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The “Open-Envelope” Approach: A Limited Open Approach for Calcaneal Fracture Fixation

  • Symposium - Hindfoot and Ankle Trauma
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Minimally invasive surgery (MIS) has a significant and evolving role in the treatment of displaced intra articular calcaneal fractures (DIACFs), but there is limited literature on this subject. The objective was hence to assess the clinicoradiological outcomes of DIACFs fixed with an innovative open-envelope MIS technique.

Materials and Methods

42 closed Sanders Type 2 and 3; DIACFs were included in this study. The Open-envelope approach was developed, which is essentially a limited open, dual incision, modified posterior longitudinal approach allowing excellent visualisation and direct fragment manipulation. The main outcome measures were American Orthopaedic Foot and Ankle Score (AOFAS) hindfoot score and preoperative and postoperative radiological angles.

Results

The Bohler angle improved from a preoperative mean of 14.3° (range 0°-28°) to a postoperative mean of 32.46° (range 22°–42°). The Gissane angle improved from a preoperative mean of 135.83° to a postoperative mean of 128.33°. The postoperative improvement in Bohler and Gissane angles was highly significant (P < 0.001). The AOFAS scores at 6 months were excellent in nine patients, good in 15 patients, and fair in six patients. Three patients had residual valgus deformity of the heel.

Conclusions

Open-envelope technique minimized soft tissue complications and achieved acceptable radiological reductions with good clinical outcomes.

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Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India

    Ankit Khurana

  2. Department of Orthopaedics, Delhi Institute of Trauma and Orthopaedics, Sant Parmanand Hospital, New Delhi, India

    Rakesh John

  3. Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Sharad Prabhakar &  Mandeep S. Dhillon

Authors
  1. Sharad Prabhakar
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  2. Mandeep S. Dhillon
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  3. Ankit Khurana
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  4. Rakesh John
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Corresponding author

Correspondence to Mandeep S. Dhillon.

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Prabhakar, S., Dhillon, M.S., Khurana, A. et al. The “Open-Envelope” Approach: A Limited Open Approach for Calcaneal Fracture Fixation. IJOO 52, 231–238 (2018). https://doi.org/10.4103/ortho.IJOrtho_576_17

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  • DOI: https://doi.org/10.4103/ortho.IJOrtho_576_17

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