Functional Outcome of Intraarticular Osteotomy and Osteosynthesis for Calcaneal Malunion with Salvageable Subtalar Joint: A Retrospective Case Series.

Background and objective: Calcaneal malunion, a frequent complication of calcaneal fractures, disrupts hindfoot anatomy, causing pain, deformity, stiffness, and gait abnormalities. While conservative management can be effective in selected cases, surgical intervention is often required. This study evaluates the efficacy of intraarticular osteotomy and osteosynthesis as a joint-preserving procedure to manage calcaneal malunion and prevent subtalar arthrodesis.

Methods: A retrospective analysis was conducted on ten male patients (aged 23-52 years) with symptomatic calcaneal malunion who underwent intraarticular osteotomy and osteosynthesis between March 2015 and March 2023. Functional outcomes were assessed using the Maryland Foot Score (MFS) and the American Orthopaedic Foot & Ankle Society (AOFAS) score. Clinical, radiological, and procedural parameters were analyzed.

Results: The average follow-up duration was 42.9 months (range 15-108 months). Type II malunion (60%) was the most common. Postoperative functional outcomes showed improvement, with a mean MFS of 92.4 and an AOFAS score of 84. Wound breakdown primarily in diabetic patients, was managed successfully with negative pressure wound therapy. Significant enhancements in radiological alignment and functional parameters were observed in all patients.

Conclusion: Intraarticular osteotomy and osteosynthesis are effective surgical options for managing calcaneal malunion, facilitating subtalar joint preservation and obviating the need for subtalar arthrodesis. This procedure optimizes functional recovery and preserves joint mobility in carefully selected patients.