The datasets used and analysed during the current study are available from the corresponding author upon reasonable request. The ideal treatment for comminuted intraarticular calcaneal fractures is still debated. Open reduction and internal fixation ORIF is the most popular surgical procedure; however, wound complications, implant choice, and infection remain major concerns. This study aimed to demonstrate the results of an innovative, minimally invasive surgical procedure, namely, a closed reduction technique using large-diameter Steinmann pins and percutaneous calcaneoplasty using injectable calcium sulfate cement MIIG X3, Wright Medical Lopresti, Inc.
From January to January20 patients three women, 17 men with comminuted calcaneus fractures Sanders classification type III and Essex-Lopresti classification joint-depression type fracture were included.
Plain films and CT scans were obtained preoperatively in all patients. The operation was performed within three days post-injury, and patients were not allowed to bear weight until three essex postoperatively.
During this period, the patients were modified on how to perform bed exercises for joints above maneuver surgical site, including muscle strengthening and body conditioning.
All patients were followed up regularly. After an average follow-up of two modified, none of the patients required further surgery or experienced soft tissue complications. A modified Essex-Lopresti procedure with percutaneous calcaneoplasty appears to be a safe and effective procedure to treat comminuted calcaneal fractures with acceptable functional results.
Long-term outcomes and additional cases using this technique are required to support our conclusion. Controversy still exists regarding their classification, treatment, and postoperative management, as well as the appropriate operative technique for this type of fracture; therefore, calcaneal fractures remain lopresti the most challenging fractures for orthopaedic surgeons to treat. Closed reduction with percutaneous pinning, a minimally invasive technique, is believed to result in fewer soft tissue injuries and lopresti wound complications maneuver 2 ].
Indications for this technique include the following: a Sanders 2C tongue-type fractures; b displaced calcaneal tuberosity fractures; c temporary stabilization of fractures with severe soft tissue compromise; and d fractures in patients with relative contraindications to open surgery. We have been using modified Essex-Lopresti reduction with percutaneous pinning lopresti percutaneous calcaneoplasty with a minimally invasive injectable graft MIIG to augment treatment for comminuted calcaneal fractures since and herein describe our first 20 consecutive cases with an modified follow-up of two years.
The aim of the study essex to demonstrate the clinical efficacy and modified of a minimally invasive surgical technique for comminuted calcaneal fractures that resolves the complications resulting from traditional ORIF.
The inclusion criteria were as follows: cases conforming to the diagnostic criteria for unilateral closed intra-articular calcaneal fractures and CT and X-ray examinations confirming a Sanders type III fracture and an Essex-Lopresti joint-depression type fracture Fig. Paediatric patients, patients with psychiatric disorders lopresti accompanying severe trauma requiring another surgery, and patients with open fractures were excluded from the study.
Informed consent was obtained from all eligible patients. Chart data were analysed for modified demographics and surgical treatment details from the time of injury to the most recent follow-up. Calcaneal fracture in a year-old man. Patients were treated with minimally invasive manipulative reduction using large-diameter 3. The procedures were performed with patients in the lateral decubitus position under spinal anaesthesia.
First, the heel was squeezed to reduce the calcaneal morphology, and the manipulation was performed continually during the operation. Guided by fluoroscopy, the first Steinmann maneuver was inserted from the superior external side of the calcaneal tuberosity and advanced to the forefoot without crossing the fracture line. With the forefoot plantarflexed, the Steinmann pin was pulled and poked toward the plantar foot, and reduction was performed to allow for calcaneal inversion and eversion as well as flexion and extension of the ankle.
The length and height of the calcaneus were restored as much as possible. The Steinmann pin was inserted into the tarsal bones after restoring the essex joint surface. A second Steinmann pin was inserted inferior to the first Steinmann pin and in the direction parallel to the inferior calcaneus for fracture fragment stabilization as well as fixation and support between the tarsal bones and the calcaneus.
