| Calcanea® - Surgical
Technique |
|
Calcaneal fractures are usually caused
by a high-velocity impact to the heel. The most common
mechanism of injury is a fall from a height of 2 meters
or more, but calcaneal fractures also result from motor
vehicle accidents.
Calcaneal fractures may be extra or intra-articular.
Surgical treatment with open reduction and internal fixation
(ORIF) is now well accepted to be the method which gives
recognized clinical results, especially for type II and
type III calcaneal fractures according to the Sanders
classification. The aim of the surgical procedure is to
restore the articular surface of the calcaneus and to
obtain an anatomic reconstruction (height and width of
the calcaneus).
However, clinical and technical problems can occur due
to the thickness and the stiffness of the plates, in particular
superficial necrosis of the surgical wounds and peroneal
tendonitis. These problems are related to the traction
onto the skin flap during surgery and to the thickness
of the plates that may cause ischemic problems to the
skin and impingement of the peroneal tendons.
Moreover, most plates have a limited number of holes
and do not allow for significant molding because of their
thickness. In this situation, the screws have to be inserted
in predetermined sites of the calcaneal wall, and especially
in the fractured zones of the lateral calcaneal wall,
in the comminuted fractures. Sometimes this can lead to
insufficient grip of the screws and therefore insufficient
mechanical resistance of the implant. In those circumstances,
early movement to prevent joint stiffness and enhance
fractured soft tissue healing is not possible.
The CALCANEA® plate is the solution
of choice for the ORIF treatment of calcaneal fractures.
This plate is made of titanium alloy (TA16V4), has an
anatomical shape corresponding to the anatomy of the calcaneus.
It is available in three different sizes, to better fit
the calcaneus shape (5.5 cm long for size small, 6.5 cm
long for size medium and 7.5 cm long for size large).
Its thickness is 1 mm in the middle, and 1.80 mm in the
sites of main fixation. 3-4 holes are present in its anterior,
posterior and upper parts for fixation screws with threaded
heads, and 9-10 holes for variable orientation of the
screws. The plate is fixed using 3.5 mm screws. Holes
in the plate provide fixation with up to 4 screws in the
posterior tuberosity, 3 screws in the anterior process,
and 7 screws in the middle. The limited thickness permits
to mould the plate and to eventually cut it if the plate
is overstuffing anatomically the calcaneus. The upper
part of the posterior and anterior borders can sometimes
be cut off, or bent for a dorso-plantar screw fixation.
Before the definitive fixation of the plate, autologous
or synthetic bone grafts may be inserted, if necessary,
in the os trigonum of the calcaneus.
Advantages:
- Increased stability by locking screw fixation and
"bridging" of the primary fracture line
- Low profile plate
- Thickness allows remodeling according to the lateral
wall of the calcaneus
- Low irritation of soft tissues and tendons
- Reconstruction of height and width of the calcaneus
- Large number of holes for versatile fixation
- Dual screw fixation system (locking & variable)
allowing stable fixation regardless of bone conditions
- Angulation of the screws up to 30°
- Bi-cortical or mono-cortical fixation
- Color-coded for the plate and the screws
