Tag Archive for: fracture

Fractures of the Calcaneus- An Illustrated Review

Vol 9 | Issue 1 | January-June 2023 | page: 05-17 | Balvinder Rana, Anand Pillai

DOI: https://doi.org/10.13107/ti.2023.v09.i01.032

Authors: Balvinder Rana [1], Anand Pillai [2]

[1] Department of Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, UK.

[2] Department of Trauma and Orthopaedics, Foot & Ankle Division, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, UK.

Address of Correspondence

Dr. Balvinder Rana,

Speciality Doctor, Department of Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, UK.

Email: anklefootsurgery@gmail.com


Calcaneal fractures are rare injuries accounting for less than 2% of all fractures. There is considerable published literature on calcaneal fractures, but the optimum management has still not been defined clearly because of different fracture patterns, patient characteristics affecting outcome, soft tissue complications associated with surgical treatment and complex anatomy of the calcaneus making accurate surgical reconstruction difficult. New techniques such as minimally invasive surgery (MIS) have shown promise. In this illustrated pictorial review, we summarise the surgical anatomy, pathophysiology, treatment strategies including tips and tricks on surgical management and discuss the current literature for this complex injury.

Keywords: Calcaneus, fracture, calcaneal anatomy, calcaneal fracture management, outcome of calcaneal fracture, classification


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8. Lee SM, Huh SW, Chung JW, Kim DW, Kim YJ, Rhee SK. Avulsion fracture of the calcaneal tuberosity: classification and its characteristics. Clin Orthop Surg. 2012 Jun;4(2):134-8. doi: 10.4055/cios.2012.4.2.134. Epub 2012 May 17. PMID: 22662299; PMCID: PMC3360186.

9. Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intraarticular calcaneal fractures: Results using a prognostic computed tomography scan classification. Clin. Orthop. Relat. Res., 1993. https://doi.org/10.1097/00003086-199305000-00012.

10. Cotton FJ, Wilson LT. Fractures of the Os Calcis | NEJM n.d. https://www.nejm.org/doi/full/10.1056/NEJM190810291591801

11. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicentre trial. Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, Galpin R.JBJS Am. 2002 Oct;84-A(10):1733-44.

12. Tufescu T V, Buckley R. Age, gender, work capability, and worker’s compensation in patients with displaced intraarticular calcaneal fractures. J Orthop Trauma 2001;15:275–9. https://doi.org/10.1097/00005131-200105000-00007.

13. Paul M, Peter R, Hoffmeyer P. Fractures of the calcaneum. A review of 70 patients. J Bone Jt Surg – Ser B 2004;86:1142–5. https://doi.org/10.1302/0301-620X.86B8.15219

14. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicentre trial. Agren PH, Wretenberg P, Sayed-Noor AS. JBJS Am. 2013 Aug 7;95(15):1351-7

15. Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: Randomised controlled trial. BMJ 2014;349:g4483–g4483. https://doi.org/10.1136/bmj.g4483

16. Luo X, Li Q, He S, He S. Operative Versus Nonoperative Treatment for Displaced Intra-Articular Calcaneal Fractures: A Meta-Analysis of Randomized Controlled Trials. J Foot Ankle Surg 2016;55:821–8. https://doi.org/10.1053/j.jfas.2016.01.035.

17. Chen L, Zhang G, Hong J, Lu X, Yuan W. Comparison of Percutaneous Screw Fixation and Calcium Sulfate Cement Grafting Versus Open Treatment of Displaced Intra-Articular Calcaneal Fractures. Foot & Ankle International. 2011;32(10):979-985. doi:10.3113/FAI.2011.0979

18. Stulík, Jiri & Stulik, Jan & Rysavy, Martin & Wozniak, A. (2007). Minimally-invasive treatment of intra-articular fractures of the calcaneum. The Journal of bone and joint surgery. British volume. 88. 1634-41. 10.1302/0301-620X.88B12.17379

19. Magnan B, Bortolazzi R, Marangon A, Marino M, Dall’Oca C, Bartolozzi P. External fixation for displaced intra-articular fractures of the calcaneum. J Bone Joint Surg Br. 2006 Nov;88(11) 1474-1479. doi:10.1302/0301-620x.88b11.17759. PMID: 17075093.

