gms | German Medical Science

Objectives: Calcaneus fractures are among the most challenging orthopedic injuries. Most of them are displaced intra-articular injuries, occurring in young men with potential to significant disabilities and economic implications. Treatment of these fractures is controversial. Non-operatively treated displaced fractures have poor outcomes. However, surgical treatment is technically demanding and may have significant complications. The aim of this study is to present a very easy, effective and less complicated surgical method.

Technique: In a lateral decubitus position by an extensile-lateral approach a full thickness soft-tissue flap, including peroneal tendons and their sheath was elevated. The sural nerve and vein were protected both proximally and distally. We reduced fragments to articular surface of the talus (working from medial to lateral) and fixed them to the talus by 1.5 mm K-wires. A countered 3.5 mm reconstruction plate was applied to the lateral surface to reduce the width of the bone. We didn't use any kind of bone graft material.

Methods: In a prospective case-control study, clinical and radiographic data of 152 calcaneal fractures in 147 patients (105 operated and 47 non-operated) were evaluated. Radiographic and clinical evaluation performed 1, 2, 3, 6 and 12 months after surgery. The Foot and Ankle Disability Index (FADI) and the American Orthopedic Foot and Ankle Society Score (AOFAS) were used to outcome measurement. The ankle range of motion encouraged immediately, K-wires were removed 2 months after surgery in an outpatient clinic. After pin removal patients allowed to partial weight bearing. Median follow-up period was 45.96 ±26.99 and 50.36±27.23 months for operated and non-operated patients respectively. The SPSS-17 was used to statistical analysis.

Results: Table 1 [Tab. 1] shows the patients demographics, FADI, and AOFAS between two groups (p-value<0.05 considered significant). In non-operated group, 10.6% of patients had peroneal tendon impingement and other 8.5% needed subtalar arthrodesis during follow-up period. Non-operated patients with depressed but congruent articular surface, had better clinical outcomes (P-value<0.05). In the operated group, initial anatomical reduction was lost in 14.3%, all of them had diabetes mellitus or bilateral calcaneal fractures. The infection rate was 1.9% (two cases), both healed after early pin removal.

Conclusions: Using the talar articular surface as a template for reduction of the calcaneal posterior facet and fixation with trans-articular K-wires is a very simple, effective and less complicate method for displaced type III & IV calcaneus fractures with significantly superior FADI and AOFAS score than conservative treatment. According to the results of this study, bilateral fractures and diabetes mellitus are strongly related to subsequent failure of reduction but cigarette smoking and age of the patient are not related to surgical outcomes and cannot be considered a contraindication to surgery.