Operative Orthopädie und Traumatologie
-
Anatomical reconstruction of displaced sustentaculum tali fractures via a direct medial approach. ⋯ Over a course of 15 years, 31 patients were treated operatively for sustentacular fractures. In all, 27 patients (87%) had additional fractures to the same foot and ankle. Eighteen patients with a mean age of 41 years treated at our institution with screw fixation for a unilateral fracture of the sustentaculum tali could be followed for a mean of 80 months (range 15-151 months). No wound healing problems or infections were seen with the medial approach. At the time of follow-up, 15 sustentaculum tali fractures had an average Foot Function Index of 21.6 and an average AOFAS Ankle-Hindfoot Score of 83.6. Patients with isolated fractures of the sustentaculum tali had significantly better scores than those with additional injuries. In 1 patient, an additional lateral process fracture of the talus required subtalar fusion due to persistent pain. Care must be taken not to overlook these atypical calcaneal fractures and accompanying injuries to the mid-tarsal joint and the lateral talar process as seen in 45% and 23%, respectively, in the present series.
-
Oper Orthop Traumatol · Dec 2013
Clinical Trial[Operative treatment of displaced intra-articular calcaneal fractures].
Anatomic reduction of displaced intra-articular calcaneal fractures with restoration of height, length, and axial alignment and reconstruction of the subtalar and calcaneocuboid joints. ⋯ Over a 4-year period, 163 patients with 184 displaced, intra-articular calcaneal fractures were treated with a lateral plate via an extended approach. In all, 102 patients with 116 fractures were followed for a mean of 8 years. A surgical revision was necessary in 4 cases (3.4%) of postoperative hematoma, 2 (1.7%) superficial and 5 (4.3%) deep infections. Of the latter, 2 patients needed a free flap for definite wound coverage, no calcanectomy or amputation was needed. Secondary subtalar fusion for symptomatic posttraumatic arthritis was performed in 9 cases (7.8%). At follow-up, the AOFAS Ankle/Hindfoot Score averaged 70.2, the Zwipp Score averaged 76.0, the German versions of the Foot Function Index and SF-36 physical component averaged 32.8 and 42.2, respectively. Scores were significantly lower with increasing fracture severity according to the Sanders and Zwipp classifications, bilateral fractures, open fractures, and with work-related injuries. With less invasive fixation using a calcaneal nail, superficial wound edge necrosis was seen in 2 of 75 cases (2.7%).
-
Oper Orthop Traumatol · Dec 2013
Clinical Trial[Fractures of the anterior process of the calcaneus].
Anatomical repositioning of isolated fractures of the anterior process of the calcaneus. Internal fixation for sufficiently large fragment sizes, for small fragments and evidence of instability of the calcaneocuboid (CC) joint in association with Chopart luxation fractures, transfixation of the CC joint. ⋯ Isolated fractures of the the anterior process of the calcaneus are rare and often initially overlooked injuries of the foot. In the literature there are only few case descriptions. From November 2009 to June 2011 a total of 5 isolated dislocated fractures of the anterior process with large fragments (type III), of which 3 were initially overlooked, were treated by osteosynthesis. In all cases the exact diagnosis could only be confirmed by computed tomography. In the follow-up after 2 years and 5 months all patients showed consolidation of the fractures, especially those with delayed therapy. Clinically all patients had recovered full function with no evidence of posttraumatic arthrosis. In this small case series extended diagnostics in cases of suitable fracture mechanisms seems to be reasonable in order not to overlook rare fractures of the calcaneus. Operative therapy by anatomical repositioning and internal fixation of fractures of the anterior process of the calcaneus is a suitable therapy for treatment of these rare injuries.
-
Anatomic reduction of talar neck and body fractures with axial realignment and restoration of the articular surfaces of the talus. ⋯ Over 8 years 79 fractures of the talar neck and body were treated. In all, 43 patients with 45 talar neck (n = 30) and body (n = 15) fractures were re-examined clinically and radiologically (mean follow-up 3 years). Definite treatment consisted of open reduction and screw fixation of the talus in 41 cases and small plate fixation in 2 cases supplemented by temporary external fixation for 1-3 weeks in 12 cases. At follow-up, the Maryland Foot Score averaged 86.1 and the AOFAS Ankle/Hindfoot Score averaged 78.9. The Hawkins classification was of prognostic value in talar neck fractures. The functional results and the rate of avascular necrosis (AVN) were unaffected by the time to definite internal fixation. AVN was observed in 11 cases (24%); with only partial AVN involving less than one third of the talar body in 8 of these patients. Due to complete AVN with collapse of the talar dome, 3 patients (6.7%) required fusion. Signs of posttraumatic arthritis of the tibiotalar or subtalar joint were seen in 21 cases (47%). The rate of symptomatic posttraumatic arthritis correlated with the occurrence of total AVN, but not with partial AVN.
-
Oper Orthop Traumatol · Dec 2013
Clinical Trial[Dorsal capsular imbrication for dorsal instability of the distal radioulnar joint].
To stabilize the distal radioulnar joint (DRUJ) by performing dorsal capsular imbrication in patients presenting with dorsal instability. The goal was to reduce pain and prevent the occurrence of posttraumatic arthrosis. ⋯ The subjective and functional outcomes of 20 patients having received capsular imbrication using this technique were good and entailed no significant complications. The postoperative DASH was 15.8 points. Of the 20 patients, 17 patients (85%) had a reduction of pain. Symptoms of DRUJ instability could be reduced in 18 patients (90%). Pronation/supination of the wrist was not restricted postoperatively.