Download PDF
OP-Journal 2021; 37(02): 148-158
DOI: 10.1055/a-1241-5246
Fachwissen

Kalkaneusfrakturen – operative Taktik und Erfolgskontrolle

Calcaneal Fractures – Operative Treatment and Intraoperative Imaging
Christine Marx
,
Konrad Kamin
,
Stefan Rammelt
› Further Information
    Permissions and Reprints

Zusammenfassung

Kalkaneusfrakturen sind häufige Verletzungen des Fußes und stellen ein anspruchsvolles Krankheitsbild dar. Sie bedürfen einer sorgfältigen Diagnostik einschließlich multiplanarer CT-Bildgebung und einer individuellen Therapieplanung. Insbesondere der Weichteilbefund hat großen Einfluss auf die therapeutischen Optionen und das Therapieergebnis. Nicht dislozierte und extraartikuläre Frakturen ohne relevante Achsfehlstellung und Verbreiterung des Fersenbeins können i. d. R. konservativ behandelt werden. Intraartikuläre Frakturen mit Verwerfungen ab 2 mm und relevante Fehlstellungen des Fersenbeins bedürfen der operativen Therapie. Diese erfolgt klassischerweise über einen ausgedehnten lateralen Zugang mittels Plattenosteosynthese. Aufgrund der vergleichsweise hohen Rate an Wundheilungsstörungen haben sich weniger invasive Verfahren, wie die Reposition über einen Sinus-tarsi-Zugang mit perkutaner Schraubenosteosynthese, etabliert.

Abstract

A calcaneal fracture is a common injury of the foot and a challenging pathology for the surgeon. It requires a precise diagnostic imaging including a CT scan with multiplanar reconstructions and a treatment tailored to the individual conditions. The soft-tissue damage profoundly affects the method of treatment and outcome. Indications for nonoperative treatment are nondisplaced, intraarticular fractures and extraarticular fractures without significant malalignment or deformity of the heel. Displaced intraarticular fractures with step-offs of 2 mm and more and extraarticular fractures with severe deformity or soft tissue incarceration warrant operative treatment. Open reduction through an extended lateral approach and stable internal fixation with a lateral plate has been established as a standard therapy. To reduce wound healing problems less invasive procedures through a direct approach over the sinus tarsi and percutaneous screw fixation have been established.

Schlüsselwörter

Kalkaneusfraktur - offene Reposition - minimalinvasive Reposition - Sinus-tarsi-Zugang

Key words

calcaneal fracture - open reduction - percutaneous reduction - sinus tarsi approach


