title: Two-stage operative treatment of comminuted os calcis fractures. Primary indirect reduction with medial external fixation and delayed lateral plate fixation.
abstract: The indication for otherwise established lateral plate fixation in fractures of the calcaneus becomes relative when severe comminution (Sander's Type III and IV) of the bone involves concomitant massive soft-tissue swelling. The calcaneus is shortened, Böhler's angle flattened, and lateral bulging and varus deformity persist throughout the six or more days needed for soft-tissue compromise to recede. Intraoperatively, problems with anatomic reduction are encountered primarily because of soft-tissue shrinkage and muscle contraction, underscoring the rationale for conservative treatment modalities. A two-stage approach--primary medial external fixation and delayed lateral plate fixation--stabilizes the calcaneus in a nearly anatomic position by calculated distraction through medial external fixation, leaving joint congruency to be restored in a secondary procedure, when soft tissues pose no problem for a lateral approach. The two-stage procedure was used in 13 of 49 cases, in which soft-tissue compromise was severe. Anatomic primary reduction greatly facilitated delayed lateral plate fixation. Infection rates were not traced to the external fixation. Massive bone grafting was associated with a high occurrence of complications.
authors: Department of Trauma, Philipps University, Marburg, Germany.
authors: F R
authors: FR
authors: Baumgaertel
authors: L
authors: L
authors: Gotzen
mesh_terms: D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D005592:Fracture Fixation; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D011859:Radiography