Complications when using threaded K-wire fixation for displaced intra-articular calcaneal fractures
Introduction
Treatment of calcaneal fractures is recognised as a major challenge for the orthopaedic trauma surgeon.6 The delicate, specialised soft tissue envelope and irregular bony anatomy of the calcaneus have made operating in this area exceedingly challenging.13 There is evidence indicating that there are certain patients that benefit from operative intervention.3, 9, 12 There have been a variety of surgical approaches and fixation techniques used.4, 6, 17, 18, 20, 21 Percutaneous fixation may be appropriate for certain calcaneal fractures.21 Trauma patients also present special challenges, including psychiatric issues, high alcoholism rates, high smoking rates and compliance issues.1, 3, 9
The primary goal of the study was to determine the complications rate of open reduction and internal fixation of displaced intra-articular fractures of the calcaneus supplemented by threaded K-wire fixation. This study is not a long term calcaneal outcome paper, but a review of a new technique and complications of using threaded K-wires in this difficult surgical area.
Section snippets
Methods
A retrospective review of all patients with calcaneal fractures requiring open reduction and internal fixation between January 1998 and July 2007 was performed. All patients were treated by a single surgeon at a Level 1 trauma facility. Patient demographics, including age, sex, smoking status and Sanders classification (Fig. 1) were all recorded.
Results
There were 265 patients with 297 fractures treated with open reduction and internal fixation. Nineteen of these patients had treatment with a technique other than the one described and were excluded, leaving 246 patients with 278 fractures. Patient demographics and injury characteristics are summarised in Table 1. All 246 patients were followed for at least 6 months. Operative reduction was measured by the change in Böhler's angle. Patient's presented with a mean Böhler's angle of −0.7° which
Discussion
Operative intervention for displaced, intra-articular fractures is necessary in most patients to restore normal function and anatomy of the calcaneus.3 Restoration of both the posterior facet,14 as well as the overall geometry of the calcaneus4 is important for maximising patient outcomes. Calcaneal fracture patients present difficult problems to the surgeon, such as high smoking rates, psychiatric issues and non-compliance.11, 15
A number of authors have successfully used smooth K-wires for the
Conflict of interest
The authors have no conflicts of interest to declare.
References (21)
- et al.
Wound complications following operative fixation of calcaneal fractures
Injury Int J Care Injured
(2000) - et al.
Calcaneal fractures
FussSprungg
(2007) - et al.
Augmentation of intraarticular fractures with injectable calcium phosphate cement: densiometry, histology and functional outcome of 18 patients
J Foot Ankle Surg
(2005) - et al.
Calcaneus fractures: facts, controversies and recent developments
Injury Int J Care Injured
(2004) - et al.
Percutaneous treatment of displaced intra-articular calcaneal fractures
J Orthop Sci
(2007) - et al.
Incidence of pin track infections in children's fractures treated with Kirschner wire fixation
J Pediatr Orthop
(2007) - et al.
Operative compared with nonoperative treatment of displaced intra-articular calcaneus fractures: a prospective, randomized, controlled multicenter trial
J Bone Joint Surg [Am]
(2002) The medial approach for calcaneal fractures
Clin Orthop
(1993)Surgical treatment of calcaneal fractures: a review of small incision approaches
J Orthop Trauma
(2005)- et al.
Combined percutaneous and minimal internal fixation for displaced articular fractures of the calcaneus
Clin Orthop
(1993)
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