SLR - June 2012 - Jeremy Perse
Reference: Woon, C.Y., Chong, K.W., Yeo, W., Yeo, N.E., Wong, M.K., (2011). Subtalar Arthroscopy and Flurosocopy in Percutaneous Fixation of Intra-Articular Calcaneal Fractures: The Best of Both Worlds. The Journal of Trauma, Injury, Infection, and Critical Care, October 2011. 71, 917-925
Scientific Literature Review
Reviewed by: Jeremy Perse, DPM
Residency Program: University Hospitals Richmond Medical Center & OCPM
Podiatric Relevance:
The aim of this study was to determine the efficacy of percutaneous arthroscopy coupled with minimally invasive reduction and fixation for the treatment of intra-articular calcaneal fractures.
Methods:
This article utilizes a prospective study of 22 patients diagnosed with Sanders II intra-articular calcaneal fractures. The mean patient age was 43 years old. The mean follow up examination time was 33 months. The patients underwent dual-modality imaging guided percutaneous fracture fixation with a minimum follow up time of two years. The AO-OTA fracture classification was used. Type A fractures involve the anterior process, sustentaculum or tuberosity. Type B fractures are non-articular body fractures. Type C fractures are articular body fractures involving the posterior facet. C1 are non-displaced fractures. C2 are two-part fractures. C3 are three-part fractures. C4 are four-part fractures. This study included all patients with Sanders type IIA, B and C, C2 fractures. The study excluded all patients with Sanders type C3 and C4 fractures. The article highlights the maximum post reduction step-off value as 1 mm and all fractures were fixated utilizing four to eight percutaneous cancellous screws.
Results:
This article revealed a significant correction of Bohler’s tuberosity-joint angle from 4.2 degrees +/- 11.1 degrees preoperatively to 21.3 degrees +/- 8.8 degrees on immediate postoperative radiographic evaluation. The study also revealed minimal subsidence to 20.1 degrees +/- 8.2 degrees at two years. Bohler’s angle and joint surface restoration was unachievable in one patient utilizing the aforementioned study parameters due to an impacted and depressed joint fragment. Overall, this study found significant improvement in mean Visual Analog Scale, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score, and Physical Function scores at three months with additional improvement up to two years. All employed patients we able to return to their previous occupations without the need for job modification. No patient required subtalar joint fusion.
Conclusions:
This study highlights the efficacy of percutaneous arthroscopy coupled with minimally invasive reduction and fixation for the treatment of intra-articular calcaneal fractures. The article indicates that subtalar arthroscopy in conjunction with intraoperative flurosocopy allows for acceptable anatomic reduction of the posterior calcaneal facet of the subtalar joint while minimizing soft tissue trauma. This methodology is found to be most effective in the correction of Sanders type 2 and C2 fractures.