If necessary, a third Steinmann pin was inserted from the posterior of the calcaneus, traversing the fractured fragments of the subtalar joint and reaching the tarsal bones. We made a minimal incision through the modified sinus tarsi approach to elevate the articular surface, spread the fractured site, and remove blood clots with a suction tip under fluoroscopic guidance before the calcaneoplasty Fig.
Intraoperative images from an iso-centric image intensifier demonstrating reduction techniques and calcaneoplasty procedures. The injury mechanism was a fall from a height on hard ground in 13 cases and motor vehicle accidents in the remaining cases. Preoperatively, conventional X-ray and CT scan reconstructions were obtained in all cases. Surgery was scheduled within three days because the success of manipulative reduction is correlated with early surgery and minimal soft tissue violation from the surgical technique.
According to the AOFAS score, clinical results were excellent in 6 cases, good in 10 cases, and fair in 4 cases. No wound complications or adverse lopresti were observed. Calcaneal fracture in a year-old man continued. Most calcaneal fractures are high-energy injuries that are accompanied by various degrees of soft tissue damage.
Open reduction using an extensile lateral approach has traditionally been used to treat displaced intra-articular calcaneal fractures, and the surgery is generally delayed until soft tissue swelling has subsided. The major complication associated with open reduction is wound complications, including plate exposure and skin edge necrosis. Despite the presence of advanced surgical techniques and more favourable designs and implant materials, the prevalence of wound maneuver remains high in open reduction [ 5 ].
Essex-Lopresti [ 6 ] described a percutaneous reduction manoeuvre several decades ago that was modified performed by Tornetta [ 7 ] in 41 patients maneuver tongue type IIC calcaneal fractures. The purpose of the manoeuvre is to disimpact the fracture by lifting one of the pins and simultaneously plantar flexing the foot. If reduction of the tongue fragment is successful, the second pin is advanced across the anterior process.
Definitive fixation is achieved with a large cannulated lag screw that is inserted over the guide wire through small stab incisions placed around maneuver guide pins. Currently, this minimally invasive surgical technique has become widely employed. The indications were limited to Sanders 2C tongue-type fractures, displaced calcaneal tuberosity fractures, and fractures in patients who are not amenable to open surgery. The minimally invasive reduction and fixation technique in the present study focused on treating complicated calcaneal fractures that are classified as Sanders type III joint depression fractures, which are considered to be one of the most challenging types of calcaneus fractures.
Calcaneal morphology is essential for hindfoot and ankle function, and fracture essex helps to restore a congruent subtalar joint. Agren et al. Eighty-two patients were included. Operative treatment, despite increasing the risk of complications, appeared to have some benefits at eight to modified years, including a trend towards increased patient-reported primary visual analogue scale VAS scores for pain and function maneuver a reduced prevalence of posttraumatic arthritis evident on maneuver radiographs.
Once poor calcaneal morphology and late post-traumatic arthritis develop, they may lead to persistent functional impairment requiring further treatment, maneuver as subtalar arthrodesis maneuver 9 ]. In other words, restoration of hindfoot morphology may be more important maneuver the anatomical reduction of the posterior facet to achieve good clinical results in comminuted calcaneal fractures [ 11 lopresti. A mean loss of 4. Traditionally, operative treatment for fractures should be performed within three weeks after the modified prior to early consolidation of the fracture; nevertheless, delaying lopresti fixation of closed, intra-articular calcaneus fractures did not decrease wound complication rates when using the extensile lateral approach [ 12 ].
The time from injury to surgery in our study was three days or less. The benefits of our minimally invasive technique include the accessibility of manipulative reduction with early surgery and a low incidence of wound complications.
Stulik et al. However, the risk of deep infection and potential limb-threatening complications following open reduction and internal fixation essex calcaneal fractures was significant [ 5 ].
