Less Invasive Treatment of 265 Intraarticular Calcaneal Fractures with An Interlocking Nail (C-nail)

Abstract

Objectives: Less invasive restoration of joint congruity and calcaneal shape in displaced intra-articular calcaneal fractures via a sinus tarsi approach followed by minimally invasive internal fixation with an interlocking nail (C-nail) results in a low rate of soft-tissue complications and good outcomes. Design: Prospective case-control study. Setting: Regional Hospital Trauma Department Patients: A total of 265 calcaneal fractures were treated by using the C-nail between 2011 and 2018 at the Department of Traumatology at the Regional Hospital Pardubice. Intervention: The reduced joint surface was fixed with one or two screws with short thread. All other fragments were fixed after reduction with the C-Nail introduced through the tuberosity. The fragments were fixed with 7 interlocking screws passing through the nail. Main Outcome Measures: Patients were assessed for complications, restoration of Böhler angle, posterior facet reduction with postoperative computed tomography, and weight-bearing radiographs after 6 and 12 months. Results: Wound edge necrosis was seen in three cases (1.1%) and soft tissue infection was observed in one case (0.4%). Böhler’s angle was improved from 5.9° preoperatively to 32.1° postoperatively, measuring 27.6° after 12 months. Conclusions: Two hundred forty-nine patients (222 males and 27 females; mean age 47.3 years) with 265 calcaneal fractures were treated between 2011 and 2018 less-invasively. The sinus tarsi-approach with use of the C-nail shows low risk of infection due to high stability of the fixed fracture.