Calcaneus Fractures

Question 1

Sanders II and III fractures treated with extensile lateral vs limited open sinus tarsi approach: outcomes?

Answer 1

similar functional outcomes. sinus tarsi with no wound issues. sinus tarsi approach with more secondary procedures such as perc screw removals etc.

restoration of Bohler’s angle achieved for all cases

seom studies show significantly decreased wound complication rates

possibly decrease surgical times

Question 2

what is “intrafocal reduction techniqe”

Answer 2

Ebraheim described - Steinman pin placed anteromedial to posterolateral to level the primary fracture fragments into position

then, pins or k-wires inserted percutaneously lateral to medial or posterior to anterior to hold remaining fragments reduced

Question 3

ORIF vs primary subtalar arthrodesis for sanders IV fractures:

Answer 3

Buckley’s prospective randomized trial demonstrated no difference in outcomes for these patients.

outcomes were: VAS, SF-36, MFAS

Question 4

Op vs Non-Op Treamtent of Calcaneus Fractures?

Answer 4

buckley RCT 2002 demonstrated significantly better reduction adn clinical outcome if treated operatively (except if you were receiving worker’s comp)

Question 5

Is the sustentacular fragment a constant fragment?

Answer 5

no - displaced in up to 72% of patients

Liporace et. al. demonstrated the variability of the position of the sustentacular fragment. It is frequently displaced and angulated, especially if the posterior facet has 50% involvement or if the middle facet is involved.

3- and 4- part fractures have high rates of sustentacular displacement