547220
research-article2014
FAIXXX10.1177/1071100714547220Foot & Ankle InternationalLetter to the Editor
Letter to the Editor
Limitations of Percutaneous Osteotomy for Malunited Tongue-Type Calcaneal Fractures Dear Editor: We read with great interest your recent publication of the article by Heng et al.1 They described a novel percutaneous osteotomy for malunited tongue-type calcaneal fractures. They concluded that their technique can be performed via small incisions to avoid the potential complications associated with the extensile lateral approach. They presented a very nice work. However, there are some concerns regarding their study. First, in the conclusion section of the article, the authors stated that the case they presented was a malunited tongue type fracture. As is known, the fracture would not be united completely within 6 weeks. Strictly speaking, it might be more appropriate to categorize this kind of fracture as a malreduced tongue type fracture. Second, we think their technique would be more suitable for the malunited tongue-type fractures without subtalar arthritis. For the fractures involving the articular surface, the post-traumatic arthritis could not be ignored. In fact, for impacted injuries, irreversible damage to the articular cartilage may occur at the time of initial injury.2 Post-traumatic arthritis might occur in malreduced and malunited calcaneal fractures with the cartilage damaged.3 For calcaneal malunion combined with subtalar arthritis, subtalar fusion should be taken into consideration. While, it seems that it is impossible to perform the subtalar fusion through the incisions described by the authors. Third, regarding the incisions for malunited calcaneal fractures requiring arthrodesis, we want to present an
Foot & Ankle International® 2014, Vol. 35(10) 1095 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100714547220 fai.sagepub.com
opinion of our own. Although CT scan and MRI are helpful for identifying the subtalar arthritis, we think it would be better to make a decision of arthrodesis on the basis of the intraoperative observation.4 The sinus tarsi approach or extensile lateral approach, which allows direct visualization of the articular cartilage, would be more suitable for the case that subtalar arthritis is doubted preoperatively. Sincerely, Bing Li, PhD, Yun-feng Yang, PhD, Da-wei Chen, PhD, and Guang-rong Yu, MD Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China Email: [email protected] References 1. Heng M, Kwon JY. Percutaneous Osteotomy for Irreducible or Malunited Tongue-type Calcaneus Fractures. Foot Ankle Int. 2014;35(4):408-414. 2. Borrelli J Jr, Torzilli PA, Grigiene R, Helfet DL. Effect of impact load on articular cartilage: Development of an intra-articular fracture model. J Orthop Trauma. 1997;11: 319-326. 3. Banerjee R, Saltzman C, Anderson RB, Nickisch F. Management of calcaneal malunion. J Am Acad Orthop Surg. 2011;19:27-36. 4. Yu T, Li B, Yang YF, Chen DW, Yu GR. Limitations of minimal incision technique for tibiotalocalcaneal arthrodesis. Foot Ankle Int. 2014;35(5):529.
Downloaded from fai.sagepub.com at PENNSYLVANIA STATE UNIV on May 25, 2015
research-article2014
FAIXXX10.1177/1071100714547220Foot & Ankle InternationalLetter to the Editor
Letter to the Editor
Limitations of Percutaneous Osteotomy for Malunited Tongue-Type Calcaneal Fractures Dear Editor: We read with great interest your recent publication of the article by Heng et al.1 They described a novel percutaneous osteotomy for malunited tongue-type calcaneal fractures. They concluded that their technique can be performed via small incisions to avoid the potential complications associated with the extensile lateral approach. They presented a very nice work. However, there are some concerns regarding their study. First, in the conclusion section of the article, the authors stated that the case they presented was a malunited tongue type fracture. As is known, the fracture would not be united completely within 6 weeks. Strictly speaking, it might be more appropriate to categorize this kind of fracture as a malreduced tongue type fracture. Second, we think their technique would be more suitable for the malunited tongue-type fractures without subtalar arthritis. For the fractures involving the articular surface, the post-traumatic arthritis could not be ignored. In fact, for impacted injuries, irreversible damage to the articular cartilage may occur at the time of initial injury.2 Post-traumatic arthritis might occur in malreduced and malunited calcaneal fractures with the cartilage damaged.3 For calcaneal malunion combined with subtalar arthritis, subtalar fusion should be taken into consideration. While, it seems that it is impossible to perform the subtalar fusion through the incisions described by the authors. Third, regarding the incisions for malunited calcaneal fractures requiring arthrodesis, we want to present an
Foot & Ankle International® 2014, Vol. 35(10) 1095 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100714547220 fai.sagepub.com
opinion of our own. Although CT scan and MRI are helpful for identifying the subtalar arthritis, we think it would be better to make a decision of arthrodesis on the basis of the intraoperative observation.4 The sinus tarsi approach or extensile lateral approach, which allows direct visualization of the articular cartilage, would be more suitable for the case that subtalar arthritis is doubted preoperatively. Sincerely, Bing Li, PhD, Yun-feng Yang, PhD, Da-wei Chen, PhD, and Guang-rong Yu, MD Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China Email: [email protected] References 1. Heng M, Kwon JY. Percutaneous Osteotomy for Irreducible or Malunited Tongue-type Calcaneus Fractures. Foot Ankle Int. 2014;35(4):408-414. 2. Borrelli J Jr, Torzilli PA, Grigiene R, Helfet DL. Effect of impact load on articular cartilage: Development of an intra-articular fracture model. J Orthop Trauma. 1997;11: 319-326. 3. Banerjee R, Saltzman C, Anderson RB, Nickisch F. Management of calcaneal malunion. J Am Acad Orthop Surg. 2011;19:27-36. 4. Yu T, Li B, Yang YF, Chen DW, Yu GR. Limitations of minimal incision technique for tibiotalocalcaneal arthrodesis. Foot Ankle Int. 2014;35(5):529.
Downloaded from fai.sagepub.com at PENNSYLVANIA STATE UNIV on May 25, 2015
