Surgical treatment of intraarticular fractures of the calcaneus: comparison between flat plate and calcaneal plate☆

Silva, Luiz Carlos Almeida da; Heck, João Mendonça de Lima; Guerra, Marcelo Teodoro Ezequiel

doi:10.1016/j.rboe.2016.05.007

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Original Article • Rev. bras. ortop. 52 (1) • Jan-Feb 2017 • https://doi.org/10.1016/j.rboe.2016.05.007 copy

Surgical treatment of intraarticular fractures of the calcaneus: comparison between flat plate and calcaneal plate^{^☆} ☆ Study conducted at the Universidade Luterana do Brasil (Ulbra), Hospital Universitário, Departamento de Ortopedia e Traumatologia, Canoas, RS, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To evaluate the clinical results of surgical treatment of intraarticular fractures of the calcaneus, comparing the use of calcaneal plate and flat plate.

METHODS:

This was a retrospective study assessing the postoperative results of 25 patients between 2013 and 2015. Patients undergoing surgical treatment of intraarticular fractures of the calcaneus without concomitant surgical lesions were included. Patients who did not complete appropriate follow-up after surgery were excluded from the study.

RESULTS:

The unavailability of calcaneal plates at resource-limited settings, associated with the availability and lower cost of flat plates, may have been a confounding factor in the present study. However, there was no statistical difference between the outcomes of fractures treated with calcaneal plates or flat plates.

CONCLUSION:

Statistical inference shows that, when calcaneal plates are not available, it is possible to use flat plates with similar clinical outcomes.

Keywords:
Calcaneus/injuries; Calcaneus/surgery; Fractures, bone/surgery; Fracture fixation, internal

	Type of plate				p^a
	CP (n = 14)		FP (n = 11)
Age	47.7	10.4	45.5	11.29	0.617^a
Sex					0.230
Female	3	21.4%	0	0.0%
Male	11	78.6%	11	100.0%

Trauma mechanism					1.000
Bicycle × motorcycle collision	1	7.1%	0	0.0%
Fall from height	13	92.9%	11	100.0%

Operated side					0.414
Right	7	50%	8	72.7%
Left	7	50%	3	27.3%

Rearfoot position in orthostasis					0.695
Neutral	8	57.1%	5	45.5%
Valgus	6	42.9%	6	54.5%

Subtalar arthrosis					1.000
No	5	35.7%	3	27.3%
Yes	9	64.3%	8	72.7%

	Type of plate				p^a
	CP (n = 14)		FP (n = 11)
Essex-Lopresti classification					0.350
Joint depression	12	85.7%	7	63.6%
Tongue	2	14.3%	4	36.4%

Sanders classification					0.655
2A	5	35.7%	3	27.3%
2B	1	7.1%	1	9.1%
3AB	2	14.3%	4	36.4%
3AC	3	21.4%	0	0%
3BC	1	7.1%	1	9.1%
4	2	14.3%	2	18.2%

	Type of plate				p
	CP (n = 14)		FP (n = 11)
	Mean	SD	Mean	SD
Waiting time until surgery (days)	23.1	17.28	19.5	6.67	0.913^a
Difference in calf diameter	1.9	0.53	1.5	1.35	0.308^a
Width of the hindfoot	6.7	0.71	7.1	0.82	0.270^b
Ankle extension	11.5	10.41	11.8	7.17	0.67.6^a
Ankle flexion	24.6	9.90	27.2	9.87	0.519^b
Forefoot supination	13	12.88	20.7	11.19	0.084^a
Forefoot pronation	13.4	9.81	11.1	9.97	0.359^a
Subtalar supination	7.6	6.12	4	7.75	0.057^a
Subtalar pronation	1	6.6	0.1	1.58	0.240^a

	Type of plate				p
	CP (n = 14)		FP (n = 11)
	Mean	SD	Mean	SD
PF-SF36 Scale Scores	52.9	36.15	52.3	28.84	0.912^a
RP-SF36 Scale Scores	25.0	39.22	25.0	35.36	0.804^a
BP-SF36 Scale Scores	47.0	34.90	54.3	27.67	0.578^b
GH-SF36 Scale Scores	74.6	27.77	74.7	25.41	0.889^a
VT-SF36 Scale Scores	65.7	20.27	71.8	24.52	0.502^b
SF-SF36 Scale Scores	63.4	36.51	63.9	36.43	0.846^a
RE-SF36 Scale Scores	38.1	43.8	36.4	43.35	0.907^a
MH-SF36 Scale Scores	69.1	20.12	68.7	25.85	0.964^b
PF-SF36 Norm-based Scale Scores	37.4	15.15	37.1	12.10	0.967^b
RP-SF36 Norm-based Scale Scores	35.1	11.7	35.0	9.98	0.804^a
BP-SF36 Norm-based Scale Scores	40.0	14.94	43.2	11.85	0.575^b
GH-SF36 Norm-based Scale Scores	52.1	13.1	52.2	11.89	0.889^a
VT-SF36 Norm-based Scale Scores	54.1	9.61	57.0	11.62	0.502^b
SF-SF36 Norm-based Scale Scores	41.2	15.85	41.3	15.80	0.868^a
RE-SF36 Norm-based Scale Scores	35.8	13.61	35.2	13.70	0.907^a
MH-SF36 Norm-based Scale Scores	46.6	11.43	46.3	14.70	0.962^b
PCS-SF36	38.1	13.37	39.2	9.47	0.817^b
MCS-SF36	47.3	10.9	47.4	13.92	0.975^b

	Type of plate				p^a
	CP (n = 14)		FP (n = 11)
	Mean	SD	Mean	SD
VAS	4.6	2.73	3.6	2.38	0.344
AOFAS	66.1	26.37	52	20.64	0.160
Radiological width of the hindfoot	4.7	0.38	4.4	0.60	0.217
Pitch angle of the calcaneus	21	5.88	16.6	5.66	0.74
Talus declination angle	18	4.79	18.9	2.95	0.587

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E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: luizcarlosmedicina@gmail.com (L.C. Silva).

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Surgical treatment of intraarticular fractures of the calcaneus: comparison between flat plate and calcaneal plate☆ ☆ Study conducted at the Universidade Luterana do Brasil (Ulbra), Hospital Universitário, Departamento de Ortopedia e Traumatologia, Canoas, RS, Brazil

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Surgical treatment of intraarticular fractures of the calcaneus: comparison between flat plate and calcaneal plate^{^☆} ☆ Study conducted at the Universidade Luterana do Brasil (Ulbra), Hospital Universitário, Departamento de Ortopedia e Traumatologia, Canoas, RS, Brazil