Restoring the Anatomy of Calcaneal Fractures: A Simple Technique With Radiographic Review

Abstract

Displaced, intra-articular fractures of the calcaneus result in gross deformity of the hindfoot, which must be reduced during surgical fixation. Described techniques aimed at restoring the normal anatomy of the calcaneus have mostly been focused on percutaneous methods, which are not without complication. Described in this report is a method of anatomic reduction during open reduction and internal fixation of these injuries, which uses a lamina spreader to simultaneously reduce calcaneal varus, restore calcaneal height, reduce the subtalar joint, and restore normal calcaneal width. Additionally, 6 patients with 7 calcaneal fractures were identified that underwent this technique, and radiographic review was performed. Varus deformity of the calcaneus was measured as 93.8 ± 4.3° (range 88.1° to 100.5°) preoperatively and 83.3 ± 3.7° (range 77.8° to 89.4°) postoperatively, with a mean difference of 10.9 ± 5.6° (range 1.3° to 17.3°; P = .0564). Bohler’s angle was measured as 16.5 ± 16.9° (range −7.5° to 37.9°) preoperatively and 33.3 ± 12.5° (range 20.5° to 54.5°) postoperatively, the mean difference being 16.7 ± 15.0° (range 0.4° to 39.9°; P = .0288). Critical angle of Gissane was measured as 108.8 ± 14.0° (range 93.1° to 132.4°) preoperatively and 123.3 ± 6.6° (range 113.9° to 134.4°) postoperatively, with a mean difference of 16.2 ± 9.1° (range 5.8° to 29.7°; P = .0004). Levels of Evidence: Level IV: Retrospective