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

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Content Introduction ............................................................................................................................................ 3 Current treatment concepts ................................................................................................................. 3 1) Conservative approach ................................................................................................................... 4 2) ”Gold standard “ .............................................................................................................................. 5 3) Minimally-invasive techniques ......................................................................................................... 6 Minimal-invasive surgery technique Traumacenter Linz .................................................................. 9 Benefits of the minimally-invasive techniques: .................................................................................... 9 Disadvantages of the minimally-invasive techniques: ......................................................................... 9 Special Problems ............................................................................................................................... 10 1) tongue-type fracture ...................................................................................................................... 11 2) depression-type fracture ................................................................................................................ 13 3) comminuted fractures .................................................................................................................... 14 4) atypical fractures ........................................................................................................................... 16 open fractures .................................................................................................................................... 16 Surgical technique with 2-point-distractor by Fröhlich ................................................................... 17 Instruments - osteosynthesis ............................................................................................................. 17 Anesthesia ......................................................................................................................................... 17 Positioning ......................................................................................................................................... 18 Imaging .............................................................................................................................................. 18 Extension ........................................................................................................................................... 20 Reduction of the central joint fragments ............................................................................................ 24 Sustentaculum screw ........................................................................................................................ 25 Static fixation with the 7.3 mm screws .............................................................................................. 26 Follow-up treatment ............................................................................................................................ 28 Patient overview UKH Linz/Austria .................................................................................................... 29 Epilog .................................................................................................................................................... 30 Project: MPCD Multiplanar Calcaneus Distractor............................................................................. 30 Additional documents ........................................................................................................................ 31 Literature .............................................................................................................................................. 32 Calcaneus fracture C. Rodemund - R. Krenn - C.Kihm - G. Mattiassich Page 2 of 34

Introduction Calcaneal fractures occur at a rate of approximately 2% of all fractures of the human body. Eighty to 90% of all calcaneal fractures are intra-articular, and these fractures are the main focus of this manuscript. Rare fracture patterns such as non-articular fractures, duckbill fractures or avulsion fractures will not be discussed in this paper. Multifragment- and comminuted fractures are common in intra-articular fractures. Additional trauma of the soft tissues could have a significant impact on surgical treatment, adjunctive procedures and patient outcomes. Due to the many patient and fracture characteristics and the lack of standardized protocols, the optimal type of treatment of intrarticular calcaneal fractures is still controversial. Treatment modalities vary between conservative, open reduction and internal fixation and many different minimal invasive approaches. Prolonged and eventful healing of the malreduced fracture fragments leads to poor outcomes and sustained disability. Due to the complexity of the fracture pattern, many different classification systems have been described. Scientifically and clinically, the most relevant and commonly used classification systems are the Essex-Lopresti, Sanders, Zwipp and Crosby classifications. The most useful classifications are useful in pairing the fracture characterists with treatment and expected outcomes. [1) 2)] Current treatment concepts Three different treatment concepts are described 1. Conservative care without reposition. This is managed with or without cast imobilization. Non-weight bearing during fracture consolidation is maintained for 6-12 weeks. 2. “Open repair through an “extended lateral approach” and open repairand fixation of the fracture with internal plate and screw fixation. This has historically been described as the “gold standard” for the treatment for intra-articular fractures. 3. Minimal invasive procedures with various described techniques and concepts. Calcaneus fracture C. Rodemund - R. Krenn - C.Kihm - G. Mattiassich Page 3 of 34

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