Abstract
Introduction: A minimally invasive procedure including percutaneous reduction and external fixation can be performed for Sanders’ type II, III and IV heel fractures in order to obtain a tridimensional reconstruction of the os calcis with a reduced risk of local complications, allowing for early motion.
Methods: 54 consecutive closed articular displaced calcanear fractures in 52 patients were treated with the Orthofix Heel Mini-Fixator. Patients were followed for an average of 49 months (range, 27 to 94 months) and assessed clinically with the Maryland Foot Score and radiographically with X-rays and CT scans.
Results: Clinical results at follow-up scored excellent or good in 49/54 cases (90.7%), fair in 2 cases (3.7%) and bad in 3 cases (5.6%). Mean preoperative Böehler’s angle was 6.98° ± 12.93 (range, – 5.95–19.86), while after surgery the average value was 21.94° ± 9.36 (range, 12.58–31.30) (p < 0.01). C.T. scans were evaluated according to the S.A.VE. score, showing excellent results in 24 cases (44.4%), good results in 25 cases (46.3%), fair results in 3 cases (5.6%) and bad results in 2 cases (3.7%). Mean preoperative S.A.VE. score was 17.58 ± 4.98 (range, 12.60 – 22.56) while the postoperative score was 25.66 ± 2.44 (range, 23.22 – 28.1) (p< 0.01).
Complications: Sudeck’s atrophy (10), pin tract superficial infections (3), thalamic displacement following early weight-bearing(3).
Conclusions: Percutaneous reduction and external fixation proved to be a reliable technique in order for obtaining stable reduction of os calcis fractures. The clinical results appear to be comparable to those obtainable with the open reduction and internal fixation, with the added advantages of being minimally invasive procedure, having substantially shorter operating times and reducing risk of complications related to surgical exposure.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office@efort.org
