Application of subtalar joint distractor in operative treatment for comminuted calcaneal fracture

Abstract

Objective To evaluate the method and clinical effect of subtalar joint distractor assisted open reduction and internal fixation of comminuted intra-articular calcaneal fracture. Methods Twenty-two patients with fresh closed calcaneal fracture treated with open reduction and internal fixation from May 2011 to July 2013 were included in the study. According to the modes of operation, the patients were randomly divided into two groups (n=11 in each): in group A patients underwent fracture reduction assisted by subtalar joint distractor and in group B patients underwent Steinmann pin traction and poking reduction. All were fixed using the lateral calcaneal plate. Operation time, Bohler angle, Gissanes angle, calcaneus height, incision healing time and complications of the two groups were investigated for evaluating the effect of operation. Clinical effect was evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) score before the removal of internal fixation. Results Period of follow-up was (14.3±0.8)months (range, 12 to 18 months). Two patients in group B had delayed wound healing, and were treated with regular wound care. At the final follow-up, no infection, nonunion, malunion and internal fixation failure were observed. Bohler angle, operation time and calcaneus height observed in group A were superior to those in group B (P 0.05). Compared to the preoperative data, Bohler angle, Gissanes angle and calcaneus height were significantly improved in both groups (P<0.01). AOFAS score was (83.6±1.4) points in group A and (81.7±1.5) points in group B. Conclusion Subtalar joint distractor assisted open reduction and internal fixation is effective to shorten operation time, improve fracture reduction, reduce wound complications and increase the operative effect for comminuted intra-articular calcaneal fracture. Key words: Calcaneus; Fractures, comminuted; Subtalar joint; Distractor