Editor
Mandeep S
Dhillon
MS (Ortho) FAMS
Professor and Chairperson Department of Orthopedic Surgery Head Department of Physical Medicine and Rehabilitation Incharge, Sports Injury Clinic Postgraduate Institute of Medical Education and Research (PGIMER)
Chandigarh,
India
Forewords
Selene G
Parekh
Kartik
Hariharan
fm7FOREWORD
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Fractures of the Calcaneus
First Edition: 2013
9789350903438
Printed at
fm5CONTRIBUTORS
- Ben Storey MD FRCS
- Fellow, University of Calgary, Lethbridge Hospital
- Calgary, Alberta, Canada
- Bibek Adhya BPT MSPT
- Senior Physiotherapist
- Department of Physical Medicine and Rehabilitation
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Bhavuk Garg MS MAMS MRCS (Glasgow)
- Assistant Professor
- Department of Orthopedic Surgery
- All India Institute of Medical Sciences
- New Delhi, India
- Devendra K Chouhan MBBS MS
- Assistant Professor
- Department of Orthopedic Surgery
- Postgraduate Institute of Medical Education and Research Chandigarh, India
- Donald McBride FRCS (Ortho)
- Consultant Trauma and Orthopedic Surgeon
- University Hospital of North Staffordshire
- Stoke on Trent, Staffordshire, United Kingdom
- Felipe López-Oliva Muñoz MD PhD
- Chief of Section
- Department of Orthopedic Surgery
- Jiménez Díaz Foundation Hospital
- Madrid, Spain
- Florian Nickisch MD
- Assistant Professor
- Department of Orthopedic Surgery
- University of Utah School of Medicine
- Salt Lake City, Utah, United States of America
- Francisco Forriol Campos MD PhD
- Professor
- San Pablo CEU University
- Madrid, Spain
- Harman Chaudhry MD
- Research Fellow
- Division of Orthopedic Surgery
- McMaster University
- Hamilton, Canada
- Herman S Johal MSc MD
- Resident
- University of Calgary
- Orthopedic Residency Program
- Calgary, Alberta, Canada
- Himanshu Gupta MBBS MS
- Senior Resident
- Department of Orthopedic Surgery
- All India Institute of Medical Sciences
- New Delhi, India
- Himmat S Dhillon BPT
- Physiotherapist
- Government Multispeciality Hospital
- Chandigarh, India
- KV Menon MS (Ortho) MCh (Ortho) MSc
- Orthopedic Engineering
- Senior Consultant Orthopedics
- Khoula Hospital
- Muscat, Sultanate of Oman
- Mandeep S Dhillon MS (Ortho) FAMS
- Professor and Chairperson
- Department of Orthopedic Surgery
- Head
- Department of Physical Medicine and Rehabilitation
- Incharge, Sports Injury Clinic
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Manuj Jain MBBS MS
- Former Senior Resident
- Department of Orthopedic Surgery
- Postgraduate Institute of Medical Education and Research Chandigarh, India
- Professor and Academic Chairperson
- Division of Orthopedic Surgery
- McMaster University
- Hamilton, Canada
- Nicola Maffulli MD MS PhD FRCP FRCS (Ortho) FFSEM
- Center Lead and Professor
- Sports and Exercise Medicine
- Consultant Trauma and Orthopedic Surgeon
- Queen Mary University of London
- Barts and The London School of Medicine and Dentistry
- William Harvey Research Institute
- Center for Sports and Exercise Medicine
- Mile End Hospital, London, United Kingdom
- Nikolaos Gougoulias MD PhD
- Consultant Trauma and Orthopedic Surgeon
- Department of Trauma and Orthopedics
- Frimley Park Hospital, Portsmouth Road
- Camberley, Surrey, United Kingdom
- Rahul Banerjee MD FACS
- Orthopedic Trauma Surgeon
- Parkland Memorial Hospital
- Assistant Professor
- Residency Program Director
- University of Texas Southwestern Medical Center
- Department of Orthopedic Surgery
- Dallas, Texas, United States of America
- Rajiv Shah MS (Ortho)
- Foot and Ankle Center
- Global Baroda Hospital
- Vadodara, Gujarat, India
- Raman Mundi MD
- Research Fellow
- Division of Orthopedic Surgery
- McMaster University
- Hamilton, Canada
- Richard Buckley MD FRCS (C)
- Professor
- University of Calgary
- Head
- Orthopedic Trauma Division
- Foothills Hospital
- Calgary, Alberta, Canada
- Sameer Aggarwal MBBS MS
- Associate Professor
- Department of Orthopedic Surgery
- Postgraduate Institute of Medical Education and Research Chandigarh, India
- Sarvdeep S Dhatt MBBS MS
- Assistant Professor
- Department of Orthopedic Surgery
