Open reduction and internal fixation plus primary subtalar arthrodesis for treatment of severely comminuted calcaneal fractures of Sanders type IV

Abstract

Objective To explore the effects of open reduction and internal fixation plus primary subtalar arthrodesis for the treatment of severely comminuted calcaneal fractures of Sanders type Ⅳ. Methods From January 2012 to December 2016, 23 patients with severely comminuted calcaneal fracture of Sanders type Ⅳ were treated by open reduction and internal fixation plus primary subtalar arthrodesis at our department. They were 16 men and 7 women with an average age of 39.6 years (range, from 32 to 67 years). Auto-iliac bone graft was performed in 18 cases and allo-bone graft in the other 5 cases. Bohler and Gissane angles were measured preoperatively, postoperatively and at the last follow-up to evaluate anatomical morphology of the calcaneus; the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate the functional recovery. Results All the 23 cases were followed up successfully for an average time of 21 months (range, from 6 to 39 months). The operations lasted from 40 to 100 minutes with an average of 60 minutes; the intraoperative bleeding ranged from 10 to 40 mL with an average of 20 mL. No one suffered from wound infection but partial epidermal necrosis happened in only one case. Union and fusion of the fractures was achieved after 3 to 5 months with an average of 3.5 months. At the last follow-up, nofailed fusion of the subtalar joint happened. Anatomical morphology of the calcaneus was improved obviously. The Bohler angles were respectively 12.47°±1.61°, 30.58°±5.34° and 30.09°±5.78° preoperatively, postoperatively and at the last follow-up; the Gissane angles were respectively 86.21°±7.70°, 127.44°±7.61° and 129.07°±5.47° preoperatively, postoperatively and at the last follow-up. There were significant differences between preoperation versus postoperation and the last follow-up in the above 2 values (P 0.05). The AOFAS ankle-hindfoot scoring at the last follow-up showed 8 excellent, 11 good and 4 fair cases, giving an excellent to good rate of 82.6%. Conclusion Open reduction and internal fixation plus primary subtalar arthrodesis is a safe alternative for the treatment of severely comminuted calcaneal fractures of Sanders type Ⅳ. Key words: Calcaneal fracture; Fracture fixation, internal; Arthrodesis; Bone graft