The Below-the-Ankle Circular Frame: A New Technique for the Treatment of Displaced Calcaneal Fractures

• DOI: 10.1053/j.jfas.2006.06.005
• Publication Date: 2006-09-02T11:22:43Z
• Authors: Konstantinos N. M...; Konstantinos Barg...; Loucia Papatheodorou; Apostolos Dimitro...; Theofilos Karacha...
• Keywords: Foot (prosody); Tarsal Bone

The calcaneus is the most commonly fractured bone of the foot and accounts for almost 2% of all skeletal fractures. Sixty percent of these are intraarticular and displaced, affecting the axis, length, height, and width of the hindfoot, thus shortening the lever arm of the triceps surae muscle (1, 2). Both operative and nonoperative treatment methods have their pitfalls and limitations. Nonoperative management cannot adequately restore normal anatomy and may result in pain and limitation of subtalar joint movement; thus, it is proposed only for calcaneal fractures with minimal displacement (3). Open reduction, internal fixation (ORIF) has evolved over the past decades. However, despite the fact that it has been proven efficient in restoring subtalar joint anatomy, it has its shortcomings (4–7). To overcome soft tissue failures and loss of reduction encountered with open techniques, percutaneous reduction and fixation (8, 9) and external fixation with unilateral (10, 11) or circular frames (12–17) have been proposed for severely comminuted fractures. In particular, circular frames (Ilizarov frames) have been used in severely injured heels with extensive bone comminution and soft tissue damage (15, 16). They allow for a less traumatic intervention, versatile placement of thin wires, and the possibility of achieving both indirect reduction of fragments through wire tensioning and/or gradual reduction by adjusting the threaded bars (13, 14, 17, 18). In the few