20. Rammelt S, Amlang M, Barthel S, Gavlik JM, Zwipp H. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin. Orthop. Relat. Res., vol. 468, 2010, p. 983–90. https://doi.org/10.1007/s11999-009-0964-x.

21. Stulik J, Stehlik J, Rysavy M, Wozniak A. Minimally-invasive treatment of intra-articular fractures of the calcaneum. J Bone Jt Surg – Ser B 2006;88:1634–41. https://doi.org/10.1302/0301-620X.88B12.17379

22. Nosewicz TL, Dingemans SA, Backes M, Luitse JSK, Goslings JC, Schepers T. A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures. Foot Ankle Surg. 2019 Oct;25(5):580-588. doi: 10.1016/j.fas.2018.08.006. Epub 2018 Aug 28. PMID: 30321924.

23. Majeed H, Barrie J, Munro W, McBride D. Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures: A systematic review of the literature. EFORT Open Rev. 2018 Jul 11;3(7):418-425. doi: 10.1302/2058-5241.3.170043. PMID: 30233817; PMCID: PMC6129959.

24. Heier KA, Infante AF, Walling AK, Sanders RW. Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome. J Bone Jt Surg – Ser A 2003. https://doi.org/10.2106/00004623-200312000-00002.

25, Fractures of the Calcaneus 2nd edition, Mandeep S Dhillon, Jaypee publishers, Chapter : Extensile Lateral approach chapter by Richard Buckley and Balvinder Rana

26. Carr JB. Early wound complications of operative treatment of calcaneus fractures: Analysis of 190 fractures. J Orthop Trauma 1999;13:372. https://doi.org/10.1097/00005131-199906000-00009.

27. Schuberth JM, Cobb MD, Talarico RH. Minimally Invasive Arthroscopic-Assisted Reduction with Percutaneous Fixation in the Management of Intra-Articular Calcaneal Fractures: A Review of 24 Cases. J Foot Ankle Surg 2009;48:315–22. https://doi.org/10.1053/j.jfas.2009.01.002.

28. Hoppenfeld S, DeBoer P, Buckley R. Surgical Exposures in Orthopaedics; The Anatomic Approach. Ch. 12, The ankle and foot. Lippincott Williams & Wilkins. 2009

29. Borrelli J Jr, Lashgari C. Vascularity of the lateral calcaneal flap: a cadaveric injection study. J Orthop Trauma. 1999 Feb; 13(2):73-7.

30. Sirisreetreerux N et al. Location of the vertical limb of Extensile Lateral Calcaneal approach and risk of injury of the calcaneal branch of peroneal artery. Foot Ankle Int. 2019 Feb: 40(2); 224-230.

31. John Y. Kwon, MD et. al. Proximity of the Lateral Calcaneal Artery With a Modified Extensile Lateral Approach Compared to Standard Extensile Approach. Foot & Ankle Int.2016; 38 (3):318-323.

32. Pitts CC, Almaguer A, Wilson JT, Quade JH, Johnson MD. Radiographic and Postoperative Outcomes of Plate Versus Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi. Foot Ankle Int. 2019 Aug;40(8):929-935. doi: 10.1177/1071100719848063. Epub 2019 May 14. PMID: 31088171.

How to Cite this article: Rana B, Pillai A | Fractures of the Calcaneus- An Illustrated Review | January-June 2023; 9(1): 05-17 | https://doi.org/10.13107/ti.2023.v09.i01.32


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Fixation of Acromion Fracture by Distal Radius Plate: A Case Report

Vol 9 | Issue 1 | January-June 2023 | page: 26-28 | Mohd Danish, Hemant Gupta, Ravi Kant, Vikas Singh

DOI: https://doi.org/10.13107/ti.2023.v09.i01.35

Authors: Mohd. Danish [1], Hemant Gupta [1], Ravi Kant [1], Vikas Singh [1]

[1] Department of Orthopaedics, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.

Address of Correspondence

Dr. Mohd Danish,

Department of Orthopaedics, Max Super Specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.

