J Korean Foot Ankle Soc.  2015 Mar;19(1):11-17. 10.14193/jkfas.2015.19.1.11.

Usefulness of Treatment with 6.5 mm Cancellous Screw and Steinmann Pin Fixation for Calcaneal Joint Depression Fracture

• Lee GS
• Kang C
• Hwang DS
• Noh CK
• Lee GY

• KMID: 1958699
• DOI: http://doi.org/10.14193/jkfas.2015.19.1.11

Abstract

PURPOSE
To report the radiographic and clinical results of 6.5 mm cancellous full threaded buttress screw or Steinmann pin fixation to maintain a reduction of calcaneal posterior facet depression fracture.
MATERIALS AND METHODS
From June 2009 to June 2012, 50 consecutive cases with calcaneal joint depression fracture that underwent open reduction and screw or pin fixation were enrolled in this study. A 6.5 mm cancellous full threaded screw was inserted from the posteroinferior aspect of the calcaneal tuberosity to the posterior facet (group A) or Steinman pin was inserted from the posterosuperior aspect of the calcaneal tuberosity to the calcaneocuboidal joint (group B). Both preoperative and postoperative Bohler and Gissane angles were measured radiographically, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale on the final follow-up were assessed.
RESULTS
The mean age of patients was 44.1 years, and the mean follow-up period was 27.2 months. According to the Sanders classification, 28 cases were type II and 22 cases were type III. In Sanders type II, Bohler and Gissane angles improved significantly from 10.1degrees and 126.2degrees preoperatively to 27.2degrees and 117.1degrees, respectively, in the immediate postoperative radiograph, and at the final follow-up, 26.6degrees and 118.6degrees, respectively. In Sanders type III, Bohler and Gissane angles improved significantly from 5.0degrees and 129.8degrees to 29.9degrees and 119.3degrees, respectively, in the immediate postoperative radiograph, and 26.9degrees and 120.2degrees at the final follow-up. All cases achieved bony union, and the average period until complete union was 13.3 weeks. AOFAS ankle-hindfoot scale was 82.6 in Sanders type II and 77.3 in Sanders type III at the final follow-up.
CONCLUSION
A 6.5 mm cancellous full threaded buttress screw or Steinman pin fixation is a noninvasive treatment method with a merit of being able to maintain the bearing capacity of the posterior facet comparable to plate fixation.

Keyword

Calcaneus; Intra-articular fractures; 6.5 mm cancellous screw; Steinmann pin

MeSH Terms

Ankle
Calcaneus
Classification
Depression*
Follow-Up Studies
Foot
Humans
Intra-Articular Fractures
Joints*

Figure

• 

  Figure 1. Measurement of Bohler and Gissane angles. (A) Bohler angle is measured by the intersection of a line drawn from most cephalic point on tuberosity to highest point of posterior facet with a line from highest point of posterior facet to most cephalic part of posterior process of calcaneus. (B) Gissane angle is measured by the intersection of a line drawn from the highest point of the posterior articular facet to the highest point of the posterior tuberosity and a line from the former to the highest point on the anterior articular facet.

• 

  Figure 2. Beginning from 2.5 cm superior to lateral malleolus tip, which is the midpoint between malleolus and Achilles tendon, the incision continues obliquely and distally toward 1 cm below the lateral malleolus tip, sinus tarsi, and dorsolateral aspect of the talonavicular joint.

• 

  Figure 3. Operative method. (A) A 6.5 mm cancellous buttress screw should be inserted from posteroinferior aspect of calcaneal tuberosity to the posterior facet (arrow). (B) Steinmann pins should be inserted from posterosuperior aspect of calcaneal tuberosity to the calcaneocuboid joint (arrow).

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