries. Several authors have reported that patients may be totally incapacitated for up to 3 years and partially impaired for up to 5 years post injury, Although modern surgical techniques have improved the outcome, controversy still exists regarding classification, treatment, operative technique, and post-operative management.
Materials and Methods: 28 out of 31 cases were analyzed prospectively and retrospectively from July 2011 to August 2013 after local ethical and scientific clearance. Three patients had lost to follow-up. All patients with calcaneum fractures above age of 18 with either simple or open injuries were included in the study, excluding pediatric and complex injuries. All patients were clinically evaluated and Bohler’s, Gissane’s angles were calculated preoperatively. All patients were treated with one of the modalities, which include conservative, Steinmann pinning, and Calcaneum plate fixation. All patients were followed up in outpatient basis fortnightly for 3 months and on 6th month and 1 year respectively, to check signs of union of fracture, subtalar movements, and complications if any. After radiological evaluation, functional outcome assessment was done using American Orthopaedic Foot and Ankle Society
Results: Mean age was 35.1 with range 20-52 years, male to female ratio of 9:1. 85% were due to high-velocity trauma. The most common type of injury was tongue type. Preoperative mean Bohler’s and Gissane’s angles which were about 14.87 and 121.5 degrees respectively, the improved angles postoperatively were 25.68 and 104.37 degrees. One patient had heel pain, one patient had residual edema, one patient developed subtalar and ankle stiffness, there was one case of tendocalcaneus weakness, one with broadening of heel, and one case of wound infection.
Conclusion: Undisplaced or minimally displaced calcaneum fractures are best-treated conservatively with cast immobilization for 6 weeks. Essex-Lopresti technique of reduction was superior technique for displaced fractures and achievement of Bohler’s and Gissane’s angle to the after reduction was judgemental for optimal functional outcome.
Keywords: Calcaneum, Essex-Lopresti, functional outcome.


References

1. Bucholz RW, Beaty JH, Rockwood CA, Green DP. Rockwood and Greens Fractures in Adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott, Williams & Wilkins; 2010. p. 2133.
2. Egol KA, Koval KJ, Zuckerman JD. Handbook of Fracture’s. 41th ed. Philadelphia, PA: Lippicot Williams and Wilkins; 2010. p. 507-519.
3. Tomesen T, Biert J, Frölke JP. Treatment of displaced intra-articular calcaneal fractures with closed reduction and percutaneous screw fixation. J Bone Joint Surg Am 2011;93(10):920-928.
4. Canale ST, Beaty JH. Campbell’s Operative Orthopedics. Philadelphia, PA: Mosby/Elsevier; 2008. p. 4833-4850.
5. Pillai A, Basappa P, Ehrendorfer S. Modified Essex-Lopresti/Westheus reduction for displaced intra-articular fractures of the calcaneus. Description of surgical technique and early outcomes. Acta Orthop Belg 2007;73(1):83-87.
6. Silva PS, Simões B, Pessole ML, Richard L. Evolution of intra-articular fractures deviated from the calcaneus with surgical treatment. Acta Ortop Bras 2006;14(1):35-39.
7. Meraj A, Zahid M, Ahmad S. Management of intraarticular calcaneal fractures by minimally invasive sinus tarsi approach-early results. Malays Orthop J 2012;6(1):13-17.
8. Yip-Kan Y, Yuen-Fong H. Percutaneous fixation of displaced calcaneal fracture. J Orthop Trauma Rehabil 2011; 15(1):5-9.
9. Stulik J, Stehlik J, Rysavy M, Wozniak A. Minimally-invasive treatment of intra-articular fractures of the Calcaneum. J Bone Joint Surg Br 2006;88(12):1634-1641.
10. El-Khalifa T, El-Bagali M, Yousif W, Hashem F. Limited open reduction and percutaneous T screw fixation of displaced intra-articular fracture of calcaneus: Review of 48 fractures. Bahrain Med Bull 2011; 33(2):97-102.


How to Cite this article:  Kharat AA, Biraris SR, Chikhalikar PP, Ali S, Goud GKN. Evaluation of Radiological and Functional Outcome of Calcaneum Fractures using Essex-Lopresti Technique of Reduction. Trauma International Sep-Dec 2017;3(2):28-30.



(Abstract)      (Full Text HTML)      (Download PDF)