Publication History

Article published online:
16 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Mitchell MJ, McKinley JC, Robinson CM. The epidemiology of calcaneal fractures. Foot Edinb Scotl 2009; 19: 197-200 DOI: 10.1016/j.foot.2009.05.001.
    CrossrefPubMedGoogle Scholar
  • 2 Coughlin MJ. Calcaneal fractures in the industrial patient. Foot Ankle Int 2000; 21: 896-905
    CrossrefPubMedGoogle Scholar
  • 3 Zwipp H, Rammelt S. Tscherne Unfallchirurgie: Fuß. Berlin, Heidelberg: Springer; 2014
    Google Scholar
  • 4 Poeze M, Verbruggen JP, Brink PR. The relationship between the outcome of operatively treated calcaneal fractures and institutional fracture load. A systematic review of the literature. J Bone Joint Surg Am 2008; 90: 1013-1021
    CrossrefPubMedGoogle Scholar
  • 5 Sanders R. Intra-articular fractures of the calcaneus: present state of art. J Orthop Trauma 1992; 6: 252-265
    CrossrefPubMedGoogle Scholar
  • 6 Zwipp H. Chirurgie des Fußes. Wien, New York: Springer; 1994
    CrossrefGoogle Scholar
  • 7 Rammelt S, Barthel S, Biewener A. et al. Kalkaneusfrakturen. Offene Reposition und interne Stabilisierung. Zentralbl Chir 2003; 128: 517-528 DOI: 10.1055/s-2003-40627.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Dürr C, Zwipp H, Rammelt S. Fractures of the sustentaculum tali. Oper Orthop Traumatol 2013; 25: 569-578 DOI: 10.1007/s00064-013-0247-2.
    CrossrefPubMedGoogle Scholar
  • 9 Rammelt S, Winkler J, Grass R. et al. Reconstruction after talar fractures. Foot Ankle Clin 2006; 11: 61-84 viii
    CrossrefPubMedGoogle Scholar
  • 10 Rammelt S, Zwipp H. Komplikationen bei der Versorgung von Fußverletzungen in Komplikationen kompakt: Orthopädie und Unfallchirurgie. Stuttgart: Thieme; 2016: 166-171
    Google Scholar
  • 11 Sangeorzan BJ, Ananthakrishnan D, Tencer AF. Contact characteristics of the subtalar joint after a simulated calcaneus fracture. J Orthop Trauma 1995; 9: 251-258
    CrossrefPubMedGoogle Scholar
  • 12 Rammelt S, Zwipp H. Corrective arthrodeses and osteotomies for post-traumatic hindfoot malalignment: indications, techniques, results. Int Orthop 2013; 37: 1707-1717
    CrossrefPubMedGoogle Scholar
  • 13 Rammelt S, Thielemann F, Zwipp H. Rekonstruktion fehlverheilter Chopart-Luxationsfrakturen. Fuß & Sprunggelenk 2009; 7: 105-117
    CrossrefPubMedGoogle Scholar
  • 14 Ahrberg AB, Leimcke B, Tiemann AH. et al. Missed foot fractures in polytrauma patients: a retrospective cohort study. Patient Saf Surg 2014; 8: 10 DOI: 10.1186/1754-9493-8-10.
    CrossrefPubMedGoogle Scholar
  • 15 Rammelt S, Biewener A, Grass R. et al. Verletzungen des Fußes beim polytraumatisierten Patienten. Unfallchirurg 2005; 108: 858-865
    CrossrefPubMedGoogle Scholar
  • 16 Clare MP, Sanders RW. Kalkaneusfrakturen. Unfallchirurg 2011; 114: 869-876 DOI: 10.1007/s00113-011-2076-9.
    CrossrefPubMedGoogle Scholar
  • 17 Essex-Lopresti P. The mechanism, reduction technique, and results in fractures of the os calcis. Br J Surg 1952; 39: 395-419
    CrossrefPubMedGoogle Scholar
  • 18 Zwipp H, Tscherne H, Thermann H. et al. Osteosynthesis of displaced intraarticular fractures of the calcaneus. Results in 123 cases. Clin Orthop Relat Res 1993; (290) 76-86
    PubMedGoogle Scholar
  • 19 Rammelt S, Zwipp H, Schneiders W. et al. Severity of injury predicts subsequent function in surgically treated displaced intraarticular calcaneal fractures. Clin Orthop Relat Res 2013; 471: 2885-2898 DOI: 10.1007/s11999-013-3062-z.
    CrossrefPubMedGoogle Scholar
  • 20 Sanders R, Vaupel ZM, Erdogan M. et al. Operative treatment of displaced intraarticular calcaneal fractures: long-term (10–20 Years) results in 108 fractures using a prognostic CT classification. J Orthop Trauma 2014; 28: 551-563
