Surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation

Abstract

Objective To evaluate the surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation. Methods From February 2014 to June 2017, 15 patients (15 feet) with intra-articular calcaneal fracture associated with peroneal tendon dislocation were treated at Department of Foot and Ankle Surgery, Orthopaedics Hospital of Zhengzhou. There were 9 males (9 feet) and 6 females (6 feet), and 8 left feet and 7 right feet. The patients were aged from 20 to 55 years (average, 42.5 years). After reduction of calcaneal fractures, titanium plates and screws were used for fixation. The bone canal was established on the lateral malleolus, and the torn superior peroneal retinaculum was fixed to the lateral malleolus by suture after reduction of the peroneal tendon. The ankle joint was immobilized with a plaster brace in the metatarsal flexion for 6 weeks. The postoperative outcomes were evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS) score and visual analogue scale (VAS); complications were recorded. Results All the 15 patients were followed up for 12 to 36 months (average, 20.5 months). All the calcaneal fractures fully healed and no re-dislocation of the peroneal tendon occurred. The AOFAS hindfoot-ankle scores ranged from 80 to 95 points, averaging of 87.4 points; the VAS scores ranged from 0 to 5 points, averaging 1.5 points. Delayed wound healing was observed in one case but primary healing was achieved eventually with regular dressing change. Another case presented with symptoms of injury to the cutaneous branch of the sural nerve which disappeared after oral administration of neurotrophic drugs for 6 months. Another case suffered from subtalar arthritis accompanied by persistent pain which disappeared after subtalar arthrodesis. No other complications were observed in the other patients. Conclusion In the surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation, the peroneal tendon dislocation should be treated simultaneously with the intra-articular calcaneal fracture to achieve satisfactory clinical outcomes. Key words: Calcaneus; Fractures; Fracture fixation, internal; Peroneal tendon; Dislocation