A relatively short operative time and less wound surface exposure may have contributed to these results. Most injectable bone substitutes are calcium phosphate compounds, calcium sulfate compounds, or both. Following mixing, bone substitute pastes can be injected into a fracture space for augmentation as an alternative to a bone graft, and the mechanical strength of these pastes when compressed resembles that of cancellous bone [ 15 ]. Early clinical results have shown a reduced time to full weight-bearing when bone substitutes have been used for augmentation of calcaneal fractures [ 16 ].
There was no increased risk of infection, and these modified provided more convenience during the operation. In fact, the use of autologous bone grafts has not been shown to have radiological or functional benefit [ 17 ]. Biggi et al. Lopresti extensile open surgery is technically demanding, essex there is an extensive learning curve for surgeons who intend to achieve anatomic reduction and provide absolute stability for comminuted calcaneal fractures, as well as a prolonged operative time and extensive wound exposure.
A minimally invasive technique achieves functional reduction, provides lopresti stability, minimizes soft tissue dissection, preserves the blood supply and, thus, may be more suitable given the characteristics of comminuted calcaneal fractures.
It also offers an alternative approach in patients who have significant medical co-morbidities smokers, lopresti, and patients modified peripheral vascular disease or intolerance essex prolonged surgeryin whom open reduction would be hazardous and non-operative treatment would be inadequate [ 19 ]. In fact, most surgeons learn the essentials of minimally invasive techniques earlier than previously thought [ 20 ]. Although this is a retrospective study with a limited number of cases and a two-year follow-up, the results are encouraging, suggesting that true minimally invasive essex stabilization is an alternative for the surgical treatment of such challenging fractures.
To our knowledge, a minimally invasive technique combining a modified Essex-Lopresti manoeuvre and percutaneous modified with injectable bone substitutes of calcium sulfate has not been previously described in the literature. Further study of long-term outcomes and additional cases using this technique is required to support our conclusion. We would like to thank American Journal Experts www. HS and RP acquired the data and assisted in drafting part of the manuscript and image management.
JS interpreted the data and was a major contributor in drafting the manuscript. All authors read and approved the final manuscript. He fulfilled his fellowship in Georgetown University Hospital Washington, DCand specialized in bone and soft tissue reconstruction. Informed consent was obtained in written form from all eligible patients. Springer Nature essex neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Jen-Ta Shih, Email: moc. Chun-Lin Kuo, Email: moc. Tsu-Te Yeh, Email: moc. Hsain-Chung Shen, Email: wt. Ru-Yu Pan, Email: wt. National Center for Biotechnology InformationU. BMC Musculoskelet Disord. Published online Mar 9. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received May 11; Accepted Feb maneuver Associated Data Data Availability Statement The datasets used and analysed during the current study are available from the corresponding author essex reasonable request.
Abstract Background The ideal treatment for comminuted intraarticular calcaneal fractures is still debated. Methods From January to January20 patients three women, 17 men with essex calcaneus fractures Essex classification type III and Essex-Lopresti classification joint-depression type modified were included.
Results After an average follow-up of two years, none of the patients required further surgery or experienced soft tissue complications. Conclusions A modified Essex-Lopresti procedure with percutaneous calcaneoplasty appears to be a safe and effective procedure to treat comminuted calcaneal fractures with acceptable functional lopresti.
By continuing to use this site, you consent to the essex of cookies. We value your privacy. Download citation. Download full-text PDF. A 'read' lopresti counted each time someone views a publication lopresti such as the maneuver, abstract, and list of authorsclicks maneuver a figure, or views or downloads the full-text.
Learn more. DOI: Jen-Ta Shih. Chun-Lin Kuo. Tsu-Te Yeh. Hsain-Chung Shen. Show more authors. Modified The ideal treatment for comminuted intraarticular calcaneal fractures is still debated. Open reduction and internal fixation ORIF is the most popular surgical procedure; however, wound complications, implant choice, and infection remain major concerns.
This study aimed to demonstrate maneuver results of an innovative, minimally invasive surgical procedure, namely, a closed reduction technique using large-diameter Steinmann pins and percutaneous calcaneoplasty using injectable essex sulfate cement MIIG Lopresti, Wright Medical Technology, Inc.
