Arthroscopic reduction and percutaneous fixation of selected calcaneus fractures: surgical technique and early results.

OBJECTIVES: To highlight a technique combining fluoroscopy and arthroscopy to aid percutaneous reduction and internal fixation of selected displaced intra-articular calcaneal fractures, assess outcome scores, and compare this method with other previously reported percutaneous methods.

DESIGN: Retrospective review of all patients treated by this technique between June 2009 and June 2012.

SETTING: A tertiary care center located in Brisbane, Queensland, Australia.

PATIENTS: Thirteen consecutive patients were treated by this method during this period. All patients had a minimum of 13 months follow-up and were available for radiological checks and assessment of complications; functional outcome scores were available for 9 patients.

INTERVENTION: The patient was placed in a lateral decubitus position. Reduction was achieved with the aid of both intraoperative fluoroscopy and subtalar arthroscopy and held with cannulated screws in orthogonal planes. The patient was mobilized non-weight bearing for 10 weeks.

MAIN OUTCOME MEASUREMENT: Outcomes measured were improvement in Bohler angle, postoperative complications, and 3 functional outcome scores (American Orthopaedic Foot and Ankle Society ankle-hindfoot score, Foot Function Index, and Calcaneal Fracture Scoring System).

RESULTS: Mean postoperative improvement in Bohler angle was 18.3 degrees, with subsidence of 1.7 degrees. Functional outcome scores compared favorably with the prior literature. Based on available postoperative computed tomography scans (8/13), maximal residual articular incongruity measured 2 mm or less in 87.5% of our cases.

CONCLUSIONS: Early results indicate that this technique, when combined with careful patient selection, offers a valid therapeutic option for the treatment of a distinct subset of displaced intra-articular calcaneal fractures, with diminished risk of wound complications. Large, prospective multicenter studies will be necessary to better evaluate the potential benefits of this technique.

LEVEL OF EVIDENCE: Level IV Therapeutic. See Instructions for Authors for a complete description of levels of evidence.