Operative management of calcaneal fractures with tentacle plate: A short-term prospective outcome analysis

Sivakumar, N (2012) Operative management of calcaneal fractures with tentacle plate: A short-term prospective outcome analysis. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Calcaneal fractures are the most common fracture of the tarsal bones, yet controversy still exists on the best treatment for these disabling injuries. However, as a better understanding of fracture patterns with computed tomography scans and modern surgical techniques and hardware has improved outcomes and lowered morbidity, a trend has developed toward open reduction and internal fixation (ORIF) for displaced, intra-articular calcaneus fractures AIM: This is a prospective cohort study to evaluate the results of open reduction through an extensile lateral approach and internal fixation with calcaneal tentacle plate as surgical treatment of the displaced intra-articular calcaneal fracture. MATERIALS AND METHODS: Total no. of 25 cases with calcaneal fracture, admitted between march 2009 to march 2011 in Rajiv Gandhi Govt. General Hospital, Chennai, were included in the study. All the cases were operated and followed up by using single protocol with regard to extensile lateral approach, surgical techniques, pre-op & post-op evaluation. Inclusion & exclusion criteria for surgery as follows : Inclusion criteria: • Age more than 16 years • Occupation of the patient (laborer, tailor) • Bohler’s angle < 20 o • Gissane’s angle >115 o • Sander’s type II, III and IV Exclusion criteria: • Fractures > 4 weeks • Sander’s type I calcaneal fracture • Extra articular fractures • Patients with other medical problems RESULTS: In our series, five cases (20%) were in between the age group of 16-25 yrs, seven cases (28%) were in 26-35 yrs, ten cases (40%) were in 36-45 yrs and three cases were in 46-60 yrs. Among them, 19 cases (76%) were male and 6 cases (24%) were female. Mean age of the patient at the time of presentation was 32.2 years (range 18 to 60 yrs). Majority of them were male – 76%. History of accidental fall from height predominate the series by 72% (18 cases). Other mode of violence was road traffic accident & polytrauma. 40% of the cases presented with associated injuries (spinal injury, pelvic fractures, multiple fractures, ipsilateral lower limb injury). CONCLUSION: In Our study of 25 cases with Sander’s type II, III & type IV calcaneal fracture, osteosynthesized with calcaneal tentacle plate and followed up for an average period of 11 months , 96% of cases had satisfactory results both functionally and radiologically. Further follow up is needed for long term results.  The extended lateral approach accounts for low incidence of complication.  After suitable interval to improve the soft tissue status, this series recommend to take the cases for surgery between 14 to 21 days from the time of injury.  Wound dehiscence is the common complication, which can be minimized by raising cutaneous-subcutaneous flap during incision.  Prevention of collapse is mainly by the rigid fixation & perfect anatomical plating and delayed weight bearing.  Bone grafting is needed for severely comminuted cases.  We systematically obtained anatomical reduction, whatever the Sanders type. This reconstruction and subtalar joint congruence, essential for a good result.  Post operative subtalar joint incongruence may lead to early subtalar arthritis, which can be managed with subtalar arthrodesis.  Osteosynthesis of type II calcaneal fractures give excellent result compared to other fracture patterns.  In case of contra-indication relating to age, associated pathology such as diabetes or arteriopathy, or psychiatric disturbance, we advise plaster cast immobilization for relatively congruent fractures, and closed percutaneous pinning or screwing for more displaced and incongruent fracture. Proper pre-operative planning, rigid fixation with calcaneal tentacle plate and adequate screws through extensile lateral approach, anatomical reduction to achieve subtalar joint congruency, using bone grafts in comminuted fractures, early post op rehabilitation, delayed weight bearing will give good results in case of displaced intra articular calcaneal fractures.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Operative management ; calcaneal fractures ; tentacle plate ; short term prospective outcome analysis.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 16:15
Last Modified: 16 Sep 2017 16:37
URI: http://repository-tnmgrmu.ac.in/id/eprint/2950

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