FUNCTIONAL OUTCOME AFTER OPEN REDUCTION AND INTERNAL FIXATION (ORIF) OF INTRA-ARTICULAR CALCANEAL FRACTURES – TWO CASE REPORTS
Unique and simple parameters have not yet been established according to which we can evaluate the surgical reduction and assume the functional outcomes in calcaneal fractures. The classic radiological Bohler’s angle is considered a sensitive parameter for assessing the quality of the reduction but not so adequate in the functional outcome assessment. In this paper we report two cases of Open Reduction and Internal Fixation (ORIF) of calcaneal fractures using already established methodology. Patients were treated according to the standard procedure using lateral approach, open reduction and osteosynthesis with anatomic locking plate. Postoperative Bohler’s angle was measured on postoperative radiographs compared to contralateral healthy leg. Functional outcomes were assessed one year after injury using the American Orthopaedics Foot and Ankle Society (AOFAS) scale.
Case report 1: A 39-year-old man, injured in a traffic accident as a car driver sustained right calcaneal fracture and a fracture of the facial bones suitable for conservative treatment. The preoperative Bohler’s angle was 15˚. Surgery was done on the eleventh day post-injury. Postoperatively Bohler’s angle was 37˚ compared to the uninjured leg where it was 32˚. The functional outcome one year after the injury was 89 points according to AOFAS scale. Case report 2: A 51-year-old woman injured by fall from a height of 1.5 meters sustained an isolated left calcaneal fracture. On the initial radiographs Bohler’s angle was 13˚. Surgery was done on the eighth day post-injury. Bohler’s angle measured on postoperative radiographs was 29˚ compared to the uninjured calcaneus - 31˚. Superficial wound infection occurred postoperatively, which was managed with local treatment. Functional outcome using AOFAS scale was 91 points. A good reduction was achieved in both presented cases which correlated to good functional outcome at one year after injury. In determining the true value of this radiological parameter as a predictor of functional outcome we suggest studies on large patient samples with extensive analysis of multiple factors that may influence.
Keywords: calcaneus, Bohler’s angle, fracture, outcome.
2. Inokuchi S, Usami N, Hiraishi E, Hashimoto T. Calcaneal fractures in children. J Pediatr Orthop 1998; 18(4): 469-74.
3. Russo A, Zappia M, Reginelli A, Carfora M, D’Agosto GF, La Porta M, et al. Ankle impingement: a review of multimodality imaging approach. Musculoskelet Surg 2013; 97 Suppl 2: S161-8.
4. Badillo K, Pacheco JA, Padua SO, Gomez AA, Colon E, Vidal JA. Multidetector CT evaluation of calcaneal fractures. Radiographics 2011; 31(1): 81-92.
5. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am 2000; 82(2): 225-50.
6. Segal D, Marsh JL, Leiter B. Clinical application of computerized axial tomography (CAT) scanning of calcaneus fractures. Clin Orthop Relat Res 1985(199): 114-23.
7. Piccolo CL, Galluzzo M, Trinci M, Ianniello S, Tonerini M, Brunese L, et al. Lower Limbs Trauma in Pediatrics. Semin Musculoskelet Radiol 2017; 21(3): 175-83.
8. Zappia M, Reginelli A, Russo A, D’Agosto GF, Di Pietto F, Genovese EA, et al. Long head of the biceps tendon and rotator interval. Musculoskeletal Surg 2013; 97 (suppl. 2): S99-S108.
9. Furey A, Stone C, Squire D, Harnett J. Os calcis fractures: analysis of interobserver variability in using Sanders classification. J Foot Ankle Surg 2003; 42(1): 21-3.
10. Dong Oh Lee , Jeong-Hyun Yoo , Dong-Wook Son , Do-Hyun Kim: Is the Bohler angle reliable for operative reduction of calcaneus fracture? Journal of Orthopaedic Science https://doi.org/10.1016/j.jos.2018.10.023.
11. Saurabh Jain, Anil Kumar Jain, Ish Kumar. Outcome of open reduction and internal fixation ofintraarticular calcaneal fracture fixed with locking calcaneal plate. Chinese Journal of Traumatology 2013;16(6):355-360.
12. Minfei Qiang, Yanxi Chen, Xiaoyang Jia, Kun Zhang, Haobo Li, Yuchen Jiang, Yijie Zhang. Post-operative radiological predictors of satisfying outcomes occurring after intra-articular calcaneal fractures:a three dimensional CT quantitative evaluation. International Orthopaedics (SICOT) DOI 10.1007/s00264-017-3577-0
13. Jan Persson, Sören Peters, Simon Haddadin, Padhraig F. O’Loughlin, Christian Krettek and Ralph Gaulke. The prognostic value of radiologic parameters for long- term outcome assessment after an isolated unilateral calcaneus fracture. Technology and Health Care 23 (2015) 285–298 285 DOI 10.3233/THC-140890 IOS Press.