Pseudoarthrosis of Calcaneus: Roentgenological Finding or Significant Condition?

Abstract

Summary. Relevance. Calcaneus non-union (CNU) occurs in 1.3% of fracture cases; however, according to different authors, the frequency of this complication is much higher and is about 10%.
 Objective: to describe the clinical and roentgenological findings in patients with CNU; to highlight important aspects of diagnostics and surgical treatment.
 Materials and Methods. 9 patients with CNU have been observed. There were 7 males and 2 females. The average age was 34±1.5 (range 23-52) years. The average term from trauma to surgery was 13.5±1.5 (range 6-21) months. Changes in vertical talus-first metatarsal angle (vT1MA), pain syndrome (VAS), ankle range of motion, and foot function using AOFAS have been investigated. The indication for surgical treatment was symptomatic foot deformity; a subtalar arthrodesis with bone graft was used.
 Results. CNU was observed in 7 cases (77.8%) after the conservative treatment and in 2 cases (22.2%) after the surgical treatment. Roentgenologycally, the most characteristic feature was the extensor position of the talus and the associated with it the positive value of vT1MA, which causes an inverse relationship with the range of extension of the foot and reduces the height of the calcaneus. A subtalar arthrodesis with bone graft was performed in 7 cases (77.8%); in 2 cases (22.2%), the procedure was combined with calcaneus closing wedge osteotomy because of significant loss of hindfoot height. Bone fusion occurred within 8-10 weeks. vTMFA was 13±10 (13-150) before surgery and 8±10 (8-100) after surgery. Functional result by AOFAS was 63±2 points before surgery and 84±2 points 6 months after surgery.
 Conclusions. Calcaneus non-union is not accompanied by pain syndrome and is detected when the patient consults a doctor. The necessity of surgery in this case is decided on the basis of a detailed clinical and X-ray analysis and CT of the foot, taking into account the deformity of the hindfoot and the need for correction.