Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: current concepts' review.
BACKGROUND
A large variety of therapeutic modalities for calcaneal fractures have been described in the literature. No single treatment modality for displaced intra-articular calcaneal fractures has proven superior over the other. This review describes and compares the different percutaneous distractional approaches for intra-articular calcaneal fractures. The history, technique, anatomical and fracture considerations, limitations and the results of different distractional approaches reported in the literature are reviewed.


METHODS
Literature review on different percutaneous distractional approaches for displaced intra-articular calcaneal fractures.


RESULTS
Eight studies in which application of a distraction technique was used for the treatment of calcaneal fractures were identified. Because of the use of different classification, techniques, and outcome scoring systems, a meta-analysis was not possible. A literature review reveals overall fair to poor result in 10-29% of patients. Ten up to 26% of patients are unable to return to work after percutaneous treatment of their fracture. A secondary arthrodesis has to be performed in 2-15% of the cases. Infectious complications occur in 2-15%. Some loss of reduction is reported in 4-67%.


CONCLUSIONS
Percutaneous distractional reduction and fixation appears to be a safe technique with overall good results and an acceptable complication rate, compared with other treatment modalities for displaced intra-articular calcaneal fractures. A meta-analysis, based on Cochrane Library criteria is not possible, because of a lack of level 1 and 2 trials on this subject.
Schepers
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Department of Surgery, Traumatology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Room H822-k, 3000 CA, Rotterdam, The Netherlands. t.schepers@erasmusmc.nl
Patka
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D002111:Calcaneus / Q000293:injuries*; D016267:External Fixators; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D016896:Treatment Outcome