6 months ago

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

1) Conservative approach

1) Conservative approach Operative treatment has generally been superior as it yields better functional outcomes with less pain and disability. [ 3) 4) ] The conservative approach is recommended for patients with comorbidities like diabetes, peripheral arterial disease or smokers, heavy laborers or patients above 50 years. Furthermore, it is primarily indicated for simple, non, or minimally dislocated (

2) ”Gold standard “ Due to the blood supply and the course of the sural nerve, the “extended lateral approach” should be utilized for direct visualization of the fracture segments. This technique, with the subsequent reduction and internal fixation through an osteosynthesis, with angular-stable plates is labeled as the “gold standard” in the literature [ 6) 7) 8) 9) ] 2 H. Zwipp. Oper. Orthop Traumatol 2013 Fig 8 2 Tim Schepers;The Journal of foot and ankle surgery, 2013 Fig 9 Based on a recent multicenter study of 250 German trauma centers, the “gold standard” was utilized in 77% of surgically treated calcaneal fractures. [ 13) ] The benefit of this technique is the direct visualization of the fracture with direct reposition of the fragments. This is also a standardized procedure, most commonly described and reportedon in the scientific literature. Disadvantages from our point of view are 1) Due to the swelling and poor condition of the soft tissue envelope, and the invasivity of the open reduction technique, surgery must often be delayed until wrinking of the skin returns about 7 to 14 days following the injury. 2) The emergence of blood-filled blisters, due to the severe internal tissue pressure (hematoma, fracture dislocation), is also a reason to delay surgery. 3) The likelihood of post-operative wound healing complications is described as to be 5 to 25% [ 10) ]. Fig 10 Fig. 11 Fig. 12 Calcaneus fracture C. Rodemund - R. Krenn - C.Kihm - G. Mattiassich Page 5 of 34

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