Our Summary

This research paper discusses a type of severe foot injury called a displaced intra-articular calcaneal fracture, which is a break in the heel bone that extends into the joint. This type of fracture can significantly alter a person’s life due to complications in healing and potential changes in the shape of the heel bone.

Two types of surgeries to treat these fractures are discussed: open reduction with internal fixation, and a newer method that involves manipulating the bone without open surgery and using a special type of nail to hold the bones in place. This newer method has been used for severe fractures and has the unique ability to naturally lead to the fusion of the joint, using the same instruments.

The article reviews both these surgical methods for treating severe heel fractures, focusing on those that either preserve the joint or lead to its fusion.

FAQs

  1. What is the CALCANAIL fracture nail fixation method mentioned in the article?
  2. How does the joint-sparing approach work in treating Sanders IV fracture patterns?
  3. What is the uniqueness of the primary subtalar joint arthrodesis procedure using the same instrumentation?

Doctor’s Tip

A helpful tip a doctor might tell a patient about joint fusion is to follow a strict rehabilitation program post-surgery to ensure proper healing and function of the fused joint. This may include physical therapy exercises, avoiding high-impact activities, and maintaining a healthy lifestyle to support joint health. It is important to follow the doctor’s instructions and attend follow-up appointments to monitor progress and address any concerns.

Suitable For

Patients who are typically recommended joint fusion procedures include those with severe intra-articular calcaneal fractures, particularly Sanders IV fracture patterns. These patients may have difficulty obtaining and maintaining calcaneal morphology and are at a significant risk of wound healing complications with traditional open reduction and internal fixation techniques. In these cases, joint fusion procedures, such as primary subtalar joint arthrodesis, may be recommended as a more effective treatment option. Other patients who may benefit from joint fusion include those with advanced arthritis or severe joint instability that has not responded to conservative treatments.

Timeline

Before joint fusion:

  • Patient sustains a displaced intra-articular calcaneal fracture.
  • Difficulty in obtaining and maintaining calcaneal morphology is experienced.
  • Significant risk of wound healing complications with an extensile lateral incision is present.
  • Open reduction with internal fixation as a joint-sparing approach is considered.
  • Closed manipulation to restore calcaneal morphology, intra-osseous fracture reduction, and rigid locked CALCANAIL fracture nail fixation are performed for Sanders IV fracture patterns.

After joint fusion:

  • Spontaneous conversion to primary subtalar joint arthrodesis using the same instrumentation is unique to this system.
  • Open and percutaneous approaches for joint-sparing and primary arthrodesis procedures are considered to treat Sanders IV fracture patterns.
  • The patient undergoes joint fusion surgery to stabilize the calcaneal fracture and address any remaining issues with the subtalar joint.
  • Recovery and rehabilitation process begin to restore function and mobility in the affected foot.

What to Ask Your Doctor

  1. What is the success rate of joint fusion for my specific condition?
  2. What are the potential risks and complications associated with joint fusion surgery?
  3. How long is the recovery process after joint fusion surgery?
  4. Will I need physical therapy or rehabilitation after the surgery?
  5. How will joint fusion surgery affect my mobility and ability to engage in physical activities?
  6. Are there alternative treatments to joint fusion that I should consider?
  7. What is the long-term prognosis for joint fusion surgery in terms of pain relief and joint function?
  8. How experienced are you in performing joint fusion surgeries, and what is your success rate with this procedure?
  9. Will I need any additional surgeries or treatments in the future after joint fusion surgery?
  10. Are there any specific lifestyle changes or precautions I should take after undergoing joint fusion surgery?

Reference

Authors: Roukis TS. Journal: Clin Podiatr Med Surg. 2019 Apr;36(2):251-268. doi: 10.1016/j.cpm.2018.10.007. Epub 2019 Jan 24. PMID: 30784535