Percutaneous fixation of fractures of the calcaneus and its functional outcomes

Abstract

Background: Closed fractures of the calcaneum are common fractures of the lower limb and which usually result from by high velocity axial loading of the calcaneum. Open reduction and internal fixation methods have formed the mainstay of their treatment. However the associated wound complications have made the management of such injuries more difficult. Percutaneous fixation techniques provide an effective method of closed treatment of these fractures and can help avoid wound related complications.Methods: Twenty- four patients with fractures of the calcaneum were treated with percutaneous reduction with Essex-Lopresti technique and fixation with Steinman pin and K-wires, followed by immobilization with a slab. The American orthopaedic foot and ankle score (AOFAS) was calculated at the final follow up. Also the heel width (with a vernier caliper) and the heel height (from lateral malleolus to the ground surface) were recorded at the final follow up.Results: Of the total patients 8 had excellent, 10 had good and 6 had fair results. None of the patients had heel widening or loss of calcaneal height of more than 1 cm as compared to the contralateral limb. Complications seen were superficial pin tract infections (3) which were treated with early implant removal and appropriate antibiotics. The Bohler’s angle at follow up was at a mean 30 degrees. Conclusion: The percutaneous reduction of closed fractures of the calcaneum provides good functional results as per AOFAS score. It also helps avoid wound related complication seen in open techniques. The Essex-Lopresti technique of reduction of such fractures has a short learning curve and can be reproduced at most operative setups. Long term follow up studies and bigger sample sizes can help support our conclusions.