Cannulated screw fixation for dislocated fractures of the calcaneus

Abstract

Introduction Fractures of the calcaneus still remain some of the most challenging injuries that an orthopedic surgeon should manage. The difficulties about these fractures arise from the specific anatomy of the region, from the unique shape and morphology of the bone, and from the mechanism of the injury (in most cases high energy trauma). Despite the progress of the medical implants that can be used for fracture fixation in the last decade there are a lot of controversies, regarding the best option. Aim The aim of the study is to present our experience with the use of cannulated screws for fixation of dislocated fractures of os calcis. Materials and Methods Twenty patients with dislocated fractures of os calcis using cannulated screws for fixation were operated on for a period of two years (2017-2018). The classifications used in the study included: the Essex-Lopresti x-ray classification modified by Stulik and Stehlik and the CT classification of Sanders. Two of the patients were with dislocated extraarticular fractures of tuber calcanei, three patients with `extreme beak` type fractures, the remaining 15 patients were with intraarticular fractures with more than 2 mm step off in the subtalar joint: 9 patients with tongue type and 5 patients with joint depression type. Gender distribution: 18 men, 2 women. Results Evaluation of the results was made by using the Maryland Foot Score. Satisfaction from the treatment was graded using the Visual Analogue Scale (VAS) score (mean 7,5). The reduction is evaluated by measurement of the angle of Gissane, Bohler and Preis pre- and postoperatively. Assessment of the calcaneal height, length and width was initiated on lateral, axial and Broden views. Conclusion Fixation of displaced calcaneal fractures by cannulated screw is effective and reliable method. These screws are introduced by stab incisions which leads to minimal soft tissue dissection in such complex area of the hindfoot. It is an enormous advantage for fracture healing and reduces the percentage of possible complications.