Tomichan M. C, Imith Kodungookaran
BACKGROUND
Calcaneus is the most injured tarsal bone mainly due to axial load resulting in intra-articular fractures. The treatment of displaced intra-articular fractures with surgery using extensile approaches are fraught with complications as high as 30%. 30 patients with displaced intra articular fractures are treated with minimally invasive surgical approach with use of multiple K wires. Results using AOFAS scoring showed average score of 82.03 at 28 weeks. 13, 33% scored above 90, 40% scored 80-90 and 46.66% scored below 80. There is significant correlation between the AOFAS Score and age of the patient, smoking habit, Diabetes, restoration of Bohler’s angle after surgery and loss of reduction of the fracture during treatment. There is no significant association for sex, side or mechanism of injury and time of surgery since trauma with AOFAS scoring. Even though no association was seen for infection with smoking, Diabetes is found to be associated with increased infection rate.
MATERIALS AND METHODS
This study was conducted in Medical College Kottayam which is a tertiary referral centre in Orthopaedics during the time period from JAN 2013 TO DEC 2013.30 cases of fracture calcaneus with joint depression were selected for treatment. Open fractures, fracture in insensate or an immobile person, fracture presented after 3 weeks were excluded. Demographic profile of the patient, history of other co-morbid illnesses, personal history of addictions were recorded. Patients were thoroughly examined and radiological investigations including CT scanning were used.
RESULTS
During the study period 30 patients were treated for joint depression type of calcaneal fractures. Majority of patients were in the age group of 30-40 (60%) with a mean age of 35.53. Males constituted 90% of all the cases. 70% of injuries were due to fall from height. Right side was involved in 60% of cases. Only 40 % of cases were operated before 12 hours. Of the patients 3 were diabetic (10%) and 6 patients were smokers (20%)
CONCLUSION
Minimally invasive technique for the treatment of joint depression type of calcaneus fractures was able to produce results comparable to open techniques with a lower rate of serious complications. In the majority of cases, an almost identical Bohler’s angle and geometry of the calcaneus was achieved. Simple removal of the Kirschner wires and shorter surgery time decrease patient stress and must be recognized as an advantage of this minimally invasive technique. Thus, we feel that our minimally invasive technique is a viable alternative for the treatment of joint depression type of calcaneal fractures.
