J Korean Foot Ankle Soc.  2017 Dec;21(4):165-169. 10.14193/jkfas.2017.21.4.165.

Treatment of Secondary Soft Tissue Compromised Calcaneus Fractures Using a Cannulated Screw and Simple Cerclage Wiring: A Report of Two Cases

Affiliations
  • 1Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea. jwansuh@gmail.com

Abstract

Secondary soft tissue injuries can occur from the pressure of the displaced fragment of posterior calcaneal tuberosity in calcaneal tongue-type fractures and calcaneal tuberosity avulsion fractures. The soft tissue injury can be prevented by immediate reduction of the displaced fragments. Various techniques can be used to fix the fracture fragments, but the stability of fixation and minimal invasiveness to soft tissue should be considered. This paper reports the successful outcomes of patients with soft tissue compromises in calcaneal tongue-type fractures and calcaneal tuberosity avulsion fractures. The fixation technique of a large cannulated screw and simple cerclage wiring is believed to be a useful surgical option for the treatment of secondary soft tissue compromised calcaneal fractures.

Keyword

Calcaneus; Avulsion fracture; Soft tissue injury; Bone screw; Bone wire

MeSH Terms

Bone Screws
Bone Wires
Calcaneus*
Humans
Soft Tissue Injuries

Figure

  • Figure 1 (A) Initial gross photograph showed skin breakdown on posterior heel due to displaced fragment. Initial lateral (B) and axial (C) radiographs showed displaced posterior tuberosity fragment in tongue-type calcaneal fracture. Postoperative lateral (D) and axial (E) radiographs showed reduction and internal fixation of the cannulated screw and cerclage wiring. (F) Postoperative gross photo at 1 week showed skin necrosis.

  • Figure 2 Surgical technique. (A) After paratendinous longitudinal incision, open reduction was done using reduction clamp and guide pin was inserted. (B) A large cannulated screw (5.0 mm or 6.5 mm sized) was inserted with a washer. (C) As an augmented reduction, cerclage wiring was done percutaneously using cruciate guide pin or wire passer. (D) The wire was tensioned, and the screw was tightened finally.

  • Figure 3 Postoperative lateral (A) and axial (B) radiographs at 1 year showed radiological union of calcaneus.

  • Figure 4 (A) Initial gross photograph showed skin tenting on posterior heel due to displaced fragment. (B) Initial lateral radiograph showed displaced posterior tuberosity fragment in calcaneal tuberosity avulsion fracture. (C) Postoperative radiograph showed reduction and internal fixation of the cannulated screw and cerclage wiring.


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