[Minimally invasive fixation of calcaneal fractures].

OBJECTIVE: Anatomic reduction of displaced calcaneal fractures with minimal soft tissue alteration.

INDICATIONS: Extra-articular and selected intra-articular calcaneal fractures (simple fracture pattern: Sanders type II, critical soft tissue conditions, contraindications to open reduction), temporary stabilization of complex injuries or polytraumatized patients.

CONTRAINDICATIONS: Impossible percutaneous reduction and fixation.

SURGICAL TECHNIQUE: Gross reduction of the main fragments is achieved with a Schanz screw introduced percutaneously into the tuberosity fragment. Fine reduction is obtained through percutaneous manipulation of the fragments wit Kirschner wires, Steinmann pins, sharp and smooth elevators via stab incisions. Anatomic reduction of the subtalar joint is controlled arthroscopically in cases of displaced intra-articular fractures. Fixation is achieved with screws introduced percutaneously.

POSTOPERATIVE MANAGEMENT: Early range of motion exercises of the ankle and subtalar joints are initiated the first postoperative day. Beginning on postoperative day 2, patients are mobilized with partial weight bearing for 6-8 weeks. As soon as the edema has subsided, patients are encouraged to wear their own shoes.

RESULTS: Between 1998 and 2008, 68 patients were treated with definite percutaneous fixation for displaced calcaneal fractures. In 37 patients with intraarticular fractures (Sanders types IIA and IIB), anatomic joint reduction was verified with subtalar arthroscopy. No soft tissue-related complications were observed. Thirty-five patients were followed for a minimum of 2 years postoperatively, the average was 5 years postoperatively. Subjectively, 33 of 35 patients were satisfied with the clinical outcome. The AOFAS Hindfoot Score averaged 90.7 (range 64-100) at a mean of 5 years after surgery. Percutaneous screw fixation of calcaneal fractures is associated with minimal soft tissue traumatization and low complication rates. It allows early rehabilitation and excellent results with proper patient selection. With intra-articular fractures, proper reduction of the articular surface has to be confirmed intraoperatively.