Correcting the deformity in the axial view!
Tools to facilitate reduction: We talked about several different methods of correcting varus, shortening and widening of the tuberosity fragment. The video linked to above “breaks down” the deformity and corrective maneuvers as seen from the axial view. https://youtu.be/ticULM3jnyM  View this email in your browser There are several techniques that can be used to mobilize the tuberosity fragment to facilitate reduction. The most common technique is using a Shanz pin (either from lateral to medial or posterior to anterior). Through the joint depressed fragment, a joker or freer can be placed thru the primary fracture line to help lever the posterior tuberosity. The Shantz pin should be placed perpendicular to the tuberosity – with the deformity it will look “crooked” relative to the tibia.  Other options include use of a femoral distractor. The Shanz pin is placed into the tuberosity fragment and the other pin is placed in the distal tibia or the talus. The calcaneal tuberosity can then be lengthened and provisionally pinned to the constant medial fragment.   Finally, you may occasionally see a medial based external fixator placed, serving as a means for deformity correction and maintenance of height.What other techniques have you seen used?There can be variation on the steps for reduction. Meaning, that sometimes you will see the posterior facet elevated and pinned to the sustentaculum first and sometimes you will see the tuberosity deformity corrected first. Remember, we often use a little larger k wires – often we use a 1.6 mm k wire, but we could use a 2.0 mm k wire. You may see these “pre-loaded” so as to facilitate placement once the reduction is achieved. (see video) You may also see these wires swapped out for a cannulated screw for the final fixation. (see photo below) The reference below does a great job of describing some of these reduction maneuvers and is a great resource if you are looking for more tips!Zwipp H, Rammelt S, Barthel S. Calcaneal fractures–openreduction and internal fixation (ORIF). Injury. 2004 Sep;35 Suppl 2:SB46-54.doi: 10.1016/j.injury.2004.07.011. PMID: 15315878.  Intraoperative axial views – Note initial k wires placed in the tuberosity swapped with a cannulated screw to hold tuberosity position. In this case, Cerement (calcium sulfate + HA) was used to fill bone void. Our next webinar is going to consist of frequently asked questions! Send us questions you’ve always wanted to ask and we will discuss these on August 20th, 2023 at 7:30 pm central time!Register for our upcoming webinar!  Copyright (C) 2023 STRASSER ORTHOPEDIC SERVICESAll rights reserved.Want to change how you receive these emails? You can update your preferences or unsubscribe |
Hi. We work according to the same principles but with distraction devices specialised in calcaneal fractures. Unfortunately, these techniques have never been made public in the Anglo-American area although they offer many advantages.
Osteosynthesis is done exclusively with screws, with pre-operatively planned placement, sufficient for early functional treatment and good bony healing.
If interested just have a look at http://www.calcaneal-fracture.com
– gladly open for further discussions and contact
regards and greetings from Austria Christian
Thanks for the comments. I’ve seen your site and technique before and very impressed with your technique. Thanks for the comments!