Surgical treatment for malunion of intra-articular calcaneal fractures

Objective To report the techniques and clinical results of surgical treatment of malunion of intra-articular calcaneal fractures. Methods From February 2003 to December 2007, 49 cases of malunited intra-articular caleaneal fractures were treated and followed up. The patients underwent lateral wall exostosectomy or subtalar arthrodesis according to their complaints and their types of deformity. The subtalar joint was either fused in situ or with bone graft following distraction depending on the severity of deformity. Osteotomy in the calcaneal body was done simultaneously to correct the residual deformity, if any. American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Scores were used to evaluate the clinical outcome. Results All the patients were followed up for a mean time of 18.4 months. The average healing time for subtalar fusion was 12.8 weeks. Postoperatively, the average talocalcaneal height, talar declination angle, talocalcaneal angle, and calcaneal pitch angle improved significantly compared with the preoperative values. The mean AOFAS Hindfoot Score increased from 25.7±4.3 points preoperatively to 74.9±4.8 at the final follow-up. Conclusions The surgical treatment of malunion of intra-articular calcaneal fracture should be based on the preoperative clinical and radiographic evaluations while individual scheme made ac-cording to the foot deformity and the patient' s expectation. Lateral wall decompression, subtalar arthrodesis and correction of the hindfoot varus/valgus deformity are keys to successful surgical treatment. Key words: Calcaneus;  Fracture;  Fracture healing;  Abnormalities;  Surgical treatment