title: Introduction of a New Locking Nail for Treatment of Intraarticular Calcaneal Fractures.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  Prospective case-control study.
  
  
  METHODS
  Two level I trauma centers (university hospital) and 1 large regional hospital in the Czech Republic and Germany.
  
  
  METHODS
  One 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.
  
  
  METHODS
  In 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.
  
  
  METHODS
  Patients 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.
  
  
  RESULTS
  Wound 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.
  
  
  CONCLUSIONS
  The C-Nail is a new locking system for treatment of displaced intraarticular calcaneal fractures combining a primary stability with reduced soft tissue complications.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *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.
authors.forename: Hans
authors.initials: H
authors.lastname: Zwipp
authors.forename: Libor
authors.initials: L
authors.lastname: Paša
authors.forename: Luboš
authors.initials: L
authors.lastname: Žilka
authors.forename: Michael
authors.initials: M
authors.lastname: Amlang
authors.forename: Stefan
authors.initials: S
authors.lastname: Rammelt
authors.forename: Martin
authors.initials: M
authors.lastname: Pompach
mesh_terms: D064386:Ankle Fractures / Q000175:diagnosis / Q000601:surgery*; D001858:Bone Nails; D001860:Bone Plates; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery*; D019544:Equipment Failure Analysis; D005060:Europe; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D057072:Intra-Articular Fractures / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011474:Prosthesis Design; D020127:Recovery of Function; D016896:Treatment Outcome