SLR - October 2012 - Devin J. Hull
Reference: Sanders, R. Turning Tongues Into Joint Depressions: A New Calcaneal Osteotomy, J Orthop Trauma. 2012 March; 26(3): 193-196.
Scientific Literature Review
Reviewed by: Devin J. Hull, DPM
Residency Program: Inova Fairfax Hospital, Falls Church, VA
Podiatric Relevance:
Tongue-type calcaneal fracture patterns pose a particular challenge in the reduction of the posterior facet when an intra-articular component is also present. The presence of a tongue fragment restricts the surgeon’s ability to reduce the articular surface, especially in the sagittal plane despite multiple reduction attempts and maneuvers. The author’s presented technique provides a fairly simple and reliable method to facilitate fracture reduction and fixation.
Methods:
An oblique osteotomy is performed posterior to and parallel to the posterior facet of the calcaneus through the tongue fragment. The remaining tongue is moved, and the freely mobile posterior facet component is anatomically reduced and fixated. The tongue is then anatomically reduced along the osteotomy site and remainder of the procedure is completed following standard reduction and fixation techniques.
A total of 30 fractures in 28 people were treated over a five year period and retrospectively reviewed. All patients were followed for a minimum of two years postoperatively. Quality of reduction was assessed with postoperative CT scans, and healing was assessed with incremental x-rays. Functional outcomes were measured using Maryland Foot Score assessments.
Results:
All osteotomies and fractures healed without incident. Twenty patients had excellent functional results as per Maryland Foot Scores, as well as six good and four fair. Lower functional scores correlated with increased fracture severity (primarily Sanders 3 fracture patterns). None of the patients went on to non-union, and there were no cases of avascular necrosis or any other negative outcome as a result of the additional maneuver.
Conclusions:
This proposed technique is a quick and relatively straightforward pearl to aid in the reduction of difficult intra-articular tongue fractures. The author’s small case series showed no negative effects on ultimate healing or function as a result of the modification.