Radiographic Results of Percutaneous Reduction of Calcaneal Fractures and Posterior Arthroscopic Subtalar Arthrodesis (C-PASTA).

Abstract

Background: Displaced intraarticular calcaneal fractures (DIACFs) are associated with high rates of posttraumatic arthritis. Traditional management with open subtalar arthrodesis often results in high revision rates and complications. Acute open arthrodesis has shown success in Sanders III and IV calcaneus fractures, with favorable return-to-work and radiographic fusion outcomes. This study evaluates the radiographic results of calcaneus percutaneous reduction and posterior arthroscopic subtalar arthrodesis (C-PASTA) for acute Sanders III and IV fractures.

Methods: A retrospective study reviewed 22 patients with acute Sanders III and IV DIACFs treated with C-PASTA. Surgeries delayed beyond 24 days were excluded. Radiographic measures included preoperative and postoperative computed tomographic (CT) scans to assess arthrodesis, screw placement, and potential complications. Patient demographics, surgical data (eg, screw count, bone graft use, tourniquet time), and changes in Bohler and Gissane angles were analyzed.

Results: Of 22 DIACFs treated, 19 met inclusion criteria (median age 46 years, range 25-82). Preoperative CT classified 6 fractures as Sanders III (32%) and 13 as Sanders IV (68%). Three-month CT showed a 100% fusion rate (n=19), with no screw penetration into the tibial-talar joint, prominence >2 mm, or flexor hallucis longus tendon impingement. Bohler angles improved significantly postoperatively, whereas Gissane angles remained unchanged. There were no major complications or return trips to the operating room.

Conclusion: C-PASTA demonstrates excellent fusion rates, significant restoration of calcaneal alignment, and minimal complications. These findings suggest that C-PASTA is a viable, minimally invasive technique for acute Sanders III and IV fractures.