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.

journal_name

Foot Ankle Int

authors

Yu GR,Hu SJ,Yang YF,Zhao HM,Zhang SM

doi

10.1177/1071100713479766

subject

Has Abstract

pub_date

2013-05-01 00:00:00

pages

726-33

issue

5

eissn

1071-1007

issn

1944-7876

pii

1071100713479766

journal_volume

34

pub_type

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