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Minimal invasive surgery of intra-articular calcaneus fractures final 31jan2018 c_rodemund

Special Problems The

Special Problems The ”learning curve” • Minimally-invasive reduction of comminuted fractures in this extent is only applied on calcaneal fractures. There is slight evidence with other fractures (tibial plateau, humeral head, etc.) • Time for surgical preparation and table positioning, for fracture evaluation, reduction and fixation technique • Evaluation of the anatomical reconstruction during surgery is difficult • Positioning of the sustentaculum screw is difficult • Experience with this technique is needed to anticipate the most realistic outcome • No standardized technique and slight evidence in literature Effort: Minimal Invasive (MI) Procedure ------ Maximal Intensive Preparation For minimal-invasive techniques, the exact evaluation of the fracture situation and planning the general procedure is always necessary. The treatment of a fracture with MI-techniques is definitely not easier than in an open approach!!! Besides standard radiographs, 3D CT reconstruction imaging should always be conducted. Fig. 45-47 UKH Linz 2017 Indication and contraindication Indications include dislocated and/or comminuted intra-articular calcaneal fractures. As mentioned, we recommend this technique also with non, or minimally dislocated fractures through regional anesthesia due to its low complications risk. Early fixation through screw osteosynthesis allows earliest possible physiotherapy. Calcaneus fracture C. Rodemund - R. Krenn - C.Kihm - G. Mattiassich Page 10 of 34

Contraindications, in comparison to the open reduction technique, are rare. Due to the decreased wound complications risks, even older patients, smokers, and patients with comorbidities can be treated with this technique in most cases. Fracture type and methods Regarding the reduction technique, we differentiate 4 groups of fracture types to allow the best possible outcome. The Essex-Lopresti classification is used because of its simple characteristics and good correlation with the prognosis. 1) Essex-Lopresti tonque-type fractures 2) Essex-Lopresti depression-type fractures 3) Comminuted fractures mainly because of a severe depression-type fracture 4) Atypical fractures with uncommon fractures lines, mainly following a direct trauma 1) tongue-type fracture With these fractures, there is a large, connected dorsal segment of the tuber calcaneus and a calcaneal subtalar segment. In most of the cases, there is a large lateral joint fragment. Shortening and varus malalignment of the foot normally is slight. The Westhues maneuver allows good reduction of this types of fractures. Fig. 48 Copyright by AO Foundation, Switzerland Fig. 49 UKH Linz 2017 Fig. 50 UKH Linz reduction Westhues Calcaneus fracture C. Rodemund - R. Krenn - C.Kihm - G. Mattiassich Page 11 of 34

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