Stabilization of calcaneus fractures in a closed manner with a distraction screw
István Kádas1, János Szita1, György Zadravecz1, László Hangody2, József Dóczi1
1National Institute of Traumatology and Emergency, Budapest, Hungary
2Department of Orthopedics and Traumatology, Uzsoki Hospital, Budapest, Hungary
Keywords: Bone screws; calcaneus/injuries; fracture fixation, internal/methods; manipulation, orthopedic/methods.
Calcaneus fractures with joint crunches need surgical treatment. This treatment can be closed reposition and overstitching, or open reposition with osteosynthesis using an H plate. There is also a minimal invasive technique, whereby the fracture is reduced with a distraction device in a closed manner and stabilized with three supporting screws. This method became widespread with Zadravecz’s endeavors and has become the most popular and most frequent way of stabilization for calcaneus fractures in our institute. To further improve the Zadravecz’s technique, we developed a new headless distraction screw. There are threads on both ends of the screw, which turn in the same direction. The size of the threads on the side of the screw head is greater in diameter and pitch compared to those on the other end, exerting and maintaining a distancing effect. The repositioning tool has undergone changes, as well. A desirable ligamentotaxis is achieved by a newly designed distraction-reposition apparatus. We currently use two half-arcs, on which three Kirschner wires can be used. For accurate repositioning, we rely upon the ligamentotaxis effect of the reposition tool, and the inner synergetic effect of the distraction screw. The technique described here was used in 56 patients (mean age 46 years; range 28 to 67 years) with calcaneus fractures. The patients were followed-up for a mean of 18.3 months (range 10 to 36 months) and were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score for the ankle and hindfoot. The mean AOFAS score was 76.5 (range 54 to 98), and the mean pain score was 22 (range 22 to 32). The authors believe that this minimally invasive technique will arose even more interest among orthopedic surgeons.