[Treatment of calcaneal fractures with a locking nail (C-Nail)].
OBJECTIVE
Anatomic reconstruction of the posterior facet by primary stabilization of the calcaneal fracture with a locking nail.


METHODS
All intraarticular calcaneal fractures and unstable two-part fractures independent of the degree of closed/open soft tissue trauma.


METHODS
High perioperative risk, soft tissue infection, beak fracture (type II fracture) and still open apophysis.


METHODS
Anatomic reduction of the posterior facet using a sinus tarsi approach. Reduction and temporary fixation of the sustentacular, tuberosity, and anterior process fragments with 1.8-2.0 mm Kirschner wires. Thereafter, the C-Nail (calcaneus nail) is introduced with its guiding device stabilizing the sustentacular, tuberostity, and anterior process fragments through its three guiding arms with 6 or 7 locking screws.


METHODS
Passive and active motion starts on postoperative day 2. Lymph drains help reduce swelling. Partial weightbearing with 20 kg for 6-8 weeks in the patient's own shoes is recommended. X‑ray controls are done at 4 and 8 weeks as well as after 6 and 12 months.


RESULTS
A total of 107 calcaneal fractures treated with the C-Nail between 2011 and 2014 were evaluated according to the AOFAS score 6 months and 1 year after surgery. The measured values were on average 93.0 (range 65-100) points at 6 months and 94.1 (range 75-100) points 12 months after the surgery. Böhler's angle with initial traumatic values of 6.2° (-30 to +13°) improved postoperatively to 31.8°, after 3 months slightly decreased to 29.6°, and after 12 months to 28.3°. There were 2 cases of superficial wound necrosis (1.9 %) and 1 case a deep infection (0.93 %) with need of early C-Nail removal.
Unfallchirurgie, Krankenhaus der Region Pardubice AG, Krankenhaus Pardubice, Pardubice, Tschechische Republik. m.pompach@gmail.com.
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Pompach
Unfallchirurgie, Krankenhaus der Region Pardubice AG, Krankenhaus Pardubice, Pardubice, Tschechische Republik.
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Carda
Universitäts Centrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland.
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Amlang
Universitäts Centrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland.
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Zwipp
D000293:Adolescent; D064386:Ankle Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001858:Bone Nails; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D016896:Treatment Outcome
Bone nails; Calcaneus; Foot; Fracture fixation; Operative procedures