SLR - May 2010 - Christopher Schmitt
Reference: Demcoe, A.R., Verhulsdonk, M., Buckley, R.E. (2009). Complications when using threaded K-wire fixation for displaced intra-articular calcaneal fractures. Injury, 40, 1297-1301.
Scientific Literature Reviews
Reviewed by: Christopher Schmitt, DPM
Residency Program: St. John Hospital and Medical Center, Detroit, Michigan
Podiatric Relevance:
This retrospective study provides useful data on the open reduction and internal fixation of calcaneal fractures utilizing a novel technique consisting of an extended lateral incision and threaded 0.062 in K-wires, in addition to standard plates, screws, and bone substitutes.
Methods:
Two hundred seventy-eight displaced intra-articular calcaneal fractures in two hundred forty-six patients were treated with open reduction and internal fixation during a nine year period (1998-2007). All patients were treated by a single surgeon at a level one trauma center. The surgery involved restoring the posterior facet and using threaded k-wires through the posterior aspect of the plantar surface into the calcaneal tuberosity. The K-wires were then advanced to the subchondral surface of the posterior facet. Large deficits in the neutral triangle were filled with calcium phosphate cement. The lateral wall was replaced and a one-third tubular plate was placed along the lateral wall of the calcaneus. The k-wires were cut 1cm outside of the skin. Eight to twelve weeks status post surgery, the k-wires were removed in clinic.
Results:
All patients were followed for six months. Operative reduction was measured by a change in Bohler’s angle which was -0.7° preoperatively and 24.0° postoperatively. Four patients suffered a collapse of their fractures and required STJ arthrodesis. The most common complication was infection with an incidence rate of 17% (48/278). Other complications included pin tract infection (2%; 5/278), wound necrosis (4%; 11/278), osteomyelitis (0.4%; 1/278), wound dehiscence (0.4%; 1/278), and amputation (0.4%; 1/278). Of the k-wires used, only 3.1% of k-wires bent or failed.
Conclusion:
Operative intervention is necessary in most patients with displaced intraarticular calcaneal fractures. The use of threaded K-wires appears to provide stable fixation, and they do not loosen as the threads prevent the K-wires from backing out. The plantar protruding k-wires also act to prevent weight bearing. This technique is useful in obtaining reduction and maintaining reduction (until removed) in intra-articular fractures of the calcaneus.