• Journal of Korean Foot and Ankle Society
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• v.10 no.1
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• pp.71-75
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• 2006

Purpose: To evaluate the results of treatments by percutaneous Acutrak screw fixation for intra-articular tongue type fracture of calcaneus, especially in elderly patient or patients with underlying disease including diabetes mellitus. Materials and Methods: Seven cases with intra-articular tongue type fracture of calcaneus, from November 2003 to February 2005, were reviewed. There were 6 males and 1 female with 65 years old mean age (range: $61{\sim}71$ years old). The average follow-up period was 16 months (range: $10{\sim}25$ months). Two Steinmann pins were used for closed reduction. After closed reduction was done like Essex-Lopresti's method, two Acutrak screws were inserted. The third Acutrak screw was inserted at the sustentaculum tali away from sinus tarsi to fix the primary fracture line. The patients were evaluated with Salama scale, the extent of recovery of Bohler angle, state of subtalar joint. Results: Clinical results according Salama scale were excellent in 5 cases, and good in 2 cases. Average preoperative Bohler angle was $13^{\circ}$ (range: $12{\sim}15^{\circ}$). Average postoperative Bohler angle was 31o (range: $23^{\circ}-40^{\circ}$). There were no soft tissue complications. There were two mild subtalar arthritis. Conclusions: We think that percutaneous Acutrak screw fixation is a good option for tongue type fracture of calcaneus in elderly patient or patients with underlying disease including diabetes mellitus.

• Journal of Korean Foot and Ankle Society
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• v.11 no.2
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• pp.221-225
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• 2007

Purpose: To evaluate the clinical results of operative treatment of the intra-articular calcaneal fracture with injectable calcium sulfate ($MIIG^{TM}$). Materials and Methods: Between March 2004 and October 2006, a total 19 intra-articular calcaneal fracture (16 patients) with a large bony defect that underwent operative treatment with plate fixation and injectable calcium sulfate ($MIIG^{TM}$) with minimum follow-up of one year following. The mean age at time of surgery was 44.7 years (23 to 54). All of the cases were type 2 and 3 on the basis of Sanders classification. The lateral L shaped approach was used in all cases. Full weight bearing on the affected extremity was regained at an average 10 weeks postoperatively. Results: The mean Bohler angle was improved from $2^{\circ}$ ($-18.5{\sim}12.5^{\circ}$) preoperatively to $23.8^{\circ}$ ($12{\sim}37.5^{\circ}$) and the angle at last follow-up was $22.5^{\circ}$ ($11.5{\sim}37.5^{\circ}$), showing about 0.3 degree decline compared to postoperative Bohler angle. Only two case of whitish leakage of graft material but other complication were none. Conclusion: $MIIG^{TM}$ augumentation of displaced intra-articular calcaneal fracture with large bone defect seems to bo useful method for initial stabilized and plate fixation.

• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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• pp.79-85
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• 2007

Purpose: To evaluate the clinical efficacy of the limited posterior approach for the surgical treatment of intraarticular fracture of calcaneus. Materials and Methods: From March 2000 to February 2006, we studied retrospectively 186 patients, 203 cases who were treated with open reduction and internal fixation through limited posterior approach and were followed up for more than 1 year. The clinical results were evaluated with Creighton-Nebraska score and circle draw test after 1 year. We checked simple AP, lateral, axial and Broden's view preoperatively and 1 year after surgery, and compared $B{\ddot{o}}hler$ angle and Gissane angle. Results: By Creighton-Nebraska score, Sanders type 2 was 86.4, type 3 was 74.3, type 4 was 62.4. And by circle draw test, type 2 was 8.9 cm, type 3 was 7.2 cm, type 4 was 5.9 cm. $B{\ddot{o}}hler$ angle and Gissane angle were $7.6^{\circ}$, $102.4^{\circ}$, and it increased to $23.5^{\circ}$, $128.6^{\circ}$ after postoperative 1 year. Conclusion: Limited posterior approach for the surgical treatment of intraarticular fracture of calcaneus was considered to an effective treatment modality.

• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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• pp.86-90
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• 2007

Purpose: We evaluated the results of operative treatment with F or H plates and screws using extensile lateral approach in intraarticular calcaneal fractures. Materials and Methods: From August 2003 to July 2006, twenty intraarticular calcaneal fractures which were operated with open reduction and internal fixation with F or H plates and screws were evaluated retrospectively. According to the Essex-Lopresti classification, 3 cases were tongue type and 16 were joint depression type. With the Sanders classification, 2 cases were IIA type, 7 were IIB, 5 were IIIAB, 2 were IIIAC and 3 were IV. We have analysed the $B{\ddot{o}}hler$ angle, Gissane angle, and calcaneal width in radiologic evaluation, and evaluated clinical result according to the Creighton-Nebraska Health Foundation Score. Results: Radiologic changes showed as follows: $B{\ddot{o}}hler$ angle improved from $5.8^{\circ}$ to $25.9^{\circ}$, Gissane angle from $119.0^{\circ}$ to $113.3^{\circ}$, and calcaneal width from 50.4 mm to 37.8 mm. In the clinical results, excellent cases were noted in 8 cases, good in 8 cases, fair in 2 cases, poor in 1 case. Conclusion: Operative treatment with F or H plates and screws using extensile lateral approach in intraarticular calcaneal fractures was thought to be a useful operative method allowing anatomical reduction.

• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.179-183
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• 2009

The triplane fracture has been described as a fracture of the distal tibial epiphysis occurring across three planes-sagittal, transverse and coronal. The characteristic pattern of fusion of distal tibial epiphysis explains the special configuration of the fragments in the triplane fracture. According to Dias-Tachdjian classification, triplane fracture is classified two part fracture, three part fracture, four part fracture and two part fracture with extension to the medial malleolus. Among four types, two part triplane fracture with extension to the medial malleolus is a relatively rare injury and generally is not treated by closed reduction. Such fractures should have an anatomic reduction and adequate fixation to restore the joint congruity and obtain an anatomic reduction of the growth plate to prevent a future growth deformity. This is usually best accomplished with an open reduction and screw fixation or k-wire fixation. We experienced two part triplane fracture with extension to medial malleolus and check the CT to define the extent of the injury completely. And then we underwent open reduction and screw fixation for the fracture. As a result, we present four cases of two part triplane fracture with extension with review of related literatures.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.174-179
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• 2008

Purpose: We evaluated the clinical results of the intraarticular calcaneal fractures treated using Ollier approach by inexperienced orthopaedic surgeon. Materials and Methods: Between August 2003 and May 2007, Of the total 46 cases, 12 cases (9 patients) of displaced intraarticular calcaneal fracture who underwent open reduction and internal fixation using Ollier approach were evaluated. The means of age was 50.5 years. According to the Sanders classification, there was no type I case and 8 cases of type II, 1 case of type III, and 3 cases of type IV. We evaluated the treatment result by assessing radiologic parameters ($B{\ddot{o}}hler$ angle, Gissane angle, and calcaneal height/width) and clinical outcomes (VAS and AOFAS score). Results: The means of follow-up period was 25.3 months. The means of B.hler angle was improved from $2.4^{\circ}$ to $26.1^{\circ}$. Radiologic and clinical union was achieved in all cases without additional procedures. Excellent result were noted in 2 cases, good in 5 cases, fair in 4 cases, and poor in 1 case. We experienced 2 cases of minor complications; 1 case of mild wound infection and 1 case of hypoesthesia on foot dorsum. Radiologic findings of subtalar arthritis were present in 2 cases. Conclusion: Ollier approach seems to be helpful to inexperienced orthopaedic surgeons for the treatment of intraarticular calcaneal fractures in that it enables them to achieve considerable clinical outcomes without serious complications.

