Talo-calcaneal distraction Ilizarov frame: an ergonomic method to manage intra-articular fractures of calcaneum

Abstract

Background: Principle of distraction and an indirect reduction was used to promote healing of fractures and adequate regeneration of cartilage at the subtalar joint.

Aims and Objectives: The study was aimed to elaborate and develop role of Ilizarov as an alternative biological
method to manage intraarticular fracture calcaneum with minimal chances of infection.

Materials and Methods: Twenty-one patients were studied and the mean age of patients was 40.7 years (span: 20 to 65 years). Sanders CT classification was used to divide into type II, 11 (52.38%); type III, 7 (33.33%) and type IV, 3 (14.28%). The average followup was 17.2 months (range: 6 to 24 months). AOFAS scale for ankle and hindfoot was used for assessment of patients- 7 (33.33%) excellent, 7 (33.33%) good, 3 (14.28%) fair, and 4 (19.04%) poor results. The average score was 81.5 ±12.1. The mean period of treatment was 12 weeks (10 to 14 weeks).

Results: On radiological assessment, Bohler’s angle change was 19.7±4.4 degrees to 33.51± 5.7 degrees; angle of Gissane changed from 126.4 ± 6.7 degrees preoperatively to 124.9 ± 6.9 degrees postoperatively; calcaneal
height changed 40.14 ± 1.98 mm preoperatively to 43.33 ± 1.87 mm and width changed 45.09 ±3.65 mm preoperatively to 43.09 ±3.16 mm postoperatively and reduction malalignment >10 degrees in 5 patients. Superficial skin infection at wire insertion sites was the most common complication encountered in our cases.

Conclusion: Our results with this ergonomic technique in a small number of 21 non-randomised cases with a mean followup of 17.2 years attribute towards an alternate surgical substitute to conventional open reduction techniques in the treatment of intra-articular fractures of calcaneum having lesser rate of complications.