• Hans Zwipp, Libor Paša, Luboš Žilka, Michael Amlang, Stefan Rammelt, and Martin Pompach.
• *University Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany;†Department of Traumatology, Medical Faculty of Masaryk University, Trauma Hospital, Brno, Czech Republic;‡Zana Plus s. r. o., Prague, Czech Republic; and§Department of Traumatology, Regional Hospital Pardubice, Czech Republic.
• J Orthop Trauma. 2016 Mar 1; 30 (3): e88-92.

ObjectivesTo reduce the complication rate associated with open reduction and internal fixation of displaced intraarticular calcaneal fractures through extensile approaches, a locking nail system (C-Nail) was developed for internal fixation.DesignProspective case-control study.SettingTwo level I trauma centers (university hospital) and 1 large regional hospital in the Czech Republic and Germany.PatientsOne hundred three patients (89 male and 14 female; mean age, 45.6 years) with 106 calcaneal fractures were treated between February 2011 and October 2013.InterventionIn all 106 cases, the stainless steel C-Nail with a length of 65 mm, a diameter of 8 mm, and 7 locking options was used for internal fixation. Previous reduction of the posterior facet was performed in 15 cases percutaneously, assisted by arthroscopy and fluoroscopy, and in 91 cases by a sinus tarsi approach. The reduced joint surface was fixed by 1 or 2 compression screws. All other fragments were fixed after reduction and temporary K-wire fixation with the C-Nail introduced percutaneously through the tuberosity and 5 to 6 interlocking screws. The latter were introduced into the sustentacular, the tuberosity, and the anterior process fragments with an aiming device consisting of 3 arms.Main Outcome MeasuresPatients were assessed for complications, restoration of Böhler angle, posterior facet reduction with postoperative computed tomography, and weight-bearing radiographs at 6 months. Functional outcome was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot scale after 6 and 12 months for all patients.ResultsWound edge necrosis was seen in 2 cases (1.9%), and soft tissue infection was observed in 1 case (0.9%). Böhler angle improved from 7.3 degree preoperatively to 28.7 degree at 6 months. The posterior facet step-off was reduced from 5.3 mm preoperatively to 0.7 mm postoperatively. The average AOFAS score averaged 89.5 at 6-month and 92.6 at 12-month follow-up.ConclusionsThe C-Nail is a new locking system for treatment of displaced intraarticular calcaneal fractures combining a primary stability with reduced soft tissue complications.Level Of EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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