Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach

Hong Ki Park; Jae Yoon Ko; Seung Kwan Lee; Jong Min Baik

doi:10.12671/jkfs.2019.32.3.135

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Original Article Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach: Hong Ki Park, Jae Yoon Ko, Seung Kwan Lee, Jong Min Baik; Journal of Musculoskeletal Trauma 2019;32(3):135-142.
DOI: https://doi.org/10.12671/jkfs.2019.32.3.135
Published online: July 31, 2019

Department of Orthopedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea. bbaik98@gmail.com

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Abstract

PURPOSE
As the functional demands for activities in elderly patients are increasing according to their life extension, the need for surgical treatment is also increasing in elderly patients with displaced intra-articular calcaneal fractures. In addition to the extensile lateral approach (ELA), which is a surgical procedure that showed good results on intra-articular calcaneal fractures, the minimally invasive approach (MIA) also showed an outstanding result. This study compared the radiological and clinical results of intraarticular calcaneus fractures in elderly patients in two groups: ELA and MIA.
MATERIALS AND METHODS
Thirty patients aged over 65 years with intra-articular calcaneus fractures, who could be followed-up more than 14 months, were included in this study. Thirteen patients of the MIA group and 17 patients of the ELA group were analyzed retrospectively using radiological and clinical assessments.
RESULTS
No significant difference in union time, posterior facet reduction accuracy, subtalar osteoarthritis frequency, Bohler angle, calcaneal width, American Orthopaedic Foot and Ankle Society score, visual analogue scale score, 36-item short form survey, and foot function index was observed between the two groups. The p-value of the average height of the calcaneus correction, average length of calcaneal correction, and average loss of correction length were <0.001, 0.005, and 0.015, respectively. The incidence of complications, including soft tissue necrosis and bone infection, were 23.1% in the ELA group and none in the MIA group.
CONCLUSION
The clinical outcomes were similar in the two groups. The degree of reduction of fracture showed a better result in the MIA group than the ELA group. Furthermore, there were no complications in the MIA group, whereas the ELA group showed some complications.

Keywords: Calcaneus, Displaced intraarticular calcaneal fracture, Extensile lateral approach, Minimally invasive approach

J Korean Fract Soc. 2019 Jul;32(3):135-142. Korean.
Published online Jul 24, 2019.
https://doi.org/10.12671/jkfs.2019.32.3.135

Original Article

Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach

Hong-Ki Park

, M.D., Ph.D., Jae-Yoon Ko

, M.D., Seung-Kwan Lee

, M.D. and Jong-Min Baik

, M.D.

Author information

Author notes

- Department of Orthopedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
Correspondence to: Jong-Min Baik, M.D. Department of Orthopedic Surgery, Gil Medical Center, Gachon University College of Medicine, 21 Namdongdaero 774beon-gil, Namdong-gu, Incheon 21565, Korea. Tel: +82-32-460-3384, Fax: +82-32-423-3384, Email: bbaik98@gmail.com

Received December 31, 2018; Revised January 29, 2019; Accepted May 27, 2019.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

As the functional demands for activities in elderly patients are increasing according to their life extension, the need for surgical treatment is also increasing in elderly patients with displaced intra-articular calcaneal fractures. In addition to the extensile lateral approach (ELA), which is a surgical procedure that showed good results on intra-articular calcaneal fractures, the minimally invasive approach (MIA) also showed an outstanding result. This study compared the radiological and clinical results of intraarticular calcaneus fractures in elderly patients in two groups: ELA and MIA.

Materials and Methods

Thirty patients aged over 65 years with intra-articular calcaneus fractures, who could be followed-up more than 14 months, were included in this study. Thirteen patients of the MIA group and 17 patients of the ELA group were analyzed retrospectively using radiological and clinical assessments.

Results

No significant difference in union time, posterior facet reduction accuracy, subtalar osteoarthritis frequency, Bohler angle, calcaneal width, American Orthopaedic Foot and Ankle Society score, visual analogue scale score, 36-item short form survey, and foot function index was observed between the two groups. The p-value of the average height of the calcaneus correction, average length of calcaneal correction, and average loss of correction length were <0.001, 0.005, and 0.015, respectively. The incidence of complications, including soft tissue necrosis and bone infection, were 23.1% in the ELA group and none in the MIA group.

Conclusion

The clinical outcomes were similar in the two groups. The degree of reduction of fracture showed a better result in the MIA group than the ELA group. Furthermore, there were no complications in the MIA group, whereas the ELA group showed some complications.

Keywords

Calcaneus, Displaced intraarticular calcaneal fracture, Extensile lateral approach, Minimally invasive approach

Figures

Fig. 1
Minimally invasive approach. (A, C, E) Lateral radiographs of the calcaneus. (B, D, F) Axial radiographs of the calcaneus.

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Fig. 2
Extensile lateral approach. (A) Lateral radiograph of the calcaneus. (B) Axial radiograph of the calcaneus.

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Fig. 3
(A) Lateral radiograph of the calcaneus shows measurements of the Böhler angle, calcaneal height, calcaneal length. (B) Axial radiograph of the calcaneus shows measurements of the calcaneal width.

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Tables

Table 1
Comparison of the Demographic Data and Clinical Outcome between the Treatment Groups

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Table 2
Comparison of the Radiologic Outcomes between the Treatment Groups

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Notes

Financial support:None.

Conflict of interests:None.

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Clinical and Radiological Outcomes of ‘Blocking Kirschner Wire Technique’ in Displaced Intra-Articular Calcaneal Fractures via the Extended Sinus Tarsi Approach
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Journal of the Korean Orthopaedic Association.2021; 56(3): 224. CrossRef

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Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach

J Korean Fract Soc. 2019;32(3):135-142. Published online July 31, 2019

DOI: https://doi.org/10.12671/jkfs.2019.32.3.135