Thursday February 22, 1996

Closed surgical technique used for severe calcaneal fractures

An alternative closed surgical technique for treatment of severe calcaneal fractures was presented Thursday in scientific exhibit S 23.

"This technique emphasizes the restoration of calcaneal width, length, and height, but not necessarily an anatomic reduction of the already destroyed subtalar joint," said Vladimir Schwartsman, MD, clinical professor at the Las Vegas School of Medicine at University Medical Center (UMC), Las Vegas.

Calcaneal fractures sometimes include irreparable damage to the surface of the bone, and open fracture reduction, if possible, can be technically demanding. During open reduction cell death also can contribute to poor clinical outcome even when the joint is anatomically corrected.

From August 1993 to February 1995, 30 Type III and Type IV calcaneal fractures were treated with this method at UMC. This reduction of the fractures was done manually using an intraoperative calcaneal skeletal traction device which was directed distally and posteriorly. During the procedure the subtalar joint was slightly distracted.

Once the heel shape was restored a circular fixator was put on the ankle while maintaining skeletal traction. The fixator consisted of two rings applied above the ankle joint that are connected to a 5/8 ring around the heel.

Partial or full weightbearing was started on the first postoperative day in order to desensitize the injured heel pad. After six to eight weeks the frames were replaced with a short walking cast for two to three weeks.

Anthony Serfustini, MD, chief of orthopaedic surgery, UMC, is the co-author of this study with Dr. Schwartsman.

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