Medial external fixation for staged treatment of closed calcaneus fractures: Surgical technique and case series

Abstract

The derangement in calcaneal morphology after a fracture can be significant and is often associated with severe soft tissue envelop problems. Medial calcaneal external fixation is useful for early restoration of calcaneal morphology and the corresponding soft tissue envelop. When performed in a stepwise fashion, external fixation can successfully restore normal calcaneal height, length, width, and coronal plane alignment. For severely displaced joint depression and broken tongue-type calcaneus fractures where open treatment is the preferred strategy, early external fixation restores the normal soft tissue tension, allows a stable environment for soft tissue recovery, and facilitates the definitive operation by restoring and maintaining overall calcaneal architecture. We describe the stepwise approach to calcaneal reduction and external fixation and report a case series demonstrating this method is safe and effective for staged management of severely displaced calcaneus fractures.

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

“…The same has been shown with use of external fixation. Githens et al 11 reported a mean postexternal fixation angle of 22 degrees, which indicated incomplete recovery. 5 Open reduction of the posterior facet fragments when performing delayed open reduction can be used to anatomically reduce the Böhler angle.…”

“…1,2,8,15 However, there are disadvantages to external fixation, such as bulky, pin-related complications, and ankle joint motion limitations. Githens et al 11 reported that pin-track infection occurred after medial external fixation was performed. 11 Because there were no deep operative site infections or wound complications that required treatment in this study, the staged-treatment protocol may be an optimal treatment strategy for displaced calcaneal fractures.…”

“…Githens et al 11 reported that pin-track infection occurred after medial external fixation was performed. 11 Because there were no deep operative site infections or wound complications that required treatment in this study, the staged-treatment protocol may be an optimal treatment strategy for displaced calcaneal fractures. Here, staged treatment using temporary pinning had good results that were similar to those found when external fixation was performed.…”

“…Several authors have described the staged treatment of DIACF using temporary external fixation. 8,11 Staged treatment using temporary external fixation effectively restores the calcaneal morphology and stabilizes the soft tissues. The temporary external fixation also distracts the joint and adjacent soft tissue.…”

Limited Approaches to Calcaneal Fractures

“…External fixation may be used as part of a staged protocol [44,45]. It is thought that early temporization with improvement in the overall calcaneal alignment may result in less complications after definitive fixation.…”