Elsevier

Injury

Volume 40, Issue 12, December 2009, Pages 1297-1301
Injury

Complications when using threaded K-wire fixation for displaced intra-articular calcaneal fractures

https://doi.org/10.1016/j.injury.2009.03.017Get rights and content

Abstract

A retrospective chart review was performed on patients treated at a level one trauma centre for displaced intra-articular calcaneal fractures by a single trauma surgeon between January 1998 and July 2007. Patients were treated with open reduction and internal fixation utilising the extended lateral incision and a new type of fixation not described before. Threaded 1.575 mm (0.062 in.) Kirschner wires (K-wires) were used for fixation post-operatively along with standard plates, screws and bone substitute.

There were 278 fractures in 246 patients that were treated with ORIF for displaced intra-articular calcaneal fractures during this 9-year period. Standard calcaneal lateral approach and hardware was supplemented with percutaneous threaded K-wires. An average of 5.0 fully threaded 1.575 mm K-wires were inserted per calcaneal fracture. Five (1.8%) patients had a K-wire infection; 0.6% of all K-wires became infected and 3.1% of K-wires broke.

Lateral calcaneal apical wound issues are minimised and patients experience an overall low complication rate. The fixation also ensures non-weightbearing compliance.

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)

There are more references available in the full text version of this article.

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