E-mail: danish.shan@gmail.com


Acromion process fractures are as rare to happen and even rare to be treated surgically. Acromion acts as a stabilizer of shoulder joint through a number of ligaments and muscles attached to it. Although most of the acromion fractures are treated conservatively which may either be due to surgeon preference or lack of sufficient training in surgically treating these fractures. Our case is of a 54 years old, Male who presented to us after being referred from other hospital with Type II acromion process fracture who was treated surgically after the fracture was fixed by the unconventional distal end radius plate in place of usually used clavicular or recon plates. The patient yielded excellent Oxford shoulder score in the subsequent follow ups. Although the acromion fractures are not fixed by most of the surgeons and if at all they are fixed they usually use the conventional plates as mentioned for its fixation, but our case shows that even the distal radius plates can be used as a fixation device in such fractures with excellent rehabilitation results and almost no complications.

Keywords: Acromion, Fracture, Plate


1. Bartonicek J. Rockwood and Green’s Fractures in Adults, 8th Edition. Vol. 1. Netherlands: Wolters Kluwer; 2015. Scapular fractures; p. 1478.

2. Cole PA, Shafiq B. Master Techniques in Orthopaedic Surgery. Vol. 1. Philadelphia: Lippincott Williams & Wilkins; 2006. Scapula fractures: open reduction internal fixation; pp. 15–36.

3. Scapular fractures. Analysis of 113 cases. Ada JR, Miller ME. https://pubmed.ncbi.nlm.nih.gov/1864036/ Clin Orthop Relat Res. 1991;269:174–180.

4. Fracture of the body, neck, or spine of the scapula. A long-term follow-up study. Nordquist A, Peterson C. https://pubmed.ncbi.nlm.nih.gov/1395237/ Clin Orthop Relat Res. 1992;283:139–144.

5. Pre- and postoperative function after scapula malunion reconstruction: a novel kinematic technique. Ganger EM, Ludwig PM, Wijdecks CA, Cole PA. J Orthop Trauma. 2013 Aug;27(8):e186-91.

6. Fractures of the acromion process: a proposed classification system. Kuhn JE, Blasier RB, Carpenter JE. J Orthop Trauma. 1994;8:6–13.

7. Operative treatment of scapular fractures: a systematic review. Lantry JM, Roberts CS, Giannoudis PV. Injury. 2008;39:271–283.

How to Cite this article: Danish M, Gupta H, Kant R,Singh V | Fixation of Acromion Fracture by Distal Radius Plate – A Case Report | January-June 2023; 9(1): 26-28 | https://doi.org/10.13107/ti.2023.v09.i01.35


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Tens Nailing in Fracture Clavicle – A Case Series

Vol 8 | Issue 2 | July-December 2022 | page: 17-20 | Mohd Danish, Hemant Gupta, Ashish Sao, Ravi Kant

DOI: https://doi.org/10.13107/ti.2022.v08i02.029

Authors: Mohd Danish [1], Hemant Gupta [1], Ashish Sao [1], Ravi Kant [1]

[1] Department of Orthopaedics, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.

Address of Correspondence

Dr. Mohd Danish,

Department of Orthopaedics, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.

E-mail: danish.shan@gmail.com


INTRODUCTION: Clavicle is one of the most commonly fractured bones accounting for 2.6 – 4 % of all the fractures. 69 – 82% of these occur in middle third of clavicle, 73 % of which are displaced midshaft clavicular fractures). Surgery has been indicated for displaced fractures of clavicle, one with NV compromise and skin tenting. Intramedullary fixation for clavicular fractures was first described by Peroni in 1950. The use of a TENS nail carries advantages of less soft tissue compromise, less operative time, better cosmetic results, load sharing fixation with relative stability that encourages copious callus formation.

MATERIAL AND METHOD: A prospective review of 20 patients who presented to our institute between January 2021 and June 2022 with displaced midshaft clavicle fractures and treated with TENS nailing was carried out. All the patients had Constant Murley score and DASH score, which were done at 6 and 12 weeks.

RESULTS: All the patients achieved clinical and radiological union at a mean of 19.6 ± 6.67.80% of the patient had excellent Constant Murley score on follow up. Based on the assessment parameters (Disability of Arm Shoulder and Hand) Score, the mean DASH score was 25.03 ± 3.36 (range 20-30), 18.56 ± 3.46 (range 14-25) at the end of 6 weeks and 12 weeks respectively.

CONCLUSION: The intramedullary fixation using TENS of midshaft clavicle fractures is a safe minimally invasive technique in indicated cases and in our hands, it provides good functional outcome and cosmetic results.

