An Alternative for Managing Calcaneal Fractures

Francesco Biggi, Stefano Di Fabio, Corrado D’Antimo, Francesco Isoni, Cosimo Salfi, and Silvia Trevisani

The calcaneus is the most frequently fractured tarsal bone, accounting for about 2% of all fractures. These fracture are often derived from high-energy trauma in young patients.

The ideal treatment for displaced intra-articular calcaneal fractures remains controversial. Nevertheless, there is evidence from studies with large patient cohorts that fragment reduction, with anatomical Bohler’s angle restoration, and subtalar joint congruity predict higher functional scores, as well as a lower incidence of post-traumatic arthritis [1, 2].

Open reduction internal fixation (ORIF) is the most popular surgical technique, utilizing a lateral approach to expose fragments, obtain reduction, and stabilize by plating with additional bone grafting [1]. However, soft tissue complications remain a major concern due to the thin and vulnerable skin over the lateral calcaneal wall, which is cut and retracted during surgery, and jeopardized by the underneath plate. The reported rate of complications is reported between 15 and 25 %, with additional problems arising from delayed work recovery and compensation [3, 4].

Looking at our belief in terms of minimally-invasive percutaneous osteosynthesis (MIPO), and supported by direct experience in kyphoplasty techniques for compression vertebral fractures, we started in 2008 the application of Kyphon (Medtronic) tools, in association with minimally invasive techniques, for closed reduction of Sander’s type II and III fractures and balloon-assisted augmentation with both acrylic cement and calcium phosphate (minimally invasive percutaneous calcaneoplasty).

Our targets were to: