• Journal of Trauma and Injury
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• v.18 no.1
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• pp.64-69
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• 2005

Purpose: We report the radiologic and the clinical results for surgical treatment of calcaneal fractures involving the subtalar joint. Methods: We evaluated the findings of radiographs and computed tomographs of 39 patients (40 cases) with intra-articular calcaneal fractures. The fractures were treated with open reduction via an extended lateral approach and internal fixation using a plate. We assessed the radiologic results, such as the $B{\ddot{o}}hler$ angle, the Gissane angle, and the height/width ratio. We assessed the clinical results based on the critieria of Salama et al. Results: According to the Essex-Lopresti classification, 9 cases were classified as tongue type and 31 cases as joint depression type. According to the Sanders classification, 10 cases were classified as type IIA, 4 cases as IIB, 16 cases as IIIAB, 4 cases as IIIAC, and 6 cases as type IV. The mean preoperative $B{\ddot{o}}hler$ angle was 7.7, the mean postoperative $B{\ddot{o}}hler$ angle was 21.1, and the mean last follow-up $B{\ddot{o}}hler$ angle was 16.8. Clinical results classified as 10 excellent, 13 good, 11 fair, and 6 poor. Conclusion: In the treatment of intra-articular fractures of the calcaneus, open reduction via an extended lateral approach seems to be a useful method in that it can provide direct exposure of the subtalar joint with little morbidity.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.151-156
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• 2010

Purpose: To analyze the clinical and radiological results of operative treatment in patients with tongue type intra-articular calcaneal fracture, and to compare the open reduction and Essex-Lopresti technique. Materials and Methods: We examined a consecutive series of 42 patients who received surgical treatment for tongue type calcaneal fracture (24 cases of the open reduction and 18 cases of the Essex-Lopresti technique) and the postoperative data was compared with a minimum 1 year follow-up. The clinical outcome was analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and Salama's criteria. The preoperative, postoperative, and last follow-up changes in the Bohler angle was radiologically analyzed. Results: There were no significant differences between the two groups in terms of the clinical and radiological results at the last follow-up. However, for the Sander's type 3 and 4 fractures, the open reduction group showed more improvement of AOFAS score and less reduction loss in the Bohler angle. Conclusion: Although the clinical results were good irrespective of surgical technique, the open reduction and internal fixation can improve clinical outcome and reduce the reduction loss as compared with the Essex-Lopresti technique in the comminuted tongue type calcaneal fracture.

• Journal of Korean Foot and Ankle Society
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• v.3 no.1
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• pp.12-18
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• 1999

Eleven patients with calcaneal fracture had 2 acute compartment syndrome of the feet and 9 late complication of the compartment syndrome of the feet. An interstitial pressure of more than 30 mmHg in either the central or interosseous compartment was considered pathologic and was treated by fasciotomy performed medially. Rigid claw toe deformity was treated by excision of the head and neck of the proximal phalanx, dorsal capsular release of the metatarsophalangeal joint, and lengthening of the extensor tendon. Patients were evaluated at a mean of 35 months(range, 21 - 44 months) after operation, and the examination was directed specifically toward symptoms and signs of myoneural ischemia, and walking pain. At follow -up, 2 patients with acute compartment syndrome of the foot had no evidence of myoneural ischemla, 9 patients with claw toe deformity had no pain with walking. Based on our clinical observations, we concluded that compartment syndrome of the foot may occur after the calcaneal fracture and fasciotomy is effective treatment for the prevention of the long term sequelae of this debilitating condition.

• Journal of Korean Foot and Ankle Society
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• v.12 no.2
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• pp.168-173
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• 2008

Purpose: To evaluate the results of treatments by percutaneous Acutrak screw fixation for intra-articular joint depression type fracture of calcaneus. Materials and Methods: Thirteen cases with intra-articular joint depression type fracture of calcaneus, from September 2004 to March 2006, were reviewed. There were 9 males and 4 females with 52.5 years old mean age (range: $31{\sim}74$ years old). The average follow-up period was 18 months (range: $8{\sim}32$ months). Steinmann pins and Freers were used for closed reduction. After closed reduction, Acutrak screws and K-wires were inserted. The patients were evaluated with Creighton-Nebraska health foundation assessment sheet for calcaneal fracture, the extent of recovery of Bohler angle, fragment size, and state of subtalar joint. Results: Clinical results according to Creighton-Nebraska health foundation assessment sheet for calcaneal fracture were excellent in 6 cases (46%), good in 4 cases (30%), fair in 2 cases (15%), and poor in 1 case (7%). Average preoperative Bohler angle was $7.6^{\circ}$ (range: $2^{\circ}{\sim}13^{\circ}$). Average postoperative Bohler angle was $24.4^{\circ}$ (range: $4^{\circ}{\sim}33^{\circ}$). There were no soft tissue complications. There were one mild subtalar arthritis and one moderate subtalar arthritis. Conclusion: We think that closed reduction and percutaneous Acutrak screw fixation with or without K-wire is a good option for joint depression type fracture of calcaneus.

• 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 the Korean Society for Nondestructive Testing
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• v.35 no.2
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• pp.103-111
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• 2015

The present study investigated the influence of thick cortical endplates on the ultrasonic properties of trabecular bone in a femur with a high fracture risk. Twelve trabecular bone samples were prepared from bovine femurs, and acrylic plates with thicknesses of 1.25, 1.80, and 2.75 mm were manufactured to simulate the cortical endplates using acrylic with a density and a sound speed similar to cortical bone. Although the thickness of the acrylic plates attached to the two sides of the trabecular bone increased, high correlations were observed between the speed of sound and the apparent bone density of the trabecular bone, with Pearson's correlation coefficients of 0.80-0.86. High correlations were also observed between the attenuation coefficient at 0.5 MHz and the apparent bone density of the trabecular bone, with Pearson's correlation coefficients of 0.84-0.91. These results suggest that the speed of sound and attenuation coefficient at a specific frequency measured in a femur with relatively thick cortical endplates compared to the calcaneus could be used as indices for predicting the bone mineral density of the femur.

• 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.