Why It Is Becoming More Common To Utilize Closed Reduction And Percutaneous Fixation

Lawrence Fallat DPM FACFAS

While preparing a lecture on closed reduction with percutaneous fixation techniques for calcaneal fractures, I was surprised to see how common this technique had become. In addition to using these techniques in the management of avulsion (beak) fractures of the superior posterior aspect of the calcaneus, surgeons are using them for Sanders II fractures. These are intra-articular joint depression injuries that are difficult to reduce even with open surgery. Some surgeons are even using arthroscopy to ensure accurate closed reduction of these fractures.

Some situations lend themselves well to closed reduction with minimal incisions and percutaneus screw fixation, and some podiatric surgeons have been employing these techniques for years. Displaced fifth metatarsal base and Jones fractures are uncomplicated and easy to reduce. One can insert a single bone screw through the base into the medullary canal and stabilize the fracture site. Surgeons can even close, reduce and percutaneously fixate some Lisfranc fracture dislocations.

Podiatric surgeons can also utilize these techniques for elective surgical procedures including calcaneal osteotomies. Arthroereisis procedures are essentially minimal incision procedures.

The advantages of these procedures are obvious. There is less chance of infection because of the small incisions and this would be beneficial for our diabetic and other immunosuppressed patients. Healing should be faster because we are not dissecting or stripping the periosteum. This is an advantage for smokers who take so much longer to heal. Post-operative pain should also be minimal because of less tissue disruption.

As a profession, we continue to develop new procedures that benefit our patients by reducing pain and achieving faster healing.

Comments

The only way to confirm accurate reduction in closed cases is adding arthroscopy.
Not viewing STJ in calcaneal joint depression fractures will likely lead to poor reduction and OA.

Vladimir Gertsik, DPM
New York

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