• Journal of Korean Foot and Ankle Society
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• v.7 no.1
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• pp.109-114
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• 2003

Purpose: The purpose of this study is to evaluate the effectiveness and indications of the modified Essex-Lopresti reduction in calcaneal fractures. Materials and Methods: We reviewed retrospectively 41 cases of displaced intraarticular calcaneal fractures. The fracture was reduced with Essex-Lopresti technique with modification in compression of the lateral wall with the specially designed compression device instead of the operator's hands. We evaluated the results of treatment by AOFAS scale and the radiographic parameters including the Bohler's angle, calcaneal width, calcaneofibular distance and the congruency of the posterior facet. Results: Boler's angle was restored from 11 to 29.6 degrees on average, heel width was reduced to 112% of contralateral value, the calcaneofibular gap was restored up to 87.9% of contralateral side, and the articular surface of the posterior facet was restored less than 2 mm of step off and less than 2 mm of gap. AOFAS scale averaged 87 points. The quality of reduction was best in Sander's type II fractures. Small sized fragments in type III fractures could not be reduced. The results were better when the reductions were performed within 24 hours of injury. Conclusion: The modified Essex-Lopresti reduction was less invasive, easy to perform, and the results of treatment were similar to those of open reduction; it seemed to be a reasonable alternative for the selected intraarticular calcaneal fractures.

• Journal of Korean Foot and Ankle Society
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• v.14 no.1
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• pp.66-72
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• 2010

Purpose: To evaluate the clinical efficacy of the minimally invasive posterior approach for the surgical treatment of intraarticular fracture of calcaneus. Materials and Methods: From March 2006 to October 2008, we studied retrospectively 45 patients, 56 cases who were treated with minimally invasive reduction and pin fixation treatment for displaced intraarticular calcaneal fracture and were followed up for more than 1 year. The clinical results were evaluated with Creighton-Nebraska score and AOFAS score, circle draw test after 1 year. We checked simple AP, lateral, axial and Broden's view preoperatively and 1 year after surgery, and compared Bohler angle and Gissane angle. Results: By Creighton-Nebraska score, Sanders type 1 was 81, type 2 was 75, type 3 was 69, type 4 was 61. By AOFAS score, Sanders type 1 was 88, type 2 was 82, type 3 was 78, type 4 was 63. And by circle draw test, type 1 was 8.8 cm, type 2 was 8.5 cm, type 3 was 8 cm, type 4 was 6.6 cm. Preoperative Bohler angle and Gissane angle were $7.2^{\circ}$, $98^{\circ}$, and it increased to $21.2^{\circ}$, $116^{\circ}$ after postoperative 1 year. Conclusion: Minimally invasive reduction and pin fixation treatment for displaced intraarticular calcaneal fracture was considered to be an effective treatment modality.

• Journal of Korean Foot and Ankle Society
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• v.14 no.1
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• pp.73-78
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• 2010

Purpose: The purpose of this study is to analyze the clinical and radiological results of minimally invasive percutaneous screw fixation in intra-articular calcaneal fractures and its complications. Materials and Methods: This study is based on 30 intra-articular calcaneal fractures that treated by index operation from June 2005 to November 2006 with at least 6 months follow-up. We assessed the clinical and radiological outcomes and complications. Results: According to Sanders classification, there were 8 in type IIA, 7 in type IIB, 3 in type IIIAB, 6 in type IIIBC, 6 in type IV. And according to Essex-Lopresti classification, there were 9 in the tongue type, 21 in the joint depression type. Average follow-up period was 14.6 months (range: 6-23 months). Average interval between from injury to operation was 2.3 days. Average AOFAS score was 87.7 (range: 52-92). Satisfactory results were obtained in 22 cases (73.3%) by AOFAS score and in 20 cases (66.7%) by VAS score (mean: 3.4). Radiological results improved from 8.7 to 20.3 degrees in the Bohler angle and from 40.2 mm to 52.1 mm in calcaneal height. Postoperative complications were 2 skin and soft tissue problems and 1 sural neuropathy. Conclusion: Minimally invasive percutaneous screw fixation may be useful alternative surgical method in the management of Sanders type II and III calcaneal fractures, which is possible to achieves the anatomical restoration and minimizes postoperative complication in patients with high risks of soft tissue compromise and allows relatively early operation.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.85-90
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• 2009

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.