Percutaneous fixation of intraarticular calcaneal fractures adequately restore the subtalar joint with lower soft tissue complications and equivalent short-term results compared to open fixation. However, studies have largely focused on less severe fracture types (Sanders types 2/3). We report our initial experience of this relatively new Mini-open Arthroscopic-assisted Calcaneal Osteosynthesis (MACO) technique for more comminuted calcaneal fractures (Sanders types 3/4). We prospectively studied consecutive patients with intraarticular calcaneal fractures requiring surgical fixation between April 2012 and June 2013. MACO involves initial subtalar arthroscopic debridement, with subsequent fluoroscopic-assisted, mini-open reduction and fixation of depressed fragments using cannulated screws. Outcome scores (Manchester-Oxford Foot(MOXFQ), AOFAS Hindfoot and SF-36 questionnaires) and radiological parameters were recorded with a mean follow-up of 12 months (7–13).Introduction:
Methods:
To assess the functional outcome after open shoulder stabilisation a retrospective study was performed with patients undergoing modified Bankart repair for traumatic shoulder instability. 47 consecutive patients were selected from theatre records over a five-year period who underwent open shoulder stabilisation under a single operator. 38 of these were successfully contacted by telephone (80% response) for functional assessment using two questionnaires – Oxford and Disabilities of the Arm, Shoulder and Hand (DASH). Of these patients 22 agreed to undergo examination for the Constant and Walch-Duplay shoulder scoring systems. The Constant score included measuring strength of pull using the Nottingham myometer. The average follow-up period was 31.3 months (6–60months) and return to work and/or sport was the focus of the study. The results from the Oxford and DASH questionnaires showed that 30 patients (79%) had returned to work, 6 patients (16%) were unemployed for reasons other than their shoulder and only 2 (5%) had put their shoulder as the reason for being unable to return to work. 13 patients did no sport out of choice so of the remaining 25, 22 patients (88%) had returned to their chosen sport. The study revealed that 2 patients suffered recurrent dislocation. The results of the Constant and Walch-Duplay scoring averages were encouraging – 91.5% and 85% respectively. Only 2 patients scored below good or excellent grading. These outcomes compare favourably to other studies. A criticism of the Walch-Duplay scoring system is that it is strongly orientated towards sports activities. Our results showed a significant variation in outcome between individuals and it may be that such a scoring system is not applicable in an inner city population as studied here. The effect of shoulder instability after traumatic dislocation can be devastating on the lifestyle and work of an individual. The Bankart repair has been shown in the literature to be successful in stabilising the shoulder joint with a low rate of recurrent dislocation and minimal loss of range of movement. However the gold standard for a successful repair must ultimately be a return to premorbid function, in particular, work and sport. This study reveals a high rate of return to work and sport after a short period following open shoulder stabilisation using a modified Bankart repair.
