Treatment of old calcaneal fractures with calcaneus V-shape osteotomy for the subtalar joint preservation

Abstract

To observe the clinical effect of calcaneus V-shape osteotomy for the subtalar joint preservation in the treatment of old calcaneal fractures. A retrospective study was conducted on 18 patients (18 feet) with old calcaneal fractures treated by calcaneus V-shape osteotomy from March 2014 to November 2017. Included 13 males and 5 females, aged from 23 to 48 years old with an average of (34.3±4.5) years and the course of disease was from 2 to 9 months with an average of (4.5±4.1) months. According to the classification of Sanders, 14 cases of type II and 4 cases of type III. The postoperative complications were observed. The changes of Böhler angle, Gissane angle, heel height and the tilt angle of talus were compared between before operation and 12 months after operation. Maryland foot score was used to evaluate the curative effect. Fourteen patients were followed up, 4 patients were loss to follow-up. And the follow-up time was 13 to 35 months, with an average of (21.2±4.1) months. The fracture healing time was 10 to 12 weeks with an average of (12.4±2.1) weeks. One patient had skin necrosis of incision after operation, and no complications such as nonunion of fracture and loosening or rupture of internal fixation were found. The tilt angle of talus, Böhler angle, Gissane angle, heel height at 12 months after operation were (11.4±5.1)°, (24.7±4.3)°, (124±3.1)°, (46.1±2. 8) mm, respectively, while before operation were (9.1±2.9)°, (6.8±3.1)°, (93.4±11.7)°, (34.5±5.3) mm, there were significant difference between before and after operation. Maryland score was significantly increased from 59.21±7.21 preoperatively to 86.34 ±4.14 postoperatively 12 months(t=43.1, P<0.05), and 8 cases got excellent results, 4 good, 1 fair, 1 poor. Calcaneus V-shape osteotomy for subtalar joint preservation is one of the effective methods in the treatment of old calcaneal fractures, which has the advantages of preserving subtalar joint, correcting calcaneal deformity, inproving foot appearance, alleviating foot pain and raising foot function.