We retrospectively evaluated the results of primary subtalar arthrodesis for the treatment of severely comminuted calcaneal fractures. Of 108 patients with 112 calcaneal fractures treated at our institution between 1989 and 1992, 16 (15%) underwent primary subtalar arthrodesis through an extensile lateral approach. The calcaneal height and width were restored with standard fixation techniques and then arthrodesis was performed with bone graft and fixation by 7.0-mm cannulated cancellous screws. Fourteen patients (12 males and 2 females; mean age, 40 years) were available for examination at a mean time of 26 months (range, 12-54 months) after surgery. Arthrodesis, evidenced by radiographic bony bridging across the arthrodesis site, was present in all patients between 8 and 12 weeks. Minor wound complications occurred in three patients. Of the 12 patients employed before the injury, 11 returned to their original occupations at a mean time of 8.8 months after injury (range, 1 month to 3 years). The mean AOFAS 100-point clinical rating scale score, evaluating pain, function, and alignment, was 72.4 points (range, 48-88 points). We conclude that primary subtalar arthrodesis is indicated as part of the management of comminuted displaced articular calcaneal fractures, yielding results that allowed 11 of 12 formerly employed patients to return to work.

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We hypothesized that the posterior-to-anterior (PA) calcaneal interlocking screw of the Biomet Ankle Arthrodesis Nail would increase rotational stability secondary to increased bone purchase compared with the standard lateral-to-medial (transverse) screw. Each of 10 fresh human cadaver lower limbs (five matched pairs) were stabilized with a nail inserted retrograde through the calcaneus, talus, and tibia according to standard technique. One limb of each pair was fixed with a transverse calcaneal screw; the contralateral limb, with a PA calcaneal screw. Each limb was then subjected to torsional testing on an MTS Mini Bionix load frame. The PA screw construct was significantly stiffer than the transverse screw construct: 1.96 and 1.41 Nm/E, respectively (P < 0.036).