Operative Treatment of Nonunion after Intra-articular Calcaneal Fracture

종골의 관절내 골절 후 발생한 불유합의 수술적 치료

  • Eun, Il-Soo (Department of Orthopedic Surgery, Busan Medical Center) ;
  • Jung, Chul-Young (Department of Orthopedic Surgery, Busan Medical Center) ;
  • Kim, Jin-Wan (Department of Orthopedic Surgery, Busan Medical Center) ;
  • Ko, Young-Chul (Department of Orthopedic Surgery, Busan Medical Center) ;
  • Huh, Jung-Wook (Department of Orthopedic Surgery, Busan Medical Center)
  • 은일수 (부산의료원 정형외과학교실) ;
  • 정철용 (부산의료원 정형외과학교실) ;
  • 김진완 (부산의료원 정형외과학교실) ;
  • 고영철 (부산의료원 정형외과학교실) ;
  • 허정욱 (부산의료원 정형외과학교실)
  • Published : 2009.06.15

Abstract

Purpose: Nonunion of intra-articular fractures of calcaneus is rarely reported complication. We present our experiences with 4 patients (5 cases) treated operatively for nonunion after intra-articular fracture of calcaneus. Materials and Methods: 4 patients (5 cases) with nonunion of intra-articular fracture of calcaneus after operative treatment were followed for 4 years (from 2002 to 2006). For assessment, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Visual Analogue Scale (VAS) were assessed for clinical outcome and the union of fracture site, the talocalcaneal height and the angle of talar declination were determined for radiologic outcome. Results: The mean talocalcaneal height was 6.94 cm (range, 5.9${\sim}$7.6 cm) preoperatively and 7.34 cm (range, 6.0${\sim}$8.3 cm) at last follow-up. The mean angle of talar declination was 5.68 degrees (range, 4.6${\sim}$8 degrees) preoperatively and 13.1 degrees (range, 5.7${\sim}$21 degrees) at last follow-up. The mean preoperative AOFAS score and VAS were 20.4 (range, 14${\sim}$36) and 4 (range, 3${\sim}$6), respectively. At last follow-up, these scores improved to a mean of 59.6 (range, 54${\sim}$68) and 3 (range, 2${\sim}$4), respectively. Unions of previous nonunion site of intra-articular fracture of calcaneus were achieved in all 4 patients (5 cases). Conclusion: The reconstructive procedure for nonunion of intra-articular fracture of calcaneus showed good results in terms of bone union, radiologic results and functional improvement than preoperative state. Because the plantar pain for the inferior angular formation in nonunion site may happen, we will pay attention to reduction of fragment.

Keywords

References

  1. Amendola A and Lammens P: Subtalar arthrodesis using interposition iliac crest bone graft after calcaneal fracture. Foot Ankle Int, 17: 608-614, 1996. https://doi.org/10.1177/107110079601701004
  2. Buch BD, Myerson MS and Miller SD: Primary subtaler arthrodesis for the treatment of comminuted calcaneal fractures. Foot Ankle Int, 17: 61-70, 1996. https://doi.org/10.1177/107110079601700202
  3. Burton DC, Olney BW and Horton GA: Late results of subtalar distraction fusion. Foot Ankle Int, 19: 197-202, 1998. https://doi.org/10.1177/107110079801900402
  4. Carr JB, Hansen ST and Benirschke SK: Subtalar distraction bone block fusion for late complications of os calcis fractures. Foot Ankle, 9: 81-86, 1988. https://doi.org/10.1177/107110078800900204
  5. Easley ME, Trnka HJ, Schon LC and Myerson MS: Isolated subtalar arthrodesis. J Bone Joint Surg, 82-A: 613-624, 2002.
  6. Essex-Lopresti P: The mechanism, reduction technique, and results in fractures of the os calcis. J Bone Joint Surg, 39-B, 395-419, 1952.
  7. Flemister AS Jr, Infante AF, Sanders RW and Walling AK: The arthrodesis for complications of intra-articular calcaneal fracture. Foot Ankle Int, 21: 392-399, 2002.
  8. Gustilo RB and Anderson JT: Prevention of infection in the treatment of one thousand and twenty five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg, 58-A: 453-458, 1976.
  9. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS and Sanders M: Clinical rating system for the anklehindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 15: 349-353, 1994. https://doi.org/10.1177/107110079401500701
  10. Mann RA, Beaman DN and Horton GA: Isolated subtalar arthrodesis. Foot Ankle Int, 19: 511-519, 1998. https://doi.org/10.1177/107110079801900802
  11. Molloy AP, Myerson MS and Yoon P: Symptomatic nonunion after fracture of the calcaneum. Demographics and treatment. J Bone Joint Surg, 89-B: 1218-1224, 2007. https://doi.org/10.1302/0301-620X.89B9.19105
  12. Myerson M and Quill GE Jr: Late complication of fracture of the calcaneus. J Bone Joint Surg, 75-A: 331-341, 1993.
  13. Neufeld SK, Uribe J and Myerson MS: Use of structural allograft to compensate for bone loss in arthrodesis of the foot and ankle. Foot Ankle Clin, 7: 1-17, 2002. https://doi.org/10.1016/S1083-7515(01)00002-X
  14. Reddy V, Fukuda T and Ptaszek AJ: Calcaneus malunion and nonunion. Foot Ankle Clin. 12: 125-135, 2007. https://doi.org/10.1016/j.fcl.2006.12.004
  15. Russotti GM, Cass JR and Johnson KA: Isolated talocalcaneal arthrodesis: a technique using moldable bone graft. J Bone Joint Surg, 70-A: 1472-1478, 1988.
  16. Sanders R: Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg, 82-A: 225-250, 2000.
  17. Sanders R, Fortin P, Dipasquale T and Walling A: Operative treatment in 120 displaced intra-articular calcaneal fractures: results using a prognostic computer tomography scan classifi cation. Clin Orthop, 290: 87-95, 1993.
  18. Trnka HJ, Easley ME, Lam PW, Anderson CD, Schon LC and Myerson MS: Subtalar distraction bone block arthrodesis. J Bone Joint Surg, 83-B: 849-854, 2001.
  19. Zwipp H, Tscherne H, Thermann H and Weber T: Osteosynthesis of displaced intra-articular fractures of the calcaneus. Clin Orthop, 290: 76-86, 1993.