Acute External Fixation and Delayed Primary Subtalar Fusion After Comminuted Joint-depression Calcaneus Fracture

Abstract

Joint-depression calcaneus fractures, such as Sanders type IV, can be complex injuries to treat surgically due to significant comminution of the posterior facet of the calcaneus. Although nonoperative management is reasonable in a nonsurgical candidate, residual calcaneal deformity and articular gap can accelerate posttraumatic arthritis. Open reduction and internal fixation remains ideal treatment in surgical candidates, and anatomic restoration of the articular surface is critical to mitigate the risk of posttraumatic arthritis. In certain circumstances, when anatomic reduction is unlikely, or in patients with an unclear prognosis, surgical fixation with subtalar arthrodesis allows for correction of calcaneal height, width, and alignment and provides a stable hindfoot. The technique presented exemplifies a stage-wise approach for the treatment of a comminuted joint-depression calcaneus fracture in a patient who ultimately recovered from a traumatic brain injury with an unclear prognosis at presentation.

Level of Evidence: Level V.