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Review
. 2009 Dec;129(12):1677-83.
doi: 10.1007/s00402-009-0915-8. Epub 2009 Jun 19.

Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: current concepts' review

T Schepers  1 , P Patka
Affiliations
Review

Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: current concepts' review

T Schepers et al. Arch Orthop Trauma Surg. 2009 Dec.

Abstract

Introduction: A large variety of therapeutic modalities for calcaneal fractures have been described in the literature. No single treatment modality for displaced intra-articular calcaneal fractures has proven superior over the other. This review describes and compares the different percutaneous distractional approaches for intra-articular calcaneal fractures. The history, technique, anatomical and fracture considerations, limitations and the results of different distractional approaches reported in the literature are reviewed.

Method: Literature review on different percutaneous distractional approaches for displaced intra-articular calcaneal fractures.

Results: Eight studies in which application of a distraction technique was used for the treatment of calcaneal fractures were identified. Because of the use of different classification, techniques, and outcome scoring systems, a meta-analysis was not possible. A literature review reveals overall fair to poor result in 10-29% of patients. Ten up to 26% of patients are unable to return to work after percutaneous treatment of their fracture. A secondary arthrodesis has to be performed in 2-15% of the cases. Infectious complications occur in 2-15%. Some loss of reduction is reported in 4-67%.

Conclusion: Percutaneous distractional reduction and fixation appears to be a safe technique with overall good results and an acceptable complication rate, compared with other treatment modalities for displaced intra-articular calcaneal fractures. A meta-analysis, based on Cochrane Library criteria is not possible, because of a lack of level 1 and 2 trials on this subject.

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Figures

Fig. 1
Fig. 1
Single-point distraction techniques by Foldes [23] (1920; a), Kaess [23] (1922; b), Gillette [22] (c), and Carabba [7] (d)
Fig. 2
Fig. 2
Two-point distraction techniques by Böhler [4] (1929; a), Conn [9] (b), Olson [41] (c) and Frohlich [17] (d)
Fig. 3
Fig. 3
Three-point distraction techniques by Gill [21] (a), McBride [37] (b), Harris [26] (c) and Forgon-Zadravecz [15] (1983; d)
See this image and copyright information in PMC

References

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