Effect of inadequate reduction of medial wall on the postoperative varus deformity following calcaneal fracture surgery and other influencing factors of varus deformity

Abstract

Objective To explore the effect of inadequate reduction of the medial wall on the postoperative varus deformity following calcaneal fracture surgery and other influencing factors of varus deformity. Methods A retrospective analysis was conducted of the 60 patients with calcaneal fracture involving the medial wall (60 feet) who had been treated from October 2005 to September 2015. They were 51 men and 9 women, 18 to 55 years of age (average, 38.4 years). According to the Sanders classification, 24 patients belonged to type Ⅱ, 30 to type Ⅲ,and 6 to type Ⅳ. We measured the integrity of the pre- and post-operative medial walls, the height and width of the pre- and post-operative calcanei, the pre- and post-operative Bohler angles and the pre- and post-operative calcaneal varus angles for statistical analysis. Results The effect of postoperative height reduction of the medial wall on the postoperative correction of varus angle was significantly larger than that of the lateral wall ( P < 0.05). The higher the integrity of the postoperative medial wall, the larger the correction of the postoperative varus angle. The normal rate of postoperative calcaneal varus angle significantly decreased with the increased Sanders classification severity (P = 0.001). The postoperative reduction of the height and width of the calcaneus and the integrity of the pre- and post-operative medial walls were significantly positively correlated to the normal rate of postoperative calcaneal varus angle (P <0.05). Conclusions The medial wall has a large influence on the postoperative calcaneal varus angle. The higher integrity of the preoperative medial wall, and the more adequate reduction and fixation of the postoperative medial wall as well, the higher rate of postoperative normal calcaneal varus angle. The postoperative reduction of the calcaneal height also affects the varus angle. When the heights of the medial and lateral walls are recovered, the normal rate of varus angle is the highest; when reduction of the medial wall is inadequate but reduction of the lateral wall is fine, the normal rate of varus angle is the lowest. Key words: Calcaneus; Fractures, bone; Fracture fixation, internal; Clubfoot