Description
The presentation, led by Callum Clark, delves into the crucial discussion surrounding calcaneal fractures, specifically whether they should be surgically fixed or left untreated. Beginning with the categorization of fractures, Clark emphasizes the urgency of addressing displaced tuberosity fractures and severely displaced tongue-type fractures due to the risk of skin necrosis, which complicates subsequent reconstructive efforts. He contrasts these with intra-articular calcaneal fractures that arise from high-energy injuries, highlighting the ongoing debate regarding management strategies, wherein both surgical fixation and non-operative treatment carry significant risks.
Clark explores the historical context, addressing how major events like the industrial revolution and the world wars advanced research on these fractures. He references pivotal figures in the field, such as Fred Cotton and Essex-Lopresti, who contributed foundational techniques and understanding of calcaneal fracture management.
The lecture reviews past clinical trials and studies, including a Canadian randomized control trial which found no definitive answers regarding the efficacy of fixation, especially in the context of patients involved in workers' compensation cases. Despite some inconsistencies in findings, contemporary practice has evolved towards a preference for surgical intervention, particularly using minimally invasive techniques such as the sinus tarsi approach, which offers benefits in terms of wound complication rates and recovery times.
The discussion also touches on the evolution of fixation methods and current debates regarding their efficacy, including comparisons of screw fixation against specialized plates designed for minimally invasive approaches. Clark concludes by advocating for the reduction and fixation of calcaneal fractures through the sinus tarsi approach, positing that this method not only addresses the immediate injury but also facilitates any future surgical interventions, such as fusion, should they become necessary.