KEYWORDS: Tens, Clavicle, Fracture, Intramedullary


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2. Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res. 1994; (300: ):127–32. 

3. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007; 89(1):1–10. 

4. Houwert RM, Wijdicks FJ, Steins Bisschop C, Verleisdonk EJ, Kruyt M. Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop. 2012; 36 (3):579–85.

5. Assobhi JE. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. J Orthop Traumatol. 2011; 12(4):185–92. doi: 10.1007/s10195-011- 0158-7 PMID: 21948051

6. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma. 2005; 19(7):504– 7. 

7. Kontautas E, Pijadin A, Vilkauskas A, Domeika A. Biomechanical aspects of locking reconstruction plate positioning in osteosynthesis of transverse clavicle fracture. Medicina (Kaunas). 2012; 48(2):80– 3. 

8. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD, Evidence-Based Orthopaedic Trauma Working G. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the EvidenceBased Orthopaedic Trauma Working Group. J Orthop Trauma. 2005;19(7):504-507.

9. Grassi FA, Tajana MS, D’Angelo F. Management of midclavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. J Trauma.2001;50(6):1096-100.

10. Leppilahti J, Jalovaara P. Migration of Kirschner wires following fixation of the clavicle–a report of 2 cases. Acta Orthop Scand. 1999;70(5):517-519.

11. Lyons FA, Rockwood CA, Jr. Migration of pins used in operations on the shoulder. J Bone Joint Surg Am. 1990;72(8):1262-1267.

12. Naidoo P. Migration of a Kirschner Wire from the clavicle into the abdominal aorta. Arch Emerg Med. 1991;8(4):292-295.

How to Cite this article: Danish M, Gupta H, Sao A, Kant R | Tens Nailing in Fracture Clavicle – A Case Series | July-December 2022; 8(2): 17-20 |  https://doi.org/10.13107/ti.2022.v08i02.029


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New Comprehensive Classification Systems for Peri-trochanteric Femur Fractures

Vol 3 | Issue 2 | Sep – Dec 2017 | page: 31-34 | Aditya K. Agrawal

Author: Aditya K. Agrawal [1].

[1]Dept of Orthopaedics, Dhiraj Hospital, SBKS MIRC, SumandeepVidyapeeth, Waghodia, Vadodara, Gujarat, 391760 India.

Address of Correspondence
Dr. Aditya K. Agrawal
Dept of Orthopaedics, Dhiraj Hospital,
SBKS MIRC, SumandeepVidyapeeth, Waghodia,
Vadodara, Gujarat, 391760 India.
Email: adityagrawal83@gmail.com


Purpose: A classification is considered as good classification if it describes the particularregion of bone, type of fracture, personality of fracture in either planes and helps in selectionof implant and most importantly easy to understand by an orthopedic surgeon. Classification becomes more complicated when there is double region involvement with comminution,or distal fracture is in shaft leading to segmental fracture.
Materials and Methods: There are numerous classification systems available in the presentliterature for peri-trochanteric femur fractures. These include Evan’s, Tronzo, and Boyd andGriffin, OTA classifications for peri-trochanteric region, Seinsheimer’s and Fieldingclassifications for sub-trochanteric region. AO classification which is widely acceptedcritically defines peri-trochanteric, head and neck region of fracture femur.
Results: Drawbacks of existing classifications are that they are based on fractureconfiguration in sagittal plane only except Seinsheimer’s classification which is based oncoronal plane fracture morphology. Furthermore, double regions/ multiple regions arenot properly defined in these classification systems. If the proper classification system is not followed, it will lead to the selection of wrong implants which thereby leads to complications.
Discussion: Advantages of our new classification system are that it is easy to understand; allregions of peri-trochanteric femur are covered, and in the selection of proper implant.Hence, intra-operative complications can be avoided with proper pre-operative planning.
Conclusion: Thus, we hope that our new comprehensive classification of peri-trochantericfemur may help to solve the mysteries surrounding the understanding, classifying, and treating the fractures of peri-trochanteric femur.
Keywords: Classification, comprehensive, femur, fracture, peri-trochanteric.


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How to Cite this article:  Agrawal A. K. New Comprehensive Classification Systems for Peri-trochanteric Femur Fractures. Trauma International Sep-Dec 2017;3(2):31-34.

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