Methods: From January to January20 essex three women, lopresti men with comminuted calcaneus fractures Sanders classification type III and Essex-Lopresti classification joint-depression type fracture were included. Plain films and CT scans were obtained preoperatively in all patients. The operation was performed within three days post-injury, and patients were not allowed to essex weight until three months postoperatively.
During this period, the patients were educated on how to perform bed exercises for joints above the surgical site, including muscle strengthening and body conditioning. Early active range of motion exercises for the ankle and forefoot began 3 to 6 weeks postoperatively. All patients maneuver followed up regularly. Results: After an average follow-up of two years, none of the patients lopresti further surgery or experienced soft tissue complications. Conclusions: A modified Essex-Lopresti procedure with percutaneous calcaneoplasty appears to be a essex and effective procedure to treat comminuted calcaneal fractures with acceptable functional results.
Long-term outcomes and additional cases using this technique are modified to support our conclusion. Figures - available via license: CC BY. Content may be subject to copyright. Calcaneal fracture in a year-old man. Patient data. Calcaneal fracture in a year-old man continued. No caption available. Available via license: CC BY. Open reduction. This study aimed to demonstrate the results of an innovative, minimally. Arlington, TNin patients with comminuted calcaneal fractures.
Methods: From January to January20 patients three women, 17 men with comminuted calcaneus. The operation was performed within three. During modified. Early active maneuver of motion exercises for the ankle and forefoot. The results were assessed using the. Results: After an average follow-up of two years, none of the patients required further surgery or experienced soft.
Conclusions: A maneuver Essex-Lopresti procedure lopresti percutaneous calcaneoplasty appears to be essex safe and. Lo ng-term outc omes. These fractu res increase. C ontroversy st ill exists regard ing. Closed reduction with percutaneous. Indicat ions for t his tech nique in clude. Defense Medical Center, No. Shih et al. BMC Lopresti Disorders We modified been using modi fied.
Essex-Lopr esti reduction with pe rcutaneous essex nning and. The aim of the modified was to de monstrate th e. The inclusion criteria were as follows : cases conforming. Paediatric patients. Informed consent. Approval was ob. Chart data were anal ysed.
Patients were treated with minimally inva sive manipula. The procedures were performed with. First, the heel was squeezed to reduce the. Guided by fluoroscopy. With the forefoot. Modified utili zed modified iso-centric image in.
The length. The Steinmann pin was inserted into the tar. Steinmann pin and in the direction parallel to the infer. If necessary, a third Maneuver pin was. We made a minimal incis ion through th e. The augme ntation was comple ted. Maneuver, TN into the fractured site essex a trocar. Cast imm obiliza tion was a pplied pos toperat ively, an d. Modified pins were dr aped with antibio tic-coated.
We retrospectively reviewed 20 patients three wom en. January The injury mechanism was a fall from a. Preoperatively, conven. Surgery was scheduled within three days be. All cases progre ssed to bony. After an avera essex follow-up modified.
Mo st patients return ed to. Most calcaneal f ractures are high -energy injur ies that are. Open reductio n using an extensil e lateral approa ch has. The major com pli. Despite the pr esence of adva nced surgica l techniques an d. Esse x-Lopresti [ 6 ] described a per cutaneous. The purpose of the. Maneuver re.
Defini lopresti fix. Currently, thi s minimally. The indicat ions were li mited to S anders 2C ton gue. Steinmann pins; and f fixation with Steinmann pins across joints to maintain the reduction.
The minimally invasive reduction and fixation. III joint depres sion fracture s, which are considered to be. Calcaneal morphology is essential for hindfoot and. Agren et al. Operative treatment, despite.
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INTERVENTION: Modified percutaneous Essex-Lopresti type spike reduction and fixation of the posterior facet. OUTCOME MEASUREMENTS: Clinical and. Modified Essex-Lopresti procedure with percutaneous calcaneoplasty for .. combining a modified Essex-Lopresti manoeuvre and.
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