MINIMALLY INVASIVE TREATMENT OF DISPLACED COMMINUTED INTRA-ARTICULAR CALCANEAL FRACTURES

Abstract

INTRODUCTION: Displaced comminuted intra-articular calcaneal fractures (DCCF) need anatomic reduction to avoid painful subtalar joint, deformities, tendon or nerve impingment. Open reduction and internal fixation has been extensively reported, but all series reported considerable rate of skin complications, infections and need of additional plastic procedure. The aim of this study is to review a series of DCCF operated by minimally invasive technique.

MATERIAL AND METHODS: 66 DCCF type Sanders II-III were selected in 63 patients aged 18–57 years. X-ray and CT scan were performed. Surgery consisted of percutaneous traction-reduction of the calcaneal body by bone forceps and fixation by K-wires under image intensifier. Then, a lateral 3 cm skin incision was performed to reduce subtalar joint and to fix it by 1 or 2 screws. In case of involvement of the calcano-cuboid joint, the incision was distally extended and a 4-hole plate was applied. K-wires were removed 5 weeks after surgery and weight bearing was permitted 12–16 weeks after surgery. Patients were evaluated clinically by AOFAS score and radiographically at 4 years follow-up (3–7).

RESULTS: No skin complications or infections were encountered in the series. All fractures healed. Mean postoperative Bohler angle was 29±5°. AOFAS score was 89±11. 31 cases were excellent, 22 good, 9 fair and 4 poor. 25 cases presented radiographic signs of subtalar joint arthritis, painful only in 4.

DISCUSSION AND CONCLUSION: Minimally invasive surgical treatment resulted adequate for treating DCCF, in fact if soft tissues are preserved by surgical trauma, dangerous complications like infections and skin problems can be avoided.