Treatment of comminuted intraarticular calcaneal fractures remains controversial and challenging. Anatomic reduction with stable fixation has demonstrated better outcomes than nonoperative treatment of displaced intraarticular fractures involving the posterior facet and anterior calcaneocuboid joint (CCJ) articulating surface of the calcaneus. The aim of this study was to investigate the biomechanical performance of three different methods for fixation of comminuted intraarticular calcaneal fractures. Comminuted calcaneal fractures, including Sanders III-AB fracture of the posterior facet and Kinner II-B fracture of the CCJ articulating calcaneal surface, were simulated in 18 fresh-frozen human cadaveric lower legs by means of osteotomies. The ankle joint, medial soft tissues and midtarsal bones along with the ligaments were preserved. The specimens were randomized according to their bone mineral density to 3 groups for fixation with either (1) 2.7 mm variable-angle locking anterolateral calcaneal plate in combination with one 4.5 mm and one 6.5 mm cannulated screw (Group 1), (2) 2.7 mm variable-angle locking lateral calcaneal plate (Group 2), or (3) interlocking calcaneal nail with 3.5 mm screws in combination with 3 separate 4.0 mm cannulated screws (Group 3). All specimens were biomechanically tested until failure under axial loading with the foot in simulated midstance position. Each test commenced with an initial quasi-static compression ramp from 50 N to 200 N, followed by progressively increasing cyclic loading at 2Hz. Starting from 200 N, the peak load of each cycle increased at a rate of 0.2 N/cycle. Interfragmentary movements were captured by means of optical motion tracking. In addition, mediolateral X-rays were taken every 250 cycles with a triggered C-arm. Varus deformation between the tuber calcanei and lateral calcaneal fragments, plantar gapping between the anterior process and tuber fragments, displacement at the plantar aspect of the CCJ articular calcaneal surface, and Böhler angle were evaluated. Varus deformation of 10° was reached at significantly lower number of cycles in Group 2 compared to Group 1 and Group 3 (P ≤ 0.017). Both cycles to 10° plantar gapping and 2 mm displacement at the CCJ articular calcaneal surface revealed no significant differences between the groups (P ≥ 0.773). Böhler angle after 5000 cycles (1200 N peak load) had significantly bigger decrease in Group 2 compared to both other groups (P ≤ 0.020). From biomechanical perspective, treatment of comminuted intraarticular calcaneal fractures using variable-angle locked plate with additional longitudinal screws or interlocked nail in combination with separate transversal screws seems to provide superior stability as opposed to variable-angle locked plating only

Displaced intraarticular calcaneal fractures are debilitating injuries with significant socioeconomic and psychological effects primarily affecting patients in active age between 30 and 50 years. Recently, minimally and less invasive screw fixation techniques have become popular as alternative to locked plating. The aim of this study was to analyze biomechanically in direct comparison the primary stability of 3 different cannulated screw configurations for fixation of Sanders type II-B intraarticular calcaneal fractures. Fifteen fresh-frozen human cadaveric lower limbs were amputated mid-calf and through the Chopart joint. Following, soft tissues at the lateral foot side were removed, whereas the medial side and Achilles tendon were preserved. Reproducible Sanders type II-B intraarticular fracture patterns were created by means of osteotomies. The proximal tibia end and the anterior-inferior aspect of the calcaneus were then embedded in polymethylmethacrylate. Based on bone mineral density measurements, the specimens were randomized to 3 groups for fixation with 3 different screw configurations using two 6.5 mm and two 4.5 mm cannulated screws. In Group 1, two parallel longitudinal screws entered the tuber calcanei above the Achilles tendon insertion and proceeded to the anterior process, and two transverse screws fixed the posterior facet perpendicular to the fracture line. In Group 2, two parallel screws entered the tuber calcanei below the Achilles tendon insertion, aiming at the anterior process, and two transverse screws fixed the posterior facet. In Group 3, two screws were inserted along the bone axis, entering the tuber calcanei above the Achilles tendon insertion and proceeding to the central-inferior part of the anterior process. In addition, one transverse screw was inserted from lateral to medial for fixation of the posterior facet and one oblique screw – inserted from the posterior-plantar part of the tuber calcanei – supported the posterolateral part of the posterior facet. All specimens were tested in simulated midstance position under progressively increasing cyclic loading at 2 Hz. Starting from 200N, the peak load of each cycle increased at a rate of 0.1 N/cycle. Interfragmentary movements were captured by means of optical motion tracking and triggered mediolateral x-rays. Plantar movement, defined as displacement between the anterior process and the tuber calcanei at the most inferior side was biggest in Group 2 and increased significantly over test cycles in all groups (P = 0.001). Cycles to 2 mm plantar movement were significantly higher in both Group 1 (15847 ± 5250) and Group 3 (13323 ± 4363) compared to Group 2 (4875 ± 3480), P = 0.048. Medial gapping after 2500 cycles was significantly bigger in Group 2 versus Group 3, P = 0.024. No intraarticular displacement was observed in any group during testing. From biomechanical perspective, screw configuration implementing one oblique screw seems to provide sufficient hindfoot stability in Sanders Type II-B intraarticular calcaneal fractures under dynamic loading. Posterior facet support by means of buttress or superiorly inserted longitudinal screws results in less plantar movement between the tuber calcanei and anterior fragments. On the other hand, inferiorly inserted longitudinal screws seem to be associated with bigger interfragmentary movements

Introduction. Intraarticular calcaneal fractures often need open reduction and internal fixation (ORIF) with plate osteosynthesis. The wound complication is one of the common problems encountered following this and affects the outcome adversely. Our study was done to assess how far postoperative slab/cast can avert wound complications. Methods. Out of 42 patients with unilateral intraarticular calcaneal fractures, 20 were offered postoperative slab/cast and this was continued for six weeks. The remaining 22 patients were not offered any plaster. All patients were followed-up for two years. Results. The incidence of wound dehiscence was 2 in the plaster group as well as 8 in the non-plaster group and this was statistically significant (p = 0.02). Also, significantly lower heel widening was reported in the plaster group (p = 0.03). Although, there was no significant difference in the patient-reported outcome (Maryland Foot Score) and the incidence of pain between the two groups, the occurrence of neurological deficit following surgery and the postoperative range of movements were comparable in these two groups. Conclusion. Thus, it may be concluded that postoperative plaster application for the initial six weeks could be a low-cost yet effective way to reduce wound complications following plate osteosynthesis in intraarticular calcaneal fractures

The study looked at early outcomes of 55 patients who underwent open reduction and internal fixation of distal radius fracture with a single variable angle volar locking plate (Variax, Stryker), by a single surgeon (GS), between May 2007 and December 2008. A retrospective review of notes and radiographs was performed. Twenty-nine women and 26 men were included. The mean age was 52 years. Mean follow up time was 3 months. The dominant wrist was involved in 38 patients. The mechanism of injury was of low energy in 38 patients and of high energy in 17 patients. All patients had comminuted fractures and 52 patients had intraarticular fractures. Seven patients underwent intraoperative carpal tunnel decompression. At latest follow up, active wrist motion averaged 37° extension, 40° flexion, 70° pronation, and 56° supination. Grip strength averaged 64% and pinch grip 77% of the contralateral wrist. Postoperative complications included one flexor pollicis longus rupture, one malunion and three patients with loosening of screws. There was a higher rate of complications seen in patients with high energy injuries. These early results suggest that volar plating with a variable angle plate is an effective treatment option, especially for complex intraarticular distal radius fractures. A medium term outcomes study of a larger number of patients is planned