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Minimally invasive surgery may be a viable option for treating calcaneal fractures
The technique may be advantageous for smokers and patients with diabetes or soft tissue problems.
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VANCOUVER, British Columbia — Using percutaneous reduction and external fixation for calcaneal fractures can lead to earlier weight-bearing and avoid complications associated with open reduction and internal fixation, according to a recently presented study.
William C. McGarvey, MD, said during his presentation at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society, that it is a viable option. “It certainly is not for everybody. It is technically challenging, but I think that it is something that you can do and learn how to do.”
Early weight-bearing
McGarvey has more than 10 years of experience using the procedure. The treatment rational is to provide fixation, restore heel height, narrow the width and restore patient mobility. Longer operating times, less control of the articular surface and the need for a secondary procedure to remove the frame are its disadvantages, he said.
He said the advantages of the technique are: it is minimally invasive; rigid fixation is ensured; almost immediate time to surgery if you desire; and you can institute early weight-bearing for the problematic heel pad.
The procedure is useful for patients with soft tissue compromise, diabetes or other medical co-morbidities and a history of smoking.
While he prefers percutaneous reduction and external fixation for patients with open calcaneal fractures, the procedure can be used in patients with any type of calcaneal fracture.
“The best part is that these patients are immediately mobile and weight-bearing,” McGarvey said.
Clinical outcomes
McGarvey and colleagues noted good clinical outcomes in a study examining 31 patients treated with the procedure for 11 open fractures and multiple other fractures.
The average AOFAS foot score was 66,” McGarvey said. “This is actually comparable to the open reduction and internal fixation series.”
“I would implore you that if you are going to try this, do it sooner rather than later,” McGarvey said.
For more information:
- William C. Garvey, MD, can be reached at 6410 Fannin Suite 950, Houston, TX, 77030, or at Katy Orthopaedics, 23920 Katy Freeway, Ste. 160 Katy, TX 77494; 281-392-6797; e-mail: william.c.mcgarvey@uth.tmc.edu. He is a part of the speakers bureau for DePuy, is an unpaid consultant for Arthrex and receives research support from Arthrex, Biomet, DePuy, Smith&Nephew and Stryker.
Reference:
- McGarvey, WC. Minimally invasive management of calcaneus fractures. Presented at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society. July 15-18, 2009. Vancouver, British Columbia.