Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
treatment of simple humeral fractures and for a pathologic fracture from malignant melanoma. The course of chemotherapy could be followed during fracture treatment. Results: Fracture healing took place except in our tumor patient where the arm became rotationally unstable. Conclusion: PEEK nails are an advance in the treatment of humerus shaft fractures from trauma and tumor. Their designs and indications are evolving. A17 A new approach for calcaneal fractures: a prelimanary step for calcaneal nailing M. Goldzak1 , G. Gradl2 , P. Simon3 , T. Mittlmeier2 . 1 Clinique de l’Union, Toulouse, France; 2 University of Rostock, Department of Trauma and Reconstructive Surgery, Rostock, Germany; 3 Hˆ opital Saint Joseph-Saint Luc, Lyon, France Aim: One of the main problems raised by articular fractures of the calcaneus is the wound healing related to lateral approach. There are reports on up to 17% of skin complications, and a 5% rate of deep infections related to open reduction and internal fixation. This study proposes a new approach which allows the reduction of the articular fracture and fixation using a specially designed locked nail. Material and Methods: Operative technique: The access from the heel is done by drilling through the calcaneal tuberosity with a hollow reamer. The second important point of the technique is the use of a talo-calcaneal distractor. The reduction is achieved using a specific curved bone pushers and a mallet in order to reduce the medial and the lateral articular fragment. This process allows a direct intrafocal access to articular fragments. We presented a prospective series of ten patients with a one year follow up operated according to this technique. Results: All fractures united. The mean OAFAS score was 84/100 with a difference related to the fracture type. We noted 1 algodystrophy, 1 tarsal tunnel syndrome, no wound trouble nor infection. The anatomical results were evaluated with Boehler angle which raised from 4° preoperatively to 22° postoperatively. Conclusion: Posterior intrafocal approach simplifies the surgical procedure and postoperative follow up. A good knowledge of the volume and the displacements of articular fragments is required. This approach will allow the use of a locking nail to maintain the reduction, however further clinical results are needed to substantiate the good early results. A18 A New approach to Calcaneal Architectural Fracture Classification (CAFC) M. Goldzak. Toulouse, France Aims: Among the usual calcaneal fracture classifications there is only one – not the latest – with a surgical concern, called the Essex Lopresti’s classification made in 1952. The authors divided the fractures into two types: the tongue type fractures and the joint depression fractures leading to different surgical management. The Tongue type percutaneal surgery was made by Steinmann with wire pinning of the calcaneal tuberosity close to the skin. The Joint depression needs an open reduction and internal fixation. Up to now, the CT scan contribution has made the description and study easier. However, the usual Utheza, Zwipp and Tcherne and Sanders classification does not give any indications about taking either percutaneal or Orif pathway. Not to mention the Ao classification with no contribution about the articular fracture treatment. Material and methods: We propose to ease up the choice between percutaneal or open surgery with a new calcaneal classification based upon a critical review of the main usual classifications of calcaneal fractures (Duparc, Zwipp, Utheza, Sanders) and upon
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a personal architectural design of the calcaneus driven from the analysis of CT scan three-dimensional reconstructions of the 450 calcaneal fractures that we have so far collected in our practice. Results: This classification into 3 types and 2 sub-types includes articular and extra articular fractures. The X-ray profile view allows the recognition of the 3 main types. This procedure is quite reliable since the features described are simple: articular involvement, parcellar fracture, calcaneal displacement. The sub-types are described by a three-dimensional CT reconstruction with OSIRIX software (copyright Antoine Rosset). Conclusion: This concept leads us to adapt surgical procedures into the percutaneal technique of reduction and fixation. The main objective of this approach is to guide surgeons in their operative strategies and to help them in the technical choice and operative procedures of the domain at stake. A19 Calcanail a new internal device for calcaneal fractures M. Goldzak1 , P. Simon2 , T. Mittlmeier3 . 1 Clinique de l’Union, Toulouse, France; 2 Hˆ opital Saint Joseph-Saint Luc, Lyon, France; 3 Poliklinik der Universit¨ at Rostock, Germany Aims: Calcaneal fractures are often well enough treated by open reduction and internal fixation, but also by percutaneal pinning as well as non operative procedures. Many surgeons who were confronted to these fractures had only a short experience. We propose a new implant to ease up the operative procedure with a standard technique based upon our expertise in calcaneal fracture management. Material and Methods: We presented a cadaveric implantation and a surgical procedure based upon our intra focal dorsal approach published in the AFCP (Association Francaise ¸ de Chirurgie du Pied) monography in November 201. The Calcanail features and our first clinical implantation outcomes were included in this presentation with a tridimensional CT reconstruction after and before the implantations. The access from the heel is done by drilling through the calcaneal tuberosity with a hollow reamer. The use of a talo-calcaneal distractor allows a direct intra-focal access to articular fragments. The nail allowS an angular stable fixation and fragment compression. We performed a biomechanical test of cadaver bone with extensometry devices and hydraulic press. Results: We compared our construct to plating and screwing in a calcaneal bone by mechanical tests. The stability and rotational forces were neutralized at the same level of triangulation plating. Our first implantationS were controlled by post operative tridimensional CT reconstructions. Conclusion: The Posterior intra-focal approach standardizes the surgical procedure. Calcanail is a locking nail used to fix the reduction with an angular and rotational stability proven by biomechanical tests. A20 Tibiotalocalcaneal arthrodesis with a compressive retrograde intramedullary nail: early results in 14 consecutive patients A. Eleftheropoulos, I. Petrakis, K. Lazaridis, Ch. Kalitsis, D. Giannekas. Naousa’s General Hospital, Naousa, Greece Aim: Tibiotalocalcaneal arthrodesis is a treatment of choice for severe arthrosis-dysfunction and malalignment of the hind foot. Complications as delayed union or nonunion and early postoperative pain of the mid foot are well known complications of this procedure. The report of the early post op results is the aim of this study. Material and Methods: Fourteen patients (10 males and 4 females) with an average age of 68 (range 42 to 78) years underwent a tibiotalocalcaneal fusion using a retrograde intramedullary nail. The mean follow up was 18 (range 6 to 36) months. Seven patients had developed a post-traumatic arthrosis, two had a severe flat