Optimal use of transmedullary support screws and fibular management in distal tibial fracture nailing based on a new biomechanical classification.

Introduction: Based on a novel simple frontal view classification, a comprehensive concept for systematic management of intramedullary fixation of distal tibial fractures is introduced. Even the usage of thin (unreamed) nails allows for anatomic reduction and stable fixation if applied in combination with transmedullary support (TMS) screws. Our classification system guides the placement of the TMS screw (medial or lateral) and suggests whether to fix the fibula or not.

Reduction and internal fixation of displaced intra-articular calcaneal fractures with a locking nail: a prospective study of sixty nine cases.

Purpose: The best treatment for intra-articular fractures of the calcaneus is still debated. The aims of this study were to determine whether intrafocal reduction of thalamic fractures is effective, to evaluate whether a locking nail is able to maintain reduction of the articular surface and to analyse the functional results of this original method.

Methods: This prospective study assessed 69 fractures treated with a locking fracture nail in 63 cases and with primary subtalar fusion in six (Calcanail (®), FH).

Primary stability of an intramedullary calcaneal nail and an angular stable calcaneal plate in a biomechanical testing model of intraarticular calcaneal fracture.

Background: Nowadays, open anatomic reduction and internal fixation can be considered as a valuable treatment for displaced intra-articular fractures of the calcaneus. However, the application of a calcaneal plate via an extensile lateral approach is at risk for a substantial rate of complications including delayed healing, skin necrosis, or infection. There is some evidence that a limited exposure might contribute to a decreased soft tissue complication rate bearing in mind that most minimally invasive techniques have to accept a reduced primary stability compared with the open application of an angular stable plate.

Locked nailing for the treatment of displaced articular fractures of the calcaneus: description of a new procedure with calcanail(®).

Although open reduction and internal fixation is considered the best method for treating displaced articular fractures of the calcaneus, lateral approach is at high risk for wound healing complications. For this reason, the authors developed a posterior approach and a new implant to perform both intrafocal reduction and internal fixation. The aim of this technical note is to describe this method of treatment for displaced articular fractures of the calcaneus, which offered the following advantages: (a) the creation of a working channel that provides also a significant bone autograft, (b) the intrafocal reduction of the displaced articular surface, (c) the insertion of a locking nail that maintains the reduced articular surface at the right height, (d) the possibility to switch from an ORIF to a reconstruction arthrodesis with the same approach and instrumentation in case of severely damaged posterior facet.

[3-dimensional imaging of thalamic fractures of the calcaneum. Validation of classifying fractures into 3 forms].

Unlabelled: Three dimensional CT scans enables to visualize the calcaneum and to follow the fracture pattern without any risk of errors.

Purpose Of The Study: This technique has been used to validate our previous classification (using three forms: vertical, horizontal, and mixed) which resulted from a two dimensional tomodensitometric study.

Material: The study was based on a series of 74 fractures, all of them studied with 3D CT and 71 of which were operated.