Technique of minimally invasive reduction and small fragment fixation of tongue-type calcaneus fractures

Abstract

Closed treatment of calcaneus fractures has had less than desirable functional outcome. A widened heel, a horizontal talus, fibular impingement, peroneal tendon injury, subtalar stiffness, and compromised soft tissue envelope all contribute to poor outcome. Conversely, postoperative complications of have diminished the success of surgical treatment. A method that reduces the fracture and the complication rate is desirable. We have treated patients who had tongue-type calcaneus fractures (OTA 73 C1.3) over an 11-year period at a level-1 trauma center using an open reduction technique with small incisions and screw fixation. The operative technique involved small (<1 cm) incisions, which were used for the introduction of Shantz pins and small elevators used for the reduction. The fracture fragments were reduced with use of the Gissane reduction technique popularized by Essex-Lopresti. All reductions were performed under fluoroscopic guidance in the lateral position and were stabilized with small-fragment screw fixation. No plates were used. Postoperatively, patients were placed in a removable splint and range of motion was begun postoperatively within 1 to 2 days. Weight bearing was initiated between 2 weeks (resulting from noncompliance) and 3 months. There is a significant reduction in hospital stay compared with traditional open treatment. We have had no wound problems. Complications after this procedure include l nerve irritation, discomfort related to implants. Böhler’s angle can be restored to the normal range.