Improved therapy of calcaneal fractures by intraoperative 3D-fluoroscopy and locked-screw plate fixation

摘要

The operative therapy of intraarticular fractures of the calcaneus is now an established surgical standard. The aim is an accurate reduction of the fracture with reconstruction of the Boehler's angle, the length and the subtalarjoint. Intraoperative 3D-fluoroscopy with the Siremobil ISO-C-3D mobile C-arm radiography system is a valuable assistant for the accurate reconstruction of these anatomical structures. Remaining incongruities can be recognized and corrected intraoperatively. The achieved reduction can be safely fixed by the advantages of an internal fixator (locked-screw plate interface). In the period from October 2002 until October 2004, we operated 58 patients with intraarticular fractures of the calcaneus by means of anatomical reduction, an internal plate fixator under intraoperative control of 3D-fluoroscopy. In 22 cases the intraoperative 3D-fluoroscopy uncovered remaining incongruity over 1 mm, which could be corrected. The Boehler's angle was raised on average by 16°. In no case a secondary dislocation of the fracture was seen. Urban & Vogel.