    CrossrefPubMedGoogle Scholar
  • 21 Swords MP, Penny P. Early Fixation of Calcaneus Fractures. Foot Ankle Clin 2017; 22: 93-104
    CrossrefPubMedGoogle Scholar
  • 22 Benirschke SK, Sangeorzan BJ. Extensive intraarticular fractures of the foot. Surgical management of calcaneal fractures. Clin Orthop Relat Res 1993; (292) 128-134
    CrossrefPubMedGoogle Scholar
  • 23 Sanders R. Turning tongues into joint depressions: a new calcaneal osteotomy. J Orthop Trauma 2012; 26: 193-196
    CrossrefPubMedGoogle Scholar
  • 24 Rammelt S, Gavlik JM, Barthel S. et al. The value of subtalar arthroscopy in the management of intra-articular calcaneus fractures. Foot Ankle Int 2002; 23: 906-916
    CrossrefPubMedGoogle Scholar
  • 25 Kendoff D, Citak M, Gardner M. et al. Three-dimensional fluoroscopy for evaluation of articular reduction and screw placement in calcaneal fractures. Foot Ankle Int 2007; 28: 1165-1171 DOI: 10.3113/FAI.2007.1165.
    CrossrefPubMedGoogle Scholar
  • 26 Rübberdt A, Feil R, Stengel D. et al. Die klinische Wertigkeit des ISO-C3D bei der Osteosynthese des Fersenbeins. Unfallchirurg 2006; 109: 112-118
    CrossrefPubMedGoogle Scholar
  • 27 Rammelt S, Sands A, Swords M. et al. Neue Techniken in der operativen Versorgung von Calcaneusfrakturen. Unfallchirurg 2016; 119: 225-236
    CrossrefPubMedGoogle Scholar
  • 28 Kwon JY, Guss D, Lin DE. et al. Effect of Delay to Definitive Surgical Fixation on Wound Complications in the Treatment of Closed, Intra-articular Calcaneus Fractures. Foot Ankle Int 2015; 36: 508-517 DOI: 10.1177/1071100714565178.
    CrossrefPubMedGoogle Scholar
  • 29 Rammelt S, Zwipp H. Fractures of the calcaneus: current treatment strategies. Acta Chir Orthop Traumatol Cech 2014; 81: 177-196
    CrossrefPubMedGoogle Scholar
  • 30 Zwipp H, Rammelt S, Amlang M. et al. Osteosynthese dislozierter intraartikulärer Calcaneusfrakturen. Oper Orthop Traumatol 2013; 25: 554-568
    CrossrefPubMedGoogle Scholar
  • 31 Schepers T, Backes M, Dingemans SA. et al. Similar Anatomical Reduction and Lower Complication Rates With the Sinus Tarsi Approach Compared With the Extended Lateral Approach in Displaced Intra-Articular Calcaneal Fractures. J Orthop Trauma 2017; 31: 293-298
    CrossrefPubMedGoogle Scholar
  • 32 Rammelt S, Amlang M, Barthel S. et al. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res 2010; 468: 983-990
    CrossrefPubMedGoogle Scholar
  • 33 Yeap EJ, Rao J, Pan CH. et al. Is arthroscopic assisted percutaneous screw fixation as good as open reduction and internal fixation for the treatment of displaced intra-articular calcaneal fractures?. Foot Ankle Surg 2016; 22: 164-169
    CrossrefPubMedGoogle Scholar
  • 34 Buckley R, Leighton R, Sanders D. et al. Open reduction and internal fixation compared with ORIF and primary subtalar arthrodesis for treatment of Sanders type IV calcaneal fractures: a randomized multicenter trial. J Orthop Trauma 2014; 28: 577-583
    CrossrefPubMedGoogle Scholar
  • 35 Rammelt S, Sangeorzan BJ, Swords MS. Calcaneal fractures – should we or should we not operate?. Indian J Orthop 2018; 52: 220-230
    CrossrefPubMedGoogle Scholar
  • 36 Radnay CS, Clare MP, Sanders RW. Subtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter?. J Bone Joint Surg Am 2009; 91: 541-546
    CrossrefPubMedGoogle Scholar
  • 37 Zhang W, Lin F, Chen E. et al. Operative Versus Nonoperative Treatment of Displaced Intra-Articular Calcaneal Fractures: A Meta-Analysis of Randomized Controlled Trials. J Orthop Trauma 2016; 30: e75-e81
    CrossrefPubMedGoogle Scholar