Reconstruction of calcaneal fracture malunion with osteotomy and subtalar joint salvage: technique and outcomes.

Abstract

BACKGROUND:

The goal of this study was to discuss the outcomes of treating calcaneal fracture malunion by restoring the subtalar joint with a reconstructive osteotomy.

METHODS:

From May 2005 to November 2008, 24 patients (26 feet) with calcaneal malunions after a displaced intra-articular calcaneal fracture were treated by osteotomy and autogenous bone graft. The subtalar joint was preserved. The mean time from initial injury to reconstructive operation was 5.7 months (95% confidence interval, 4.5-8.8 months). The displaced posterior facet was restored through a reconstructive osteotomy, whereas the bone defect in the calcaneus after reduction was filled with the exostosis that had been removed; iliac bone graft was used if necessary. All patients were evaluated clinically and radiographically at a minimum of 24 months. Twenty patients (21 feet) were followed for a mean of 34.2 months (29.0-39.4 months).

RESULTS:

According to American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, the average score was 85.9 points (95% confidence interval, 81.5-90.4 points), which was significantly higher than the preoperative assessment. Radiographs showed that Böhler's angle, Gissane's angle, talus declination angle, and width and height of calcaneus were improved to a great extent. Six patients had wound edge necrosis, and 2 had superficial infection. One patient required a subtalar fusion for subtalar arthritis at 2 years after surgery.

CONCLUSIONS:

Restoring the subtalar joint with a reconstructive osteotomy and autogenous bone graft was an effective treatment method for selected calcaneal fracture malunions. It reconstructed calcaneal morphology and preserved the subtalar joint.

LEVEL OF EVIDENCE:

Level IV, retrospective case series.

• Authors: Guang-Rong Yu, Sun-Jun Hu, Yun-Feng Yang, Hong-Mou Zhao, Shi-Min Zhang
• Journal: Foot & ankle international (Foot Ankle Int) Vol. 34 Issue 5 Pg. 726-33 (May 2013) ISSN: 1071-1007 [Print] United States
• PMID: 23460670 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Arthroplasty (methods)
• Calcaneus (injuries)
• Cohort Studies
• Female
• Fracture Fixation, Internal
• Fractures, Malunited (diagnostic imaging, etiology, surgery)
• Humans
• Intra-Articular Fractures (diagnostic imaging, etiology, surgery)
• Male
• Middle Aged
• Osteotomy
• Patient Selection
• Radiography
• Recovery of Function
• Subtalar Joint (injuries)
• Treatment Outcome
• Young Adult