Minimally invasive treatment of displaced intra-articular calcaneal fractures using the balloon kyphoplasty technique: Preliminary study

Summary Background The balloon kyphoplasty approach to the treatment of vertebral fractures can be adapted to achieve the reduction and cement stabilisation of intra-articular compression fractures at other sites, such as the calcaneus. Patients and method We studied six patients with a median follow-up of 12 months (range, 6–30 months). Fluoroscopy guidance was used to obtain optimal balloon positioning under the joint depression site. Reduction was achieved by expanding the balloon and stabilisation by injecting the cavity with resorbable tricalcium-phosphate cement in the younger patients and polymethyl-metacrylate cement in the two elderly patients with osteoporosis. No internal fixation was used. Results No intra-operative, postoperative, or delayed complications were recorded. Median hospital stay length was 4.5 days (range, 3–7 days). All the fractures healed within the usual timeframe, without loss of reduction. Median time to full weight-bearing ambulation was 52.5 days (range, 15–75 days). The functional outcomes correlated with the good anatomic results, with a median American Orthopaedic Foot and Ankle Society score of 87.0 (range, 86–97). Discussion This preliminary study shows that balloon reduction and cement fixation of intra-articular calcaneal fractures is easy to perform, reproducible, and devoid of specific complications. Good-quality reduction and stabilisation until fracture healing were achieved, and time to recovery of self-sufficiency was short, even in elderly patients with osteoporosis. These results support the use of this minimally invasive technique. Level of evidence Level IV, retrospective study.