- Postgraduate Institute of Medical Education and Research Chandigarh, India
- Sharad Prabhakar MBBS MS
- Assistant Professor
- Department of Orthopedic Surgery
- Postgraduate Institute of Medical Education and Research Chandigarh, India
- SS Suresh MS (Ortho) MCh (Ortho) FACS
- Head
- Division of Orthopedics
- Ibri Regional Referral Hospital
- Ibri, Sultanate of Oman
- TH Lui MBBS (HK) FRCSEd FHKCOS FHKAM (Ortho)
- Consultant
- Department of Orthopedics and Traumatology
- North District Hospital
- Hong Kong, China
- Vikas Bachhal MBBS MS
- Senior Resident
- Department of Orthopedic Surgery
- Postgraduate Institute of Medical Education and Research Chandigarh, India
- Vishal Kumar MBBS MS
- Assistant Professor
- Department of Orthopedic Surgery
- Postgraduate Institute of Medical Education and Research Chandigarh, India
- Vivek Trikha MBBS MS
- Associate Professor
- Department of Orthopedic Surgery
- Jai Prakash Narayan Apex Trauma Center
- All India Institute of Medical Sciences
- New Delhi, India
Historically, calcaneal fractures have been challenging to treat, with plenty of controversies in orthopedic surgery. To present time, there is heated debate as to whether operative versus nonoperative surgery is beneficial for the patient. Even with surgical intervention, there is debate regarding surgical approaches and techniques.
Through the last two decades, we have seen the refinement of surgical techniques and an increased level of sophistication regarding the selection of patients for surgical intervention. We have gained an understanding of patient's characteristics, which are predictive of increased complications and unpredictable outcomes.
Surgically, the pendulum continues to swing back and forth between extensile approaches to the calcaneus and minimally invasive techniques. Now more than ever before, there are a variety of instruments, technologies and implants available to the surgeon to address these fractures. Globally, these techniques are being utilized to refine the treatment of calcaneal fracture patients.
Mandeep S Dhillon has been a pioneer for foot and ankle surgery. He has chosen to focus one entire textbook into a fracture that has been full of controversies, life-changing for the patient, and at times, having uncertain outcomes. This book relies on the expertise of global surgeons to provide their insight into the current state of treatment of calcaneal fractures. The content of the book evolves from the basic understanding of the anatomy of the calcaneus, to fracture patterns, the mechanism of injury, and nonoperative and operative fixation options. More importantly, this book provides contents to the reader regarding rehabilitation, outcomes and a review of evidence-based medicine.
I am confident that this book will be invaluable to the reader. It may enhance or change the treatment of calcaneal fractures. Ultimately, I am sure this book will improve the care of patients receiving globally.
Selene G Parekh MD MBA
Associate Professor
Department of Orthopedic Surgery
Adjunct Faculty
Fuqua Business School
Duke University
fm9FOREWORD
Professor Mandeep S Dhillon and his accomplished contributors have provided this excellent piece of literary work which condenses the large amount of splintered information and evidence about calcaneal fractures to a concise yet thorough and easily readable version. I can only marvel at the amount of dedication, time and effort that went into the writing of this text.
Calcaneal fractures are difficult clinical trauma situations to manage, often in patients who are young and involved in manual work and, furthermore, often associated with other injuries. The results of the management of these fractures are often difficult to quantify and conclusive evidence is sparse at best. Surgical algorithms for their treatment are complex and controversial. Preoperative planning and procedural specifics are still evolving. Iatrogenic complications are still high and often reflect a poor understanding of the pathoanatomy of the fracture in its three-dimensional complexity. These fractures are not for the occasional surgeon!
