gms | German Medical Science

Objective: The authors present the first clinical results in treatment of calcaneal fractures using a newly developed calcaneal nail (C-NAIL). In their presentation the authors describe the clinical study, the indication for the minimal-invasive operation and explain in detail the surgical procedure using this new method. Calcaneal nail C-NAIL allows for a minimal-invasive approach and high stability with low risk of infection.

Method: The fragments are fixed with seven or less screws, two sustentacular screws, three lateral screws and two superior screws. The underlying principle of the operation is the fixation of a fractured calcaneus with a nail which is introduced by stab incision after initial anatomic reduction of the posterior facet. During the surgery, the patient is in a lateral position. We perform the short incision (3-4cm) below the tip of the lateral malleolus in the direction towards the base of the fifth metatarsal bone. This way we gain access into subtalar joint. In the next step we aim the guide wire in the axis of the calcaneus in the direction of calcaneo-cuboideal joint. The nail with the attached aiming device is inserted into the drilled hole. Two screws in the sustentacular fragment determine the correct position of the nail in the calcaneal bone.

Results: Since 2011 do end of 2013 was performed in department of traumatology in Pardubice, Czech Republic and in department of traumatology in Dresden, Germany 77 cases. The average age of patients was 46 (17-73 years). The fractures were classified using Sanders-Type system: I (n=9), IIA (n=25), IIB (n=18), IIC (n = 3), IIIAB (n=13), IIIAC (n=2), IIIBC (n=3) , IV (n=4). Soft tissues were classified by Gustilo-Anderson O1 (n=2), O2 (n=1) and Tscherne G0 (n=24), G1 (n=41), G2 (n=9). Four weeks after surgery, all patients were examined radiologically and after half year the AOFAS scores were evaluated. Outcome scores were between 65 and 100 points, with an average score of 94,0 points (first 54 patients 6 months after surgery).

Conclusion: As a conclusion, we can say that the C-NAIL is a new minimal-invasive system that allows for high primary stability, early functional aftertreatment with improved hindfoot motion and reduced probability of the risk of infection. In our practice, smokers, insulin non-dependent diabetics and the patients with high age are no contraindication to surgery by C-NAIL.