Davos Courses

Executive Editor: Joseph Schatzker

Authors: Richard Buckley, Andrew Sands

Calcaneus - Displaced body fractures

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Glossary

General considerations

Controversy exists in this area more than in most areas of orthopedic trauma. However, as is the case with most of the articular injuries, accurate reconstruction can provide the best long term outcome for this devastating injury. Late reconstruction is difficult meaning that timely appropriate ORIF can salvage a complex fracture. Careful indications are important in this fracture type as seen below.

ORIF - plate and screw fixation
Main indication Skill Equipment
Displaced, mal angulated hind feet in healthy compliant individuals. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications

  • Poor heel position and shape
  • Displaced articular involvement
  • No medical contraindications to operative care
  • Open fractures
  • Compliant patients < 60 years old
  • Patients with no medical comorbidities, or controlled single comorbidities
  • Nonsmokers

Contra indications

  • Non compliance
  • Uncontrolled medical conditions (diabetes)
  • Vasculopathy
  • Unrepentant smokers
  • Age over 60
  • Extremely sedentary

Advantages

  • Articular surface reconstruction
  • Foot height, width, and length reconstruction
  • No varus
  • No need for specialized shoe ware
MIO - K-wire and screw fixation (joint-depression type)
Main indication Skill Equipment
Simple joint depression fractures in patients where large incision ORIF is contraindicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications

  • Displaced intra articular fracture of joint depression type
  • Individual with medical unwellness precluding full open reduction
  • Simple fracture type (two fragments only)
  • Older patients where large incision ORIF may have high complication risk

Contraindications

  • More than 3 days between trauma and surgical intervention
  • Comminuted joint depression type fracture

Advantages

  • Small incision surgery may promote better range of motion in early rehabilitation
  • Less chance of wound complication
  • Opportunity for surgery in marginal medical patients (heavy smokers, diabetics)

Disadvantages

  • Joint reduction cannot be as perfectly seen
MIO - K-wire fixation (tongue type)
Main indication Skill Equipment
Tongue type fractures in patients where large incision ORIF is contraindicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications

  • Displaced intra articular fracture of tongue type
  • Individual with medical unwellness precluding full open reduction
  • Simple fracture type (two fragments only)
  • Older patients where large incision ORIF may have high complication risk

Contraindications

  • More than 3 days between trauma and surgical intervention
  • Comminuted joint depression type fracture

Advantages

  • Small incision surgery may promote better range of motion in early rehabilitation
  • Less chance of wound complication
  • Opportunity for surgery in marginal medical patients (heavy smokers, diabetics)

Disadvantages

  • Joint reduction cannot be as perfectly seen
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2010-10-14