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Percutaneous Reduction and Fixation of Displaced Intra-Articular Calcaneus Fractures

DeWall, Matthew MD; Henderson, Christopher E MD; McKinley, Todd O MD; Phelps, Thomas BA; Dolan, Lori PhD; Marsh, J L MD

Journal of Orthopaedic Trauma: August 2010 - Volume 24 - Issue 8 - p 466-472
doi: 10.1097/BOT.0b013e3181defd74
Original Article

Objectives: The purpose of this study is to assess the initial results of percutaneously reducing and fixing calcaneus fractures compared with a concurrent control group that was openly reduced and internally fixed through an extensile lateral approach.

Design: Retrospective cohort study, consecutive series.

Setting: Level I trauma center.

Patients/Participants: One hundred twenty patients with 125 intra-articular calcaneus fractures were selected as a consecutive series with treatment method randomized by surgeon and time of presentation.

Intervention: Patients treated with open reduction and internal fixation (OR group) had an extended lateral approach and fractures were fixed with plates and screws. Patients treated with percutaneous reduction (PR group) had small incisions with indirect fragment manipulation, and the reduction achieved was secured with screws alone.

Main Outcome Measurement: Clinical and radiographic assessment.

Results: There were 41 patients with 42 fractures in the OR group and 79 patients with 83 fractures in the PR group. There were no significant differences in sex, age, open fractures, fracture classification, or initial Bohler's angle between the two groups. Bohler's angle was improved after surgery by an average of 22.4° in the OR group and 25.3° in the PR group (P = 0.31). The average loss of reduction at healing (minimum 4 months postoperatively) was not significantly different between the two groups. Deep infection occurred in six of 42 of the OR group and zero of 83 of the PR group (P = 0.002). The incidence of minor wound complications was nine of 42 in the OR group and five of 83 in the PR group (P = 0.03). The need for late subtalar fusions (two of 26 and three of 41 with full 2-year follow-up) and implant removal (five of 42 and 10 of 83) was not significantly different.

Conclusions: The results of this study suggest that in comparison to open reduction, this method of percutaneously reducing and fixing calcaneus fractures minimizes complications and achieves and maintains extra-articular reductions as well as the standard extensile open reduction and internal fixation. Further study of this technique is warranted. This should include assessment of articular reduction and longer follow-up of a larger number of patients.

From the Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.

Accepted for publication November 25, 2009.

This work was funded by the following grant: NIH 5 P50 AR055533. No benefits were received.

Reprints: J. L. Marsh, MD, Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.