This book goes a long way in unpicking the various components of the fracture complex and its treatment. It compartmentalizes the various aspects elegantly making it easy-to-read book not only for the accomplished senior surgeon but also for the young surgeon about to embark on a foot and ankle surgical career. The information in it allows for a wide exposure to the topic at hand and serves as a reference for all matters related to calcaneal fractures. Whether it is a quick reminder for the senior surgeon or a step-by-step guide for a novice, it is very useful for all surgeons wishing to provide optimal treatment of this fracture.
I have had the pleasure of working with Professor Dhillon on many an educational forums and have marveled at his teaching style which always demonstrated clarity of thought, precise articulation and a practical approach to problem solving in foot and ankle surgery. This book certainly exemplifies his various traits and will, therefore, be by definition easy to read and understand.
Many congratulations to Professor Dhillon and his contributors for this fine addition to the orthopedic library providing an up-to-date and erudite instructional text on calcaneal fractures.
Kartik Hariharan MB BCh FRCS (I) FRCS (Ortho)
President 2011-2012
fm11PREFACE
In the 21st century, trauma surgery has reached a stage where specialists focused on specific areas are becoming necessary to manage many complex fractures. The spine is one such area, as is the pelvis. The foot and ankle have received little or no attention, and many times the injuries to this important weight-bearing structure are managed “conservatively”, often due to lack of confidence or ability to reconstruct complex fractures in this area.
In modern orthopedics, the recognition that inadequate treatment of foot injuries can have lifelong disastrous complications are coming to the forefront. Surgeons realize that complex midfoot injuries need to be accurately reconstructed, calcaneus fractures benefit from well-applied surgical interventions, and the talus needs an accurate reduction and stabilization.
The calcaneus, or “os calcis” is the most commonly fractured bone in the foot, in addition to being the largest, and has a major role in the biomechanics of the whole foot. Nevertheless, controversy still exists as to whether the outcomes are better with or without surgery. I personally feel that this data may be skewed somewhat by the fact that some operations on fractured calcaneus may have been done by inexperienced surgeons, leading to more complications and, hence, the impression that surgery may not be so beneficial in these cases.
The purpose of this book is to dispel this myth. There is enough evidence in the literature that if surgery is done in well-selected patients, in a proper way, using appropriate implants, the outcomes could be significantly improved. The structure of this book is thus designed for surgeons of all levels of training and experience. There are chapters, which talk about radiology, patient selection, surgical exposures, and rehabilitation, which would help the trauma surgeon doing all kinds of fracture surgeries. Chapters on primary arthrodesis, minimally invasive surgery, malunion corrections and role of arthroscopy are meant for the specialist foot surgeons. And, of course, there are specific chapters, which discuss how outcomes are measured, and how patients are rehabilitated. Perhaps, one of the most important chapters reviews the evidence-based medicine for calcaneal fracture management.
In a nutshell, I have tried to compile the best available data, contributed by the best minds currently working in their respective fields, with the singular aim of helping the reader manage any type of calcaneal fracture that they encounter, at any stage of their career. I hope that this aim is achieved, as one of my passions is educating the young minds of today, especially in areas of interest that are dear to me.
fm13ACKNOWLEDGMENTS
My educative process has been so complex that a standard dedication may not suffice for this book on a complex fracture. Let me start by naming my first orthopedic teacher, Professor RL Mittal of Patiala, who inculcated a specific interest in me about problems of the foot; this was taken forward by my subsequent chief Professor ON Nagi of Chandigarh, who encouraged me to look into this often neglected area of orthopedics. Along the way, many associates, friends and specialists influenced me and the list is too long to name.
On the personal front, the usual suspects come to the forefront. My wife of many years, Rima, who indulges with me in my long hours on the computer; my mother (of longer years!), Dr Ganda Singh, who gave me the gift to clearly express myself in my formative years. And, of course, my two sons, Himmat and Sidak, who have stoically borne my absences from their lives as I struggled with my academic aspirations. Perhaps, they are better off for it.
I definitely have to acknowledge the many patients, who form the basis of much of the knowledge that I have gained to be able to reach this level of understanding. And, of course, all the authors who have contributed to this work, from India and abroad, without whom the value of this book would be much diminished.