CALCANEAL FRACTURES: INDIRECT REDUCTION AND EXTERNAL ILIZAROV FIXATOR

Abstract

Aim: Our purpose was to evaluate the use of indirect and closed reduction with Ilizarov external fixator in intra-articular calcaneal fractures.

Materials and Methods: In a period of 5 years (2004–2008), 26 patients with 29 intra-articular fractures of calcaneus (eighteen type III and eleven type IV according to Sanders classification) were treated with the Ilizarov fixator. Twenty-one patients were male and five female. The average age was 45 years (range 22 – 67 years). Five fractures were open. Fractures were evaluated by preoperative radiographs and CT scans. Restoration of the calcaneal bone anatomy was obtained by closed means using minimally invasive reduction technique by Ilizarov fixator. Arthrodiatasis and ligamentotaxis, and closed reduction of the subtalar joint were performed in 24 cases. In 5 cases the depressed posterior calcaneal facet was elevated by small lateral incision and stabilized in frame by wires. Postoperatively, partial, early weight bearing was encouraged in all patients.

Results: The mean follow-up period was 2,1 years (range 1 – 4 years). The AOFAS Ankle – Hindfoot Score, and physical examination were used in functional evaluation. The average score was 77,4 (range 70–90). Seven patients had limited degenerative radiological findings of osteoarthrosis about the subtalar joint and three of them had painful subtalar movement. Two of the patients complained of heel pad pain. Nine patients had grade II pin tract infections and were detected from a total of 258 wires. No secondary reconstructive procedures, including osteotomies, subtalar fusions, or amputations, have been done.

Conclusion: Indirect closed reduction of calcaneal bone anatomy and arthrodiatasis of subtalar joint with Ilizarov external fixator is a viable surgical alternative for intra-